Original Publication Date
Odyssey Conference 2021 / VHHA Virginia Patient Safety Summit 2021
Date of Submission
Purpose: The purpose of this evidence-based practice (EBP) project was to identify and implement evidence-based practice to reduce Catheter-Associated Urinary Tract Infections (CAUTI).
Background: CAUTIs are deemed never events by Centers for Medicaid and Medicare and are tied to financial reimbursements. CDC states 17-69% of CAUTIs are preventable with recommended infection control measures. UTIs are the most common type of Hospital-acquired infection, with an estimated of occurrence of 9.5% reported by acute care hospitals. Every day a catheter is in place, the risk of CAUTI increases by 3-7%. Current recommendations for reduction in CAUTI rates include educational strategies, catheter avoidance, policies for catheter insertion, daily review of necessity, and urine testing stewardship. Surgical Trauma ICU incurred an increase in CAUTI rates in May & June. Drill down of events identified near-perfect compliance with nursing modifiable risk factors but opportunities for testing stewardship.
Methods: A literature search was conducted to identify best practices of CAUTI reduction. Researched incidence of biofilm on indwelling catheters. Databases searched include Pubmed, Embase, and CINAHL. The search strategy included CAUTI, Biofilm, reduction, fever. Education was provided to the Multi-disciplinary team including nursing, medical providers, and advanced practice providers. Education focused on the difference between catheter-associated asymptomatic bacteriuria and CAUTI, the concept of source control, biofilm, the incidence of symptomatic CAUTI, and best practices. Implemented a practice change to replace indwelling catheters with any urine culture. Conducted daily prevalence studies for direct follow-up with nurse and provider for data collection and adherence to education and practice change.
Results/Findings: 70% decrease in urine cultures ordered from implementation. The STICU has incurred ZERO CAUTIs since the implementation of education and practice change.
Conclusions and implications for Practice: Translation of EBP to the bedside is the most critical step in promoting positive patient outcomes. CAUTI is rarely symptomatic and should only be considered after investigating all other sources. The collaboration of our medical director was essential for multi-disciplinary accountability. In this EBP project, an educational intervention, multi-disciplinary accountability, and a practice change led to a significant reduction in Urine testing and CAUTIs.
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