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Hospital acquired infection (HAI) is a critical patient safety concern. These infections are a reflection of hospital care provided to patients. The prevalence of HAI is widespread with catheter acquired urinary tract infections (CAUTIs) accounting for approximately 40% of HAIs with the highest rates in intensive care units. At the University of Kentucky we identified that our rates were higher than expected. It was determined that a support structure was needed to help direct and identify all the activities that would be necessary to decrease the CAUTI rate. The purpose of the performance improvement project was to create an organizational structure to centralize all enterprise wide initiatives to decrease CAUTIs.
Methods:
An alliance was formed with senior leadership, clinical nurse specialists and our colleagues in Infection Prevention and Control. This alliance led to a workflow algorithm that outlined an organizational structure consisting of a CAUTI workgroup that reported up to a CAUTI Steering Committee, led by senior leadership. The work group met weekly and followed a systematic process that identified gaps in care, designed interventions and implemented the measures. The Steering Committee met monthly to review and examine the progress of the workgroup. The Steering Committee provided the leadership and oversight to support the interventions and the authority to move forward with the implementations. This organization structure was instrumental to guide and direct improvement measures.
Results:
With the organizational support structure and the standardized workflow of the workgroup, our enterprise-wide monthly ICU CAUTI rates having been trending downward. In the first quarter of FY 2014 our rates ranged from 5.9 to 9.0. In October 2014 our rate decreased to 2.4.
Conclusion:
Having a well-defined organizational structure to centralize identification and interventions provided the support needed to decrease our high infection rate. This model has shown very positive outcomes and has provided a clear line of communication between hospital administration, physician services, nursing leadership, clinical nurse specialist, staff development, staff nursing and Infection Prevention and Control. The model has been duplicated to direct our work with combating other nurse sensitive indicators; central line infections, pressure ulcers and venous thromboembolism.