Since 2008, the Centers for Medicare & Medicaid Services (CMS) has held acute-care hospitals accountable for failing to avert preventable harms resulting from medical care. CMS is denying additional payments to hospitals for preventable hospital-acquired conditions, such as a CAUTI. Monitoring these infections has become both a federal and state function. In 2007, Pennsylvania became the first state to require hospitals and nursing homes to report facility-acquired infections to the CDC.
Methods to decrease IUC use and prevent hospital-acquired CAUTIs have been identified and they include: instituting hospital-wide administrative interventions, implementing quality improvement programs, educating physician and nursing staff on indications and evidence-based nursing care of an indwelling urinary catheter to prevent infection.
Some acute care hospitals have been successful in implementing facility-wide programs to decrease CAUTI. One successful program has been reported by Wenger and colleagues (2010) who describe an initiative implemented in 2006, at Lancaster General Hospital, a 550-bed Magnet hospital in Lancaster, Pennsylvania. They decided to start an initiative to decrease CAUTIs when they determined that the CAUTI rate in their critical care units was at the upper range (7.9 per 1,000 device or catheter days) of the national mean (3.1 to 7.5 per 1,000 device days). They knew that what was needed was a multifaceted approach and thus, instituted a three-pronged initiative—beginning with education, progressing to tests of new and better products, and ending with a nurse-driven protocol for catheter removal. This hospital used the Plan-Do-Study-Act model in which change is first proposed, and then it is tested and assessed before implanted. After implementation, the model requires ongoing monitoring.
A key element of the initiative was education, particularly education of bedside nurses on practices that contribute to CAUTIs (e.g. urine collection, insertion technique). Product enhancement was also studied and the use of a tamper-evident seal system (manufactured by Bard Medical Division) and securing the catheter were two product changes that were instituted. These products have been standard catheter supplies in my hospital, Hospital of the University of Pennsylvania in Philadelphia, for many years. The final element was a nurse-driven protocol, eliminating the need for a physician order to “pull the catheter.” By developing a protocol driven algorithm, they were able to remove unnecessary catheters in a timely fashion.
This initiative was successful as over a 3 year period, UTI rates significantly decreased (from 2.75 per 1000 device days to 1.02). It shows that with a concerted effort, these devices can be used safely, while minimizing CAUTIs.
Wenger, J.E. (2010). Cultivating quality: reducing rates of catheter-associated urinary tract infection. American Journal of Nursing. 110(8):40-5