Reducing Foley Catheter Days and Infection in an Acute Care Setting: Using the Urinary Catheter Bundle

Problem: Urinary tract infections (UTIs) are a common Hospital Acquired Infection (HAI). Approximately 80% of hospital acquired UTIs occur in the presence of a urinary catheter. Lengthy dwell time (time period in which an indwelling Cather is in the bladder) is an important contributor in catheter-associated urinary tract infection (CAUTI).

 

Purpose: This project translated evidence into an intervention to decrease CAUTIs on a medical unit that averaged above the National Healthcare Safety Network (NHSN) benchmark for CAUTIs during the first eight months in 2013.

 

Evidence: A systematic literature search was conducted using the cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews (CDSR), and PubMed. Five systematic reviews and 28 studies were appraised, and 15 background articles were reviewed. By means of rapid critical appraisal, six relevant studies and one systematic review were identified for synthesis. Levels of evidence ranged from the highest quality (systematic review) to descriptive studies. The evidence supported early removal of urinary catheters to reduce CAUTI rates and catheter days.

 

Practice change strategy: An assessment of baseline knowledge of registered nurses (RNs) and Patient Care Technicians (PCTs) on the urinary catheter bundle was performed via electronic survey. Knowledge deficits related to catheter care, removal guidelines, and bladder scanner use were identified. Education was provided to caregivers targeting the identified knowledge deficits. Collaboration with infection prevention provided a tracking log for patients with indwelling urinary catheters. Catheters were removed if patients did not meet criteria for a urinary catheter listed in the urinary catheter bundle. Following the staff education, urinary catheter utilization rates and CAUTI rates continued to be monitored and observed on the unit monthly.

 

Evaluation/Results: NHSN data showed catheter utilization rates decreased by 19% in the three months post education. Only one UTI was reported during the 3 month project period compared to the three month period before the project.

 

Recommendations: We strongly support providing formal CAUTI prevention education to staff including: catheter care, removal guidelines (including prior to patient transfer between units), proper documentation, and bladder scanner use. A reasonable next step is to initiate a nurse driven removal protocol and continue to trend data monthly.