Overview: Catheter-Associated Urinary Tract Infection (CAUTI) Reduction Program
We began our work over 10 years ago, and through our research we have identified key elements for developing a comprehensive program to reduce indwelling urinary catheter use and reduce CAUTI. A general overview for developing a program to reduce CAUTI can be found via the button below. That document also includes a sample assessment tool and table outlining implementation team roles and responsibilities with suggestions for the type of personnel to be considered.
Program development and implementation follows, in part, the 4 E’s model developed by Pronovost and colleagues for translating evidence into practice. Saint, Howell, and Krein published on applying this model.
Facility-specific Practice Assessment
We suggest that you begin by targeting one or two units for improvement. The units chosen should have the combination of a higher than average (for your institution) prevalence of Foley (urinary) catheters along with staff that are engaged and willing to support a catheter use improvement project. By implementing a pilot program on one or two units to start, the project is not only more manageable, but also allows you to make adjustments if needed before expanding the scope of the project to other units.
The section on Tracking Performance section (below) has resources that describe what to measure and how to collect the data.
Putting Together an Intervention Team
A key aspect of implementing a ‘catheter out’/CAUTI prevention program is to identify an implementation team at your site. This team plays a critical role in developing the program and assisting with program implementation. One strategy for assembling this team is to first determine the roles and responsibilities of the team members and then identify personnel to fill those roles.
Some key roles include: project coordinator, nurse champion, and physician champion. In general, these “champion” roles have been effective when they engage at a unit-based, direct-care personnel level. Key responsibilities are: education, data collection, and evaluation. Individuals can fill more than one role and some may be short-term and others longer-term. The infection preventionist may have served as a subject matter expert on prevention of CAUTI so it is important that they be a member of the team. However, it is also important to include the unit leadership champions because they can resonate with direct care personnel and, therefore, can impact care processes.
Customizing a Plan: Deciding on Strategies
This toolkit provides materials and information to reduce indwelling urinary catheter use and CAUTI among hospitalized adult patients. However, because each hospital or even each unit within a hospital may be different it is important to recognize that the materials and plan for using these materials needs to be customized for your hospital or setting. This customization process is one of the responsibilities of the implementation team because the individuals on this group are the most likely to have insights about what may or may not work in your hospital.
Factors to consider in the customization process include:
Current policies and procedures
Resources
Patient population
Involved personnel
Use the materials in this toolkit as a template, but be creative and construct a program that will be successful and lead to a sustainable reduction in catheter use at your institution. The materials found in Detailed Protocols can also be used as a standard approach that may require little or minimal customization at some hospitals.
Getting Ready for Change
Changing practice patterns is hard!
Busy nurses and physicians often feel overwhelmed and because new initiatives in healthcare seem to come and go, they may not want to commit to an initiative that they believe will add to their workload, only to fade away a few months later. The sections found under Engaging Providers tab offer many useful suggestions and strategies to enlist the support and buy-in of clinical and non-clinical staff, so that they will willingly embrace the change. There is even a troubleshooting guide – a table of barriers and possible solutions – to help you get over common hurdles. In the Research section we provide access to abstracts and, where possible, complete articles so that you’ve got the facts to back you up.
Tracking Performance
Collecting, analyzing and reporting information on your primary outcomes of interest is critical as you begin your program and to ensure continued success. For example, measuring indwelling urinary catheter use rates can provide important information for identifying the units in which to begin your program, while continued assessments can be used to encourage staff and to help maintain observed improvements. This section of the toolkit contains a number of suggestions and tools to assist you with determining what outcomes to measure, how to collect data, and strategies for constructing effective feedback for clinical staff.
Collecting data is critically important for understanding whether or not your facility has an unacceptably high number of patients with indwelling urinary catheters without an appropriate indication. Collecting and comparing data both before and after an intervention will provide a relatively objective way to evaluate if your interventions are successful in reducing unnecessary catheter-days and subsequent catheter-associated urinary tract infection (CAUTI). Occasional assessments, done after the initial intervention and compared to historical trends from the same unit, will allow you to assess if the intervention has been sustained.
In this section, we provide several examples of the many data collection tools you can use. These examples are taken from multiple sites, including some that have been initially developed and implemented at St. John Hospital and Medical Center in Detroit, Michigan. You may decide to modify these tools or use a different option altogether. Whichever tools you decide to use, it is important to apply a consistent approach to data collection at all stages of your prevention program, so that you can compare across time periods and units.
Continuing to Improve
Once indwelling catheter use and catheter-associated urinary tract infection rates have substantially decreased, you’ll want to know how to keep these rates low. Suggestions and tools under the Educational Tools may be helpful with broadly circulating the message that your organization is serious about reducing CAUTI.
And speaking of education, why not disseminate how well your organization has managed to reduce and possibly eliminate the most common of all healthcare-associated infections? Reducing CAUTI can become a source of organizational pride and possibly lead to a reduction in other infections as well.
Putting It All Together
Sometimes, a picture is worth a thousand words. This figure details the steps in developing a comprehensive CAUTI reduction.
At other times, examples of what others have done are also useful. In the Detailed Protocols section are two detailed protocols, one designed to reduce CAUTI in the emergency department, and another designed for nurses to lead and to reduce CAUTI in non-intensive care units.