WASHINGTON, DC—An initiative to prevent catheter-associated urinary tract infections (CAUTI) “provided the nursing staff with the best evidence for the care of the oncology patient with an indwelling urinary catheter,” research presented at the Oncology Nursing Society (ONS) 38th Annual Congress has shown.
The Centers for Medicare and Medicaid Services (CMS) lists CAUTI as a preventable hospital-acquired complication, and the Joint Commission also included CAUTI prevention as part of 2012 National Patient Safety Goals. In 2011, at Memorial Sloan-Kettering Cancer Center in New York, NY, 80% of catheters were placed in the operating room and 20% on inpatient units.
“Within a 7 month period in 2012, we reported a CAUTI rate of 16%, thus making CAUTI prevention a priority,” noted Debra Rodrigue, RN, BSN, CNS, of the cancer center. To address this concern while tailoring it to the specific needs of the oncology population, a multidisciplinary working group of inpatient nursing and infection control practitioners was convened.
The group “developed a comprehensive evidence-based policy reflecting best practice guidelines and conducted a nursing-wide education program focusing on CAUTI prevention,” Rodrigue stated.
The program included implementing criteria for appropriate insertion of catheters and alternatives to indwelling catheters. Emphasis was placed on routine maintenance bundle, which included “keeping the drainage bag off the floor and below the level of the bladder, keeping the catheter secured, daily personal hygiene, performing hand hygiene before and after manipulating the catheter, maintaining a sterile closed drainage system, and ensuring measuring gradients are properly labeled,” she noted.
Subsequently, several measures were developed to enhance the guidelines that included an evidence-based patient care plan, a form to document patient education, an order set for urinary catheter insertion, handoff notification, and a CAUTI prevention sticker for drainage bag placement. In addition, supplies were updated to reflect the current standards.“A decrease in CAUTI rates and compliance to the maintenance bundle will be the markers of our success,” Rodrigue stated.
Measurement of the process outcome will include the monthly compliance monitoring of the maintenance bundle with a goal of 100% compliance. Additionally, the outcome measurement of CAUTI rates will be monitored monthly with a goal of zero detected.