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A multi-modal evidence-based approach to preventing CAUTIs in a three-hospital health system was implemented under the leadership of the system’s CWOCN. The goals were process improvement to achieve 100% compliance with Foley catheter removal by the 2nd post-operative day and outcome improvement in CAUTI occurrences. The system CAUTI rate was 4.21 per 1000 device days prior to the project, with a goal of 3.0 or lower. Evidence sources for the project were derived from literature review, surveys of hospital practices, and information presented at a regional WOCN meeting. The implementation plan included sequential implementation of strategies for staff education, remediation, and equipment innovation. First, a mandatory CAUTI module was introduced with a knowledge verification test placed on the system’s web-based learning center for completion by all RNs, LPNs, and CNAs. 96% compliance with completion was achieved. Next, traveling CAUTI posters that included evidence-based approaches to decrease CAUTI occurrences rotated through each nursing unit for a two week period. A CAUTI Bundle was initiated and copies were distributed to all nursing units. Chart reviews of CAUTI occurrences identified unit-specific problems that were addressed by unit educators. In evaluating the results of this multimodal approach, we have achieved 100% compliance in removing Foley catheters by post-operative day two. The CAUTI rate decreased to 1.47 per 1000 device days for the quarter following project implementation.
Efforts continue. Mandatory learning modules with random peer reviews are targeting technique-related Foley catheter insertion and maintenance competencies. We identified the need for equipment modification and are preparing to implement an attachment device to our IV poles for hanging Foley bags to assure they are consistently lower than the bladder while the patient is ambulating or in bed. A random CAUTI audit will be held to identify catheter issues at the bedside.