1. Changing ICU culture to reduce catheter-associated urinary tract infections.
- Author
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Maxwell, Marcia, Murphy, Kristy, and McGettigan, Maude
- Subjects
CATHETER-associated urinary tract infections ,AWARDS ,COMPARATIVE studies ,CORPORATE culture ,HOSPITALS ,INTENSIVE care units ,LONGITUDINAL method ,PERSONNEL management ,QUALITY assurance ,URINALYSIS ,QUALITATIVE research ,URINARY catheters ,DESCRIPTIVE statistics ,PREVENTION - Abstract
Background: The presence of an indwelling urinary catheter predisposes a patient to a Catheter Associated Urinary Tract Infection. Each day a catheter is left in place, the patient risk for a CAUTI increases 5%. Many characteristics of a Level II Trauma Center ICU/IMCU contribute to the routine insertion of, and reluctance to remove, indwelling urinary catheters. The aim of this project was to decrease the patient harm of CAUTI incidence by focusing on a cultural transformation around the use of indwelling urinary catheters. Methods: A core group of nursing staff, leadership, physicians and infection preventionists within the ICU/IMCU of a regional Level II Trauma Center in the state of Colorado led this quality improvement project. The goal of the project was to clarify appropriate indwelling urinary catheter indications for use, assess organizational and cultural influences and develop a support structure around CAUTI prevention using the Plan-Do-Study-Act model of Quality Improvement. The team also participated in the "On the CUSP: STOP CAUTI" initiative sponsored by the Colorado Hospital Association. Results: At year-end 2015, infection prevention data demonstrated an 87.5% decrease in CAUTI from 2014, as well as a decrease in utilization of 9%. A zero CAUTI rate was sustained for 394 consecutive days from May 2015-May 2016. During daily multidisciplinary rounds, nurses are now reporting the plan for urinary catheter removal before the question is asked. Conclusion: The deliberate layering of single interventions over an extended period of time allowed for the adoption of each intervention before moving on to the next. Nurses and other members of the healthcare team supported each other in adopting the interventions. Interventions included considering alternatives to indwelling urinary catheters, aseptically inserting catheters for appropriate criteria only, removing catheters as soon as possible, improved urine specimen collection practices and enhanced care and maintenance measures for critical care patients. [ABSTRACT FROM AUTHOR]
- Published
- 2018