1. University of South Florida CON
Preventing Catheter-Associated Urinary Tract Infections in the Hospital Setting
Desiree Hartzell Matthew Pierson
Amber Morin Spencer Brown
Allison Hitpas Alyssa Escobar
University of South Florida CON
AMBER
The ultimate plan is to reduce CAUTI, we are providing a plan to do so.

2. What is the Problem?
“The urinary tract is the most common site of healthcare–associated infection (HAI), accounting for more than 30% of the infections reported by acute care hospitals. Of these infections, 80% are attributable to an indwelling urethral catheter” (Rothfeld & Stickley, 2010).
Typical Progression:
Physician knows the patient has an IUC.
Physician deems the IUC unnecessary.
Physician writes order to remove IUC.
Nurse removes IUC.
(Meddings, Rogers, Macy, & Saint, 2010)
AMBER
Study found: only 75% of the time an IUC was appropriately indicated with a doctor’s order. IUCs only appropriately indicated in 56% of the time without an order.
“In most hospitals, 4 key steps are needed before being able to remove the UC from the patient:”
These steps are a lot of work and time spent by the nurse and physician.
However, the “catheter reminders and stop orders have the ability to bypass several of these steps, leading to routine and prompt removal of unnecessary catheters. The reminders and stop orders are simple tools to enhance patient safety and comfort”

3. Proposed Change
Utilize a stop-order generating assessment tool to reduce catheter-associated urinary tract infections (CAUTI) by promoting prompt removal of indwelling urinary catheters (IUCs) in instances of inappropriate use.
SPENCER

4. Plan Implement: IUC Assessment Tool:
Separate form from basic shift assessment
Based on appropriate IUC criteria
Nurse completes once per shift
Filed in the patient’s EMR documents
Stop-Order System:
Generates after tool is completed
Generates based on appropriate criteria
SPENCER
-The stop-order system is generated by the assessment tool.
-Similar to how sepsis screening tool functions
Different assessment sheet than the Assessment flowsheet.
Completed forms found in pt.’s documents (nurse doesn’t have to search everywhere)

5. Plan: Supporting Evidence
“The rate of CAUTI (episodes per 1000 catheter-days) was reduced by 52% (P<0.001) with use of a reminder or stop order. The mean duration of catheterization decreased by 37%” (Meddings, Rogers, Macy, & Saint, 2010).
“Even 1 fewer day of catheter use could be clinically important as the risk of CAUTI increases daily” (Meddings, Rogers, Macy, & Saint, 2010).
Another study found that when UCs were used for appropriate circumstances and removed promptly when no longer necessary “the incidence of CAUTIs decreased by 57% (P < .05)” (Rothfeld & Stickley, 2010).
DESIREE
Many studies found significant decrease in CAUTI rates when UCs were used appropriately.

6. Plan: Supporting Evidence
Appropriate Indications
Inappropriate Indications
HOUDINI
Hematuria
Obstruction
Urology Surgery
Decubitus Ulcer with incontinence
Input/Output Measurement (needs to be a specific reason)
Nursing End of Life Care
Immobility
(Adams, Bucior, Day, & Rimmer, 2012)
Neurogenic Bladder (Fakih MG, Watson SR, Greene M, et al., 2012)
Urinary Retention (Centers for Disease Control and Prevention [CDC], 2009)
Perioperative needs (i.e. prolonged procedure, large volume infusions, intra-operative monitoring) (CDC, 2009)
Emergent Pelvic Ultrasound (Fakih, et al., 2010)
Acute Hip Fracture (Fakih, et al., 2010)
Confusion
Incontinence
Patient Request
(Fakih MG, Watson SR, Greene M, et al., 2012)
Prolonged Post-Op period
Obtaining urine culture
(CDC, 2009)
DESIREE
This will be the standard for our assessment and stop-order criteria.

7. Do: Evaluate and Educate
Consult Nursing Informatics to create the assessment tool and stop- order system in the EMR.
Educate personnel in a 10-minute brief information session on the indwelling catheter assessment tool and stop-order generation system to be completed each shift.
ALLISON

8. Do: Implementation
Assessment tool and stop-order system will be created.
Staff education will take place.
Staff implementation will take place.
CAUTI rates and inappropriate indwelling urinary catheter use will decrease.
ALLISON

9. Study
Catheter reminders and stop orders were beneficial regardless of tools used. These interventions are low-cost strategies to be implemented in any health care system (Meddings, Rogers, Macy, & Saint, 2010).
Pros
Cons
Simple
Efficient/Less time taken by healthcare team
Economical
Reduce Inappropriate IUC use
Prompt removal of unnecessary IUCs
Reduce facility costs related to CAUTI
Earlier discharge
Forms easily accessible
Improves patient outcomes, safety, and satisfaction
Less work for nurses
More charting
Burden
Possibility of recatheterization if premature stop-order
Nurses or doctors not adapting to change
MATT
Pros
Possible earlier discharge by facilitating steps like removal of Foley to go home
Patient more easily kept in “the loop” of their care
Cons
More charting/ things to look at
(Research shows recatheterization occurred in less than 14% of cases)

10. Act: Generalizability
Alert may generate in EMR when IUC assessment has not been completed.
Personnel may be weary about this stop-order protocol for fear of need for IUC reinsertion.
Need for additional education on supporting evidence.
ALYSSA

11. Summary
Implementing a nurse-driven stop-order protocol to discontinue inappropriate indwelling catheters will:
Reduce hospital CAUTI rates
Reduce the cost of CAUTI
Improve patient safety
Improve patient satisfaction
Decrease length of stay
Improve staff satisfaction
ALYSSA

12. References
Adams, D., Bucior, H., Day, G., & Rimmer, J. (2012). HOUDINI: Make that urinary catheter disappear - nurse-led protocol. Journal of Infection Prevention, 13(2),
Centers for Disease Control and Prevention. (2009). Guideline for Prevention of Catheter-associated Urinary Tract Infections, Retrieved February 20, 2016, from
Fakih MG, Watson SR, Greene M, et al. Reducing Inappropriate Urinary Catheter Use: A Statewide Effort. Arch Intern Med. 2012; 172(3): doi: /archinternmed
Fakih, M. G., Pena, M. E., Shemes, S., Rey, J., Berriel-Cass, D., Szpunar, S. M., Savoy-Moore, R. T. and Saravolatz, L. D. (2010), Effect of Establishing Guidelines on Appropriate Urinary Catheter Placement. Academic Emergency Medicine, 17 (3), 337–340. doi: /j x
Meddings, J., Rogers, M. A., Macy, M., & Saint, S. (2010). Systematic Review and Meta‐Analysis: Reminder Systems to Reduce Catheter‐Associated Urinary Tract Infections and Urinary Catheter Use in Hospitalized Patients. Clinical Infectious Diseases, 51(5),
Rothfeld, A., & Stickley, A. (2010). A program to limit urinary catheter use at an acute care hospital. American Journal of Infection Control, 38(7),
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