Introduction
Catheter-associated UTI (CAUTI) is a common nosocomial infection associated with pain, higher hospitalization costs, and prolonged LOS of up to one additional day (Esteban et al., 2013). The CMS penalizes hospitals reporting a rise in CAUTI. Most patients are given urinary catheters without justifiable indications (Esteban et al., 2013). Kendall has a below-average safety score due to the high catheter-associated UTIs, an indication of a process failure.
Strategies for Quality Improvement
Evidence-based interventions for reducing CAUTI include aseptic insertion, use of the CMS-recommended catheterization guidelines, and avoidance of unnecessary catheters (Keller, Linkin, Fishman, Lautenbach, 2013). Studies have shown that the interventions such as aseptic insertion, proper catheterization guidelines, and removal of unnecessary catheters can reduce the CAUTI rate by 48-81% (Keller et al., 2013). The aim is to minimize catheter utilizations and exposure to equipment.
Aseptic Insertion
One of the pros of aseptic insertion is that it is a sterile procedure. It entails using sterilized equipment such as surgical gloves, sponges, and drapes during catheterization. Other interventions include the use of antiseptic chlorhexidine solution in urethral meatal cleansing and utilization of a single packet of lubricating jelly per patient (Al Mohajer & Darouiche, 2013). Additionally, a catheter of appropriate size is recommended to minimize catheter trauma. The disadvantage of this strategy relates to the high risk of infection from uropathogenic bacteria.
Use CMS Recommended Guidelines
Hospitals can adopt the CMS-recommended guidelines to minimize CAUTI risk factors. An aseptic, continuous drainage system and maintaining the catheter below the bladder minimize movements that cause urethral traction (Al Mohajer & Darouiche, 2013). Further, ensuring an unobstructed urine flow, regular emptying of the collection bag, and routine metal cleansing can minimize the CAUTI risk in catheterized patients. The evidence-based guidelines can enhance safety and quality outcomes of the hospital. However, it requires only trained personnel to maintain the catheters based on the recommended guidelines.
Daily Monitoring of Catheter Necessity
A daily review of catheter necessity is selected as an effective strategy for reducing the CAUTIs rate at the Kendall medical center. According to Oman et al. (2011), over 21% of catheters have no valid justification with over 58% placed in unnecessary sites. Further, catheters increase the CAUTI risk, cause discomfort, and affect mobility (Oman et al., 2011). For these reasons, catheter duration should be minimized. A daily review of indwelling catheters can allow prompt identification and removal of unnecessary catheters.
Selected Strategy
A daily review of indwelling catheters helps detect and manage leaks and blockages in the urinary drainage system. Additionally, routine activities such as ensuring that the catheter is well fastened and assessing the need for continued catheter use can minimize the infection risk.
Rationale
The rationale for choosing the strategy above is that delays in catheter removal accounts for the high CAUTI rate in hospitals. According to Halpin, Milstein, Shortell, Vanneman, and Rosenberg (2011), 74% of hospitals do not monitor catheter duration and most catheterizations lack valid justifications. While aseptic insertions and catheter maintenance guidelines are common practices in hospitals, the assessment of catheter duration and necessity is rarely done. Thus, a daily review catheter necessity can prevent CAUTIs related to delays in removing catheters.
Quality Improvement Ideas
Quality improvement at the facility would involve eliminating the CAUTI risk factors. Reduced exposure to devices during catheterization, regular review of catheter necessity and timely removal, and aseptic practices can minimize these risks. In addition, staff/patient education on daily care can eliminate mistakes that increase the CAUTI risk.
The surveillance of CAUTI cases can help identify the causes to develop appropriate interventions. Quality improvement at the unit level should involve quality committees comprising of trained RNs to insert, maintain, and remove the catheters. Data on CAUTI rates can indicate the progress made. Nurse communication and bedside reporting can improve the outcomes of patients with indwelling catheters. In addition, collaboration between facilities can help develop and reinforce best practices in this area.
Organizational Mission
The quality improvement plan is consistent with Kendall’s mission of providing quality, patient-centered care. A reduction in the CAUTI rate in the hospital will improve patient safety and quality outcomes. Moreover, nurse communication will help reduce the potential for sentinel events and support patient-centered care. Healthcare quality improvement will minimize the length of stay and result in fewer 30-day readmissions.
Organizational Vision & Value Statement
The vision of becoming a preferred provider in the region can be achieved through a focus on quality and patient-centered care to improve the facility’s rating nationally. Reducing the CAUTIs rate and improved nurse communication will translate into better inpatient experience. As a result, the HCAHPS scores and hospital rating will increase. Further, the reduction of CAUTI rates will lower the hospitalization costs in line with the hospital’s values of quality, compassion, and cost-effectiveness.
Conclusion
The rate of CAUTIs is an indicator of quality. The CMS requires hospitals to reduce hospital-associated infections to qualify for reimbursements (Halpin et al., 2011). Evidence-based strategies such as aseptic insertion, CMS guidelines for catheter maintenance, and daily review of catheter necessity can minimize hospital-acquired infections, including CAUTI.
References
Al Mohajer, M., & Darouiche, R. (2013). Prevention and treatment of urinary catheter-associated infections. Current Infectious Disease Reports, 15(2), 116–123.
Esteban, E., Ferrer, R., Urrea, M., Suarez, D., Rozas, L., Balaquer, M.,…Jordan, I. (2013). The impact of a quality improvement intervention to reduce nosocomial infections in a PICU. Pediatric Critical Care Medicine, 14(5), 525–532.
Halpin, H., Milstein, A., Shortell, S., Vanneman, M., & Rosenberg, J. (2011). Mandatory public reporting of hospital-acquired infection rates: A report from California. Health Affairs, 30(4), 723-729.
Keller, S., Linkin, D., Fishman, N., Lautenbach, E. (2013). Variations in identification of healthcare-associated infections. Infection Control & Hospital Epidemiology, 34(7), 678–686.
Oman, S., Makic, F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2011). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 6(6), 1-6.