Introduction
CAUTI accounts for 41% of all hospital-acquired infections in the US with implications for hospital spending and LOS (Esteban et al., 2013). A process improvement plan grounded in evidence-based practices is proposed to minimize CAUTI cases at KRMC and boost its below-average score in CAUTI prevention.
Purpose of the Project
The purpose of this process improvement project is to minimize CAUTI cases at KRMC through a CAUTI bundle for Foley catheter insertion, removal, and maintenance. Aseptic insertion, CMS catheterization guidelines, and Foley necessity evaluation have been shown to reduce the CAUTI risk by up to 81% (Keller, Linkin, Fishman, & Lautenbach, 2013). By focusing on the process, the project will accomplish three goals:
- Reduce CAUTIs at the facility
- Decrease the Foley catheter days
- Increase patient outcomes and safety.
Data Collection and Display Tools
The process and outcome measures will determine the project’s progress based on the baseline CAUTI rate. Bernard, Hunter, and Moore (2012) give some of the data collection tools for CAUTI reduction performance, i.e., “NHSN definition for symptomatic CAUTI, HICPAC guidelines, and CAUTI process data collection tool” (p. 33). The project will focus on process measures, i.e., CAUTI prevalence (positive urine culture), catheter days, and Foley appropriateness/necessity (Oman et al., 2011). Therefore, the best tool is the CAUTI-process data collection tool. The data reporting/communication to staff will involve newsletters, presentations/webinars, and posters.
Quality Milestones
The quality milestones set for this process improvement plan include:
- Decreased CAUTI prevalence by 40% at KMRC from the current rate
- Lower indwelling catheter days/utilization through surveillance
- Better patient outcomes and satisfaction (HCAHPS) scores
- Reduced LOS and 30-day readmissions
The Role of IT
IT will be applied in staff education and coaching on proper catheter insertion, maintenance, and removal. Virtual educational tools such as PowerPoint and webinars will help deliver content during staff training sessions. Further, web-based data collection and reporting tools will be useful in the submission of data related to processing outcomes (catheter utilization and CAUTI rates).
Internal or External Benchmarks
KRMC’s score in nosocomial infections, including CAUTIs, is lower than the national average of 41% (Kendallmed.com, 2016). Nationally, CAUTI-related hospital days stand at 90,000 annually (Syndor & Trish, 2011). External benchmarks will be used to evaluate the project’s progress. They include:
- Reduce the CAUTI rate at KRMC to 40% by April 2017
- Lower the average length of stay to 1-2 days
- Ensure 90% of all catheter insertions have proper indications
- Reduce the indwelling catheter days to 3 days
Evaluation and Re-evaluation Timelines
The Key Players
To achieve the target of 40% CAUTI by April 2017, the project will involve a multidisciplinary team. Its key players will include RNs and staff nurses, physicians, infection control officers, urologists, lab technicians, unit managers, and the leadership team (director of nursing and CFO). The nursing staff will observe the CAUTI bundle while the physicians, the lab team, and urologists will assess Foley’s necessity. The leadership team will provide the resources for the project and ensure the set targets, i.e., CAUTI rate, LOS, and catheter days are met.
Conclusion
CAUTI reduction requires a cultural change. This quality improvement project will enhance KRMC’s process measures, i.e., LOS, CAUTI rate, and indwelling catheter days through staff education and utilization of the CAUTI bundle. Improvements in these indicators will enhance patient safety and satisfaction leading to better quality outcomes.
References
Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urologic Nursing, 32(1), 29-37.
Esteban, E., Ferrer, R., Urrea, M., Suarez, D., Rozas, L., Balaquer, M.,…Jordan, I. (2013). The impact of a quality improvement intervention to reduce nosocomial infections in a PICU. Pediatric Critical Care Medicine, 14(5), 525–532.
Keller, S., Linkin, D., Fishman, N., & Lautenbach, E. (2013). Variations in identification of healthcare-associated infections. Infection Control & Hospital Epidemiology, 34(7), 678-686.
Kendallmed.com. (2016). Web.
Oman, S., Makic, F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2011). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 6(6), 1-6.
Sydnor, M., & Trish M., P. (2011). Hospital epidemiology and infection control in acute care settings. Clinical Microbiology Review, 24(1), 141–173.