208. Reduction of Catheter Associated Urinary Tract Infections on General Medicine Wards through Implementing a Nurse Driven Protocol to Reduce Indwelling Urinary Catheter Utilization
Session: Poster Abstract Session: Catheter-associated UTIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • CAUTI.pdf (1.3 MB)
  • Background: Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired infections.  The risks of CAUTIs are well known and are directly related to the duration of urinary catheterization. Moreover, lack of knowledge of catheter presence among physician staff leads to prolonged urinary catheterization. Thus, we designed and implemented a nursing-driven protocol to review and remove unnecessary urinary catheters.

    Methods: The urinary catheter campaign was piloted on 2 medical wards of Duke University Hospital in Q2 2012, starting with catheter audits, work group meetings and intense education. We then designed a nurse-driven protocol to review ongoing indications for urinary catheters on a daily basis; the protocol was implemented in September 2012. Nurses performed reviews at each shift to identify urinary catheters which did not fulfill pre-defined continuation criteria and alerted the medical teams.  The continuation criteria included: patient on comfort care, urinary incontinence with stage 3/4 decubitus ulcer, chronic urinary retention, hemodynamic instability requiring input/output monitoring, patient awaiting operation, post-operative within 48 hours of surgery, recent urological surgery, and continuous bladder irrigation. Unnecessary catheters were automatically removed if the medical team did not override the protocol with an order or provided a clinical indication.

    We performed a before-after comparison of catheter utilization ratio, and incidence rate of CAUTIs. Baseline period was the fiscal year before the urinary catheter campaign. 

    Results: The urinary catheter utilization ratio decreased from 0.15 to 0.11 (p=0.05) for Unit A, and CAUTI rate reduced from 5.1 to 2.8 per 1000 catheter-days (p=0.44). For Unit B, the urinary catheter utilization ratio decreased from 0.13 to 0.10 (p=0.044) and CAUTI rate reduced from 4.4 to 1.6 per 1000 catheter-days (p=0.33).

    Conclusion: The urinary catheter campaign and the nurse-driven catheter removal program were effective in reducing urinary catheter utilization ratio and showed encouraging trend towards reduction in CAUTIs rates in 2 medical wards. Future studies should assess the effectiveness of this strategy in other healthcare units and settings.

    Luke F. Chen, MBBS, MPH, CIC, FRACP1, Noppon Setji, MD1, Aubrey Jolly Graham, MD1, Sarah H. Timberlake1, Jonathan Bae, MD1, Susan Wright, RN1, Carol Buckner, BSN, BS, RN1, Jade Clausen, RN, BSN1, Laura Thompson, RN1, Rebecca Martt, RN1, Alicia Clark, MD1, Mary Jane Stillwagon, BSN, RN1, Yvonne Spurney, MSN, RN1, Deverick J. Anderson, MD, MPH2, Daniel J. Sexton, MD, FIDSA1 and Pamela Isaacs, BSN MHA CIC1, (1)Duke University Medical Center, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC


    L. F. Chen, Merck, Inc.: Grant Investigator, Research support
    Optimer Pharmaceuticals: Investigator and Speaker's Bureau, Research grant and Speaker honorarium
    Cubist Pharmaceuticals: Speaker's Bureau, Speaker honorarium

    N. Setji, None

    A. Jolly Graham, None

    S. H. Timberlake, None

    J. Bae, None

    S. Wright, None

    C. Buckner, None

    J. Clausen, None

    L. Thompson, None

    R. Martt, None

    A. Clark, None

    M. J. Stillwagon, None

    Y. Spurney, None

    D. J. Anderson, None

    D. J. Sexton, None

    P. Isaacs, None

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