A Practical Approach to Prevent CAUTI

Mercedes Tobin, MSN, RN, CBN, CMSRN, PCCN, CCRN-K, Surgical Care Center, Inspira Health Network, Medical Center of Vineland, Vineland, NJ
A Practical Approach to Prevent CAUTI

Catheter-Associated Urinary Tract Infection (CAUTI) is one of the most prevalent hospital acquired infections (HAI) acquired by a patient with indwelling urinary catheters in a Healthcare facility. CAUTI can impact hospital costs, extends length of stay (LOS), and impacts the quality of life of all patients afflicted by this infection. In 2012, Inspira Health Network’s two divisions which consist of 372 beds were struggling to decrease the occurrence of CAUTI. A cohesive interdisciplinary team led by a Clinical Outcomes Manager was organized, and the goal was to engage clinical experts and frontline care providers in developing measures which reduced both indwelling urinary catheter utilization and the infections. A practical approach, peri-care with soap and water was implemented as an integral part of a patient daily hygiene.

  • Peri-care with soap and water before insertion, maintenance and every after bowel movement
  • Daily review  of catheter necessity
  • Criteria-based insertion guidelines
  • Hand hygiene and aseptic insertion technique
  • Securement device to stabilize the urinary catheter tubing

H-O-R-N-O, a part of Nurse Driven Protocol is an acronym for easy memory aid, and guideline utilized by staff as criteria for insertion and removal of urinary catheter with descriptions; (H) Hemodynamic instability, (O) Obstruction, (R) Retention, (N) Neurological, and (O) Other for rare exceptions like palliative care for terminally ill patients, radiation oncology patient admitted for GYN implant.

An internal cost analysis which compared the inpatient stay cost of patients who developed CAUTI to the inpatient stay cost of patient with the same diagnosis who did not develop a CAUTI. The analysis mimicked national findings on the financial impact of CAUTI by showing a direct cost rose by 88% for patients with CAUTI (approximately $10,676 per case). Outcome of this project is an 87% decrease in CAUTI (40 counts to 5 counts).