An innovative program that gives oncology nurses more autonomy to manage patients with catheters can dramatically reduce catheter-associated urinary tract infections (CAUTIs), according to new data presented at the American Nurses Credentialing Center 2014 National Magnet Conference, in Dallas, Texas.
An interdisciplinary task force was established at Roswell Park Cancer Institute, in Buffalo, New York, to implement changes that would significantly reduce CAUTIs. The task force put in place a strategic methodology based on change theory and set up a bundle. It consisted of interventions based on clinical evidence to allow for safer care of patients with urinary catheters and to support removal of catheters as soon as they are no longer medically necessary.
“The results after 1 year are that for second quarter of 2014 we reached zero CAUTIs. Since every CAUTI is one too many, this is a significant improvement,” said Pamela McLaughlin, BSN, RN, OCN, who is assistant magnet coordinator for nursing at Roswell Park Cancer Institute. “The CAUTI bundle has allowed for improved patient outcomes, which is what we set out to do in every hospital setting. While the procedure for insertion and maintenance of catheters has become more involved, the care required for CAUTI will decrease due to the absence of infections from urinary catheters. Additionally and more importantly, prevention of infections corresponds to shorter hospital stays for our patients.”
McLaughlin, who presented the study finding at the meeting, said urinary tract infections (UTIs) are one of the most common types of health care-associated infection. Up to 25% of hospitalized patients receive urinary catheters during their hospital stay, and prolonged use of a urinary catheter is the most common risk factor for developing a CAUTI.
The task force at Roswell Park Cancer Institute included nursing leaders, physicians, nurses, and staff with specialized focuses in areas such as infection prevention. Christina Ostwald, BSN, RN, infection control coordinator at Roswell, said the staff completely changed the way it viewed urinary catheters. She said every member of the team took ownership of their specific area and worked together to get the initiative implemented.
THE CAUTI BUNDLE
The bundle implemented by the task force focused on prompting physicians to assess a patient’s urinary catheter status daily as well as updating flow sheets to electronically track catheter usage. The approach also involved standardizing catheter supplies and maintenance practices, and providing comprehensive education for all clinical staff and ancillary departments. Catheters should be removed as soon as possible, and care for catheters is performed individually; an example of the standard operating procedure for CAUTI maintenance bundle includes the following points.
- Perform a daily review of the need for the urinary catheter.
- Check the catheter has been continuously connected to the drainage system.
- Ensure patients are aware of their role in preventing urinary tract infection. Alternatively, if the patient is unable to be made aware, perform routine daily meatal hygiene.
- Empty urinary drainage bags as separate procedures, regularly and each into a clean container.
- Perform hand hygiene and don gloves and apron prior to each catheter care procedure; on completion of the procedure, remove gloves and apron and perform hand hygiene again.1
McLaughlin said the infection control record was good before the CAUTI bundle was implemented, but since its implementation, the CAUTI infection rate has dropped to zero. She said the current goal is to maintain a zero-infection level, and to highlight this approach for a national audience so that other centers can adopt it.