BERKELEY, CA (UroToday.com) - This is one of a twelve-part series that AJN launched in November 2009 titled “Evidence-based Practice: Step by Step.” This series highlights best practicse from studies and patient care data with clinician experience and patient performances and values. This article reports on a quality improvement initiative in which a multidisciplinary team applied the 7-step evidence-based approach to reduce catheter-associated UTIs at the Mississippi Hospital for Restorative Care, a long-term care acute care hospital within the Mississippi Baptist Health Systems.
Their goal was to reduce duration of catheterization in adult patients. Prior to beginning the initiative, a review of the evidence was conducted that included a critical appraisal combined with clinical expertise to successfully integrate the evidence. The authors cultivated a spirit of inquiry which incorporated:
- practice of good hand hygiene
- use of standard precautions (use of gloves and gowns, as appropriate, during any manipulation of the catheter or collecting system
- ensure that properly trained persons insert and maintain catheters using aseptic technique
- use high quality sterile equipment
- maintain a closed drainage system
- ensure unobstructed flow at all times, and
- keep drainage bag below the level of the bladder.
A catheter Continuation Algorithm was developed. Using evidence-based guidelines, this hospital system was able to decrease catheter-associated UTIs and device days. Amont the lessons learned from implementation of this initiative was the difficulty encountered when managing data from multiple sources as well as the importance of mentor presence until there is sufficient evidence of improvement in care.
The results of this initiative were disseminated throughout the hospital.
Reference: Am J Nurs. 2013 Jun;113(6):34-42; quiz 44, 43