Let's Keep the Bugs Out! Implementing a Nurse Designed Program to Decrease the Use of Non-Indicated Urinary Catheters

Catheter associated urinary tract infections (CAUTI) are one of several conditions identified by CMS as a ‘never event’. Because urinary catheters are a common cause of nosocomial infections in the hospitalized patient we participated in a statewide initiative to encourage appropriate use of urinary catheters.  Using guidelines based on the State Hospital Association Keystone hospital associated infections project and CDC, a program was developed to decrease unnecessary urinary catheters.

PROCESS: A pilot unit was chosen based on number of urinary catheters identified during a prevalence audit.  Evidence-based criteria, recommended by the state initiative and based on literature review,  were used to determine indications for appropriate urinary catheter utilization.   These included Urinary Tract Obstruction, Neurogenic Bladder, Urologic Study/Urologic Surgery, Stage 3 or 4 Pressure Ulcers, Hospice/Comfort/Palliative Care.  Urinary Catheters were considered non-indicated if used for Nephrology, Transferred from Critical Care, Patient Requests Catheter, Confusion, Incontinence, or Other.

An eight-week implementation plan was developed.  This included an online power point presentation outlining the project as well as brochures and fliers.  While all nursing staff were required to view the power point, it was also available to the entire health care team including physicians.  Nurses monitored catheter use and notified physicians to discontinue those not indicated.  Following the pilot the program was implemented on the remaining Medical-Surgical units. 

RESULTS: The number of patients with urinary catheters decreased from 24% - 17%.  The number of non-indicated catheters decreased from 52% to 23%. Though not statically significant, due to limited data, positive urine cultures decreased from 2.53% to 1.78%.  This project spurred a number of related efforts including a policy for nurses to independently discontinue non-indicated catheters, a review of incontinence management including usage of male external containment devices and underpad usage, and development of a patient/family brochure about CAUTI.