Original Publication Date
National Association of Clinical Nurse Specialists (NACNS) Annual Conference 2022 and AACN National Teaching Institute & Critical Care Exposition (NTI) 2022
Date of Submission
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.
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VCU Health Nursing