SAN ANTONIO, Tex.–The formation of a multidisplinary taskforce and the introduction of improved products successfully reduced the rates of catheter associated urinary tract infections (CAUTI) at an oncology hospital, a study presented at the ONS 41st Annual Congress has shown.1
CAUTI is an infection caused by the use of a urinary catheter. It is 1 of the most common type of health care-associated infection accounting for approximately 13 000 deaths per year. Immunocompromised patients with cancer are particularly at risk for developing these infections due to complex treatment regimens and disease process. Therefore, nurses at Roswell Park Cancer Institute in Buffalo, New York, led a taskforce to implement a new CAUTI bundle.
“A CAUTI bundle is an approach that avoids all unnecessary catheters,” said Pamela McLaughlin, BSN, RN, OCN, assistant magnet coordinator at Roswell Park Cancer Institute. “Catheters should only be inserted for appropriate indications, such as when strict inputs and outputs are required or the patient is sedated.”
In addition, the catheter should only be left in as long as it is needed. The longer it is in, the higher the risk for developing a CAUTI. Alternatives, including external catheters, a bedside commode, and bed pans, should be considered, and the catheter should be inserted using aseptic technique.
“Review the necessity of the catheter daily and remove promptly if unnecessary,” McLaughlin added.
In addition, several initiatives were introduced including: development of an IT prompt in the electronic medical record (EMR) to evaluate daily medical necessity; update of EMR nursing flow sheets to capture accurate data; complete overhaul of catheter inventory; standardization of catheter supplies and catheter maintenance practices; the introduction of a bladder scanner protocol algorithm; education by Nursing Education; Infection Prevention and supply vendors on the entire CAUTI bundle for more than 1 month to educate nurses; a website for CAUTI prevention with links to information and a checklist; inexpensive instructional videos created by staff; and the recruitment of nurse champions of the CAUTI bundle.
“Our most recent innovation and modification is the implementation of CAUTI Root Cause Analysis (CAUTICA) for each CAUTI developed by a nurse, including the urology physician champion, unit nurse administrator, nurse involved in the insertion, practitioners involved in documentation, and the quality nurse,” McLaughlin said.
Results showed that the CAUTI rate decreased from 3.8 CAUTI per 1000 catheter days in the fourth quarter of 2012 to 0.9 CAUTI per 1000 catheter days during the second quarter of 2015.
1. McLaughlin P. Realizing a sustained decrease in catheter associated urinary tract infection rates at an oncology hospital. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.