Purpose:
Objectives: The purpose of this study is to develop, implement, and evaluate a catheter-associated urinary tract infection (CAUTI) bundle. The bundle is hypothesized to reduce CAUTI rates, with a focus on evidence-based practice. The objective is educate nurses on urinary catheter care, elicit a change in practice, and promote downward trends in the incidence of CAUTI.
Significance:
The literature estimates that 25% of hospitalized patients are catheterized, with 40% being unnecessary. This may result in CAUTI and increased length of stay and costs. Catheter-associated urinary tract infection is the most common nosocomial infection and the second most common cause of blood stream infection.
Background/Design:
Prevention of CAUTI is an important nurse-sensitive quality indicator. The AACN Beacon standard of less than 5.6 urinary tract infections per 1,000 catheter days was not consistently met. An examination of practice noted opportunities for improvement in nursing management of urinary catheters. The Advancing Research and Clinical Practice Through Close Collaboration Model guiding the implementation of evidence-based practice provides the framework.
Methods:
A multidisciplinary team was formed to develop a CAUTI bundle. Stakeholders included clinical nurse specialists, clinical nurse specialist students, critical care leadership, staff nurses, infection control, and the medical director. The Institute for Healthcare Improvement's definition of a bundle guided the selection of 5 interventions. Educational presentations included pretests/posttests to assess and evaluate staff in the cognitive domain. Process measures were tracked weekly on each unit to determine psychomotor behavior change. During data collection, just-in-time coaching was provided when bundle noncompliance was identified.
Findings:
Improved compliance with bundle measures and composite scores resulted from a multimodal educational approach. Rates of CAUTI will be analyzed for trends preintervention/postintervention.
Conclusions:
Data trends continue to be monitored to validate or aid in modification of the CAUTI bundle as necessary and as new evidence evolves.
Implications:
Integrating a variety of educational strategies, the Advancing Research and Clinical Practice Through Close Collaboration Model, and evaluation processes can provide tools for other critical care unit's infection control measures. The interventions can demonstrate the value of nursing in relationship to improving outcomes. The bundle may decrease CAUTI rates and subsequently benefit patients. This project has become the impetus for housewide implementation; product evaluation; and policy, procedure, and protocol revisions.
Section Description
The following clinical nurse specialist student abstracts were selected for poster presentations.