Methods: Nationwide qualitative study of early adopting EDs, defined as those using criteria for urinary catheter placement and tracking a decrease in ED-placed catheters. We screened over 400 EDs identified from a nationwide survey and national publicity. Among 6 EDs, we conducted 52 semi-structured interviews and 9 focus groups with 102 participants (nurses, doctors, infection control staff). Interviews and focus groups were audio-recorded and transcribed verbatim. Study authors used a conventional content analysis to code transcripts in NVivo9.
Results: Several themes emerged concerning ED nurses’ roles in CAUTI prevention. Nurses were the principal champions of CAUTI prevention efforts. ED nurses reported that they felt ownership of urinary catheters as they historically initiated most urinary catheters and were responsible for catheters’ placement and care. Close examination of ED workflow by nurses identified local opportunities to: minimize catheter use, ensure proper insertion technique and maintain catheters post-insertion. To minimize use, nurses affixed indications for urinary catheter to insertion kits, questioned urinary catheter orders for appropriateness and championed the use of alternatives e.g. unisex urinals. To improve aseptic technique during catheter placement, nurses developed protocols to improve perineal care and implemented a two-person insertion practice where a helper provided technical assistance, allowing the primary operator to focus on sterility. To maintain catheters post-insertion, nurses collaborated with supply personnel to fasten urinary catheter hooks onto mobile equipment, which prevented the backflow of urine in the urinary catheter drainage system.
Conclusion: Among early-adopting EDs, CAUTI prevention efforts were largely nurse-driven and the interventions nurse-centric. Nursing examination of workflow was the key common feature that led to novel strategies that redesigned workflow. Nurse engagement and empowerment are critical to ED CAUTI prevention.
E. J. Carter,
L. Mandel, None
J. Schuur, None