Document Type
Poster
Original Publication Date
2022
Journal/Book/Conference Title
National Association of Clinical Nurse Specialists (NACNS) Annual Conference 2022 and AACN National Teaching Institute & Critical Care Exposition (NTI) 2022
Date of Submission
March 2022
Abstract
Purpose: The purpose of this evidence-based quality improvement project was to decrease catheter associated urinary tract infections in a 28 bed Surgical Trauma Intensive Care Unit in a Level One Trauma Academic Medical Center.
Background: Catheter Associated Urinary Tract Infections (CAUTI) are deemed never events by the Centers for Medicare & Medicaid Services. Centers for Disease Control and Prevention estimates 17-69% of CAUTIs are preventable. Current recommendations for CAUTI reduction include: Education strategies, chlorhexidine gluconate bathing and catheter care, catheter avoidance, policies for insertion, and urine culture testing stewardship. Our unit experienced an increase in CAUTI incidence in May and June of 2020. Case reviews demonstrated compliance with nursing modifiable risk factors. Opportunities for improvement in urine testing stewardship were identified.
Methods: A literature search was conducted to identify opportunities for improvement. Databases searched include Pubmed, Embase, and CINAHL. Search strategy CAUTI, Biofilm, Fever, and Reduction.
Interventions: Education (grand rounds & PowerPoint presentation) provided to a multi-disciplinary team focused on: CAUTI vs Catheter Associated Asymptomatic Bacteriuria, Biofilm, Fever related to CAUTI, and Urine testing stewardship. Implemented testing guidance using the 2008 IDSA and ACCM guidelines for evaluation of fever. Implemented a practice change to replace catheter when obtaining urine specimens for culture to minimize the risk of false positive due to biofilm. Bedside RN escalated to nursing leadership who utilized a testing stewardship algorithm.
Measurements: Conducted daily audits to ensure adherence to practice changes and compliance with testing stewardship guidelines. Developed report with IT that identified all urine testing on a weekly basis. Ongoing monitoring of CAUTI incidence and modifiable risk factors.
Results/Findings: 73% reduction in urine culture specimen collection rate. Zero CAUTIs for over 400 days.
Conclusions and Implications for Practice: In this evidence-based quality improvement project: interdisciplinary collaboration, educational intervention, multi-disciplinary accountability, Implementation of a practice change obtaining urine specimen led to a 73% reduction in urine culture testing and Zero CAUTIs for over 400 days.
References:
Mullin, K.M., Kovacs, C. S., Fatica, C., … Fraser, T. G. (2017). A multifaceted approach to reduction of catheter-associated urinary tract infections in the intensive care unit with emphasis on "stewardship of culturing". Infection Control & Hospital Epidemiology 38(2), 186-188. http://doi.org/10.1017/ice.2016.266
National Healthcare Safety Network. (2021). NHSN Patient Safety Component Manual. Centers for Disease Control and Prevention. Accessed on January 4, 2021. Retrieved from https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
O'Grady, N., Barie, P. S., Bartlett, J. G., … Masur, H. (2008). Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Critical Care Medicine 36(4), 1330-1349. http://doi.org/10.1097/CCM.0b013e318169eda9
Sabir, N., Ikram, A., Zaman, G., … Ahmed, P. (2017). Bacterial biofilm-based catheter-associated urinary tract infections: causative pathogens and antibiotic resistance. American Journal of Infection Control 45(10), 1101-1105. http://doi.org/10.1016/j.ajic.2017.05.009
Saint, S., Meddings, J. A, Calfee, D., … Krein, S. L. (2009). Catheter-associated urinary tract infection and the Medicare rule changes. Annals of Internal Medicine 150(12), 877-884. http://doi.org/10.7326/0003-4819-150-12-200906160-00013
Shuman, E. K., & Chenoweth, C. E. (2018). Urinary Catheter-associated infections. Infectious Disease Clinics of North America 32(4), 885-897. http://doi.org/1016/j.idc.2018.07.002
Tambyah, P. A., & Maki, D. G. (2000). Catheter-associated urinary tract infections in intensive care unit patients. Infection Control and Hospital Epidemiology 11(36), 1330-1334. http://doi.org/10.1017/ice.2015.172
Tedja, R., Wentink, J., O'Horo, J. C., Thompson, R., & Sampathkumar, P. (2015) Catheter-associated urinary tract infections in intensive care unit patients. Infection Control & Hospital Epidemiology 36(11), 1330-1334. http://doi.org/10.1017/ice.2015.172
Rights
This poster is distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Is Part Of
VCU Health Nursing