Instituting a quality improvement program at a community medical designed to reduce urinary catheter days and the incidence of catheter associated urinary tract infections

Abstract

<p><strong>Background:</strong> In the United States (US) it has been reported that approximately 40% of all healthcare-associated infections (HAIs) are indwelling urinary catheter associated. These infections give rise to increased morbidity, mortality, and result in increased healthcare costs (Nicolle, 2012). A northwest community hospital has identified a higher number of infections related to urinary catheter use and an excessive number of urinary catheter days as compared to the state average.<strong><br />Purpose:</strong> In an attempt to reduce the rate of catheter-associated urinary tract infections (CAUTIs) a quality improvement project involving the development of an evidence-based nurse-driven urinary catheter protocol (UCP) as well as ongoing educational efforts was instituted.</p> <p><strong>Method:</strong> Nursing staff reviewed catheter use daily and contacted physicians to discontinue urinary catheters based on the protocol. Education of nursing staff and patients in alternatives to catheter use and post catheter care were emphasized. All patients with urinary catheters were included in the quantitative analysis. Urinary tract infections were monitored by Infection Prevention through the review of all positive urine cultures and all physician diagnoses of urinary tract infection. Urinary catheter days were collected by nursing staff.</p> <p><strong>Results:</strong> Urinary catheter days were reduced from a three-month average of 2844 in the year before the intervention to 2361 in the three months after the intervention. The incidence of CAUTI was reduced by 67% with a resulting decrease in CAUTI rate from 3.79 to 1.30 infections/100 catheter days although the results were not statically significant (<em>P</em>=0.48).</p> <p><strong>Conclusion: </strong>The present study was limited due to time constraints and lacked statistical power but did appear to indicate that the use of a nurse-driven urinary catheter protocol may decrease the rate of hospital acquired CAUTI and warrants further ongoing study.</p> <p><strong>Keywords</strong><strong>: </strong><em>Quality Improvement</em>, <em>Urinary Catheter Protocol, Catheter-Associated Urinary Tract Infection (CAUTI), Infection Prevention, Standard Infection Ratio (SIR), and Healthcare-Associated Infections (HAIs)<br /><br /></em></p>