In my role as a director in the intensive care unit, one of the biggest problems we had was the high rate of catheter-associated urinary tract infections (CAUTIs). To address this, we initiated a rapid cycle improvement with PDSA and implemented several best practice bundles. A key approach was conducting daily observational rounds to ensure securing devices STAT-LOCK were on and focused on urine drainage by checking for dependent loops. An education “reboot” was initiated, requiring every nurse to check off on Foley catheter insertions and CHG bathing. To strengthen our practices around Foley catheter insertions, we introduced a “BUDDY” system, pairing nurses during insertions. The study by Fletcher-Gutowski et al. (2019) found that a 2-person urinary catheter insertion protocol with a checklist decreases the risk of CAUTI.

We established a Foley-free policy in the emergency room. If any patient arrives with a Foley catheter from a nursing home or had one placed emergently in the ER, would have it replaced within 24 hours to reduce infection risk. We also promoted alternative urinary devices such as male external catheters and the PURE Wick for females to reduce reliance on indwelling catheters.

Empowering our nursing staff was important, so we created a nurse-driven protocol that allowed them to discontinue Foley catheters when criteria for their use were no longer met. As Harvey et al. (2022) stated, an effective method is a nurse-led catheter removal protocol. Removing foley catheters that aren’t needed helps reduce CAUTIs (Untalan et al., 2017).

Assessing the need for catheters and removing them as soon as possible can prevent CAUTIs (Shadle et al., 2021). Monitoring catheter utilization rate, documentation and care plans daily helped ensure compliance with these protocols. We fostered multidisciplinary communication through bedside shift reports, safety huddles, and physician rounds to discuss catheter discontinuation plans, which kept the entire care team on track toward reducing CAUTI occurrence. High-risk huddles and device huddles are useful tools to prevent the unnecessary use of catheters (Shadle et al., 2021). Through the use of these methods, we successfully lowered CAUTI rates in the ICU by 56%.

References

Fletcher-Gutowski, S., & Cecil, J. (2019). Is 2-person urinary catheter insertion effective in reducing CAUTI? American Journal of Infection Control, 47(12), 1508–1509. https://doi.org/10.1016/j.ajic.2019.05.014

‌Harvey, S., Watson, J., & Jorgensen, A. (2022). Rapid cycle process improvement in urinary catheter utilization. Nursing. https://institutionalrepository.aah.org/nurs/246/

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A Bundle-Based Approach to Prevent Catheter-Associated Urinary Tract

Infection in the Intensive Care Unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934

‌Untalan, E., Mendoza, M., Davis, C., Gardner, M., Putman, K., & Robinson, D. (2017). Peroperative Foley Removal Project Using Rapid Cycle Improvement and Lean Methodology. Journal of PeriAnesthesia Nursing, 32(4), e13. https://doi.org/10.1016/j.jopan.2017.06.061