2.  To purse a higher education and become more knowledgeable  To become a well-rounded nurse  Professional Growth and Development  To become more marketable in the job market

3.  Research Utilization Project  Introduction to Research  Apply knowledge learned in class  Find a policy that needs to be updated  Evidence based practice (EBP)

4. UTI’s are the most common healthcare associated infection. According to the CDC, 15-25% of hospitalized patients receive catheters and 75% of UTI’s acquired in the hospital are associated with a urinary catheter.

5. Patient - Discomfort - Prolonged hospital stay - Estimated 13,000 deaths (mortality rate 2.3%) Hospital - Estimated cost per infection ranges from $750-$1,000 -Estimated total cost in the United States ranges from $340 million - $450 million annually

6.  Insert catheters only when deemed necessary. The most effective way to prevent CAUTI is prompt removal. Urinary catheter use should be limited to patients with strong clinical indication; risks and benefits of having the urinary catheter should be assessed carefully. Consider other methods of catheterization (e.g. condom catheters, in- and-out catheter). Use an ultrasound bladder scan to determine need for catheterization or re-catheterization. Limit catheter use to:  a. Perioperative use for selected surgical procedures  b. Urine output monitoring in critically ill patients  c. Management of acute urinary retention and urinary obstruction  d. Assistance in healing for incontinent patients with Stage III-IV pressure ulcers  e. Comfort care in end of life situations.

7.  daily assessment for necessity,  daily pericare, and pericare after fecal incontinence,  maintaining sterility of the urine collection system,  maintaining aseptic technique during specimen collection,  maintaining the collection bag below the level of the bladder,  securing the catheter appropriately to prevent movement and urethral trauma or traction,  ensure unobstructed flow and drainage.  Perform hand hygiene before & after catheter insertion and/or manipulation.  Ensure adequate hydration in patients with indwelling catheter to dilute the urine and make it acidic to prevent or dissolve the encrustation. For postoperative patients, collaborate with the physician to determine that the urinary catheter be removed Postoperative day 1 or Postoperative day 2 with the day of surgery being zero. Reasons for not removing the catheter are to documented in the medical record (CMS/The Joint Commission). Patients admitted with an existing urinary catheter in place will need a urine specimen obtained.

8. Physician will receive computerized daily reminders for each patient with a foley catheter in place. If physician determines catheter should remain in place, the physician must document reason for continued catheter need.

9.  Centers for Disease Control and Prevention. (2015). Catheter-Associated Urinary Tract Infections (CAUTI). Retrieved on November 6, 2015 from http://www.cdc.gov/HAI/ca_uti/uti.html  Centers for Disease Control and Prevention. (2009). Guideline for Prevention of Catheter- Associated Urinary Tract Infections. Retrieved on November 6, 2015 from http://www.cdc.gov/hicpac/cauti/02_cauti2009_abbrev.html#table2http://www.cdc.gov/hicpac/cauti/02_cauti2009_abbrev.html#table2  Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Jones, L., Bennett, Y. P., &... Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal Of Critical Care, 24(3), 216-224 9p. doi:10.4037/ajcc2015898  Gould, C., Umscheid, C., & Agarwal, R. (2009). Guideline for prevention of catheter-associated urinary tract infections. Healthcare Infection Control Practices Advisory Committee (HIPAC).  Gould, C. V., Umschied, C. A., Agarwal, R. K., Kuntz, G., & Pegues, D. A. (2009). CDC - 2009 CAUTI Guideline:VI. Scope and Purpose - HICPAC. Retrieved from http://www.cdc.gov/hicpac/cauti/006_scopePurpose.htmlhttp://www.cdc.gov/hicpac/cauti/006_scopePurpose.html  Harrod, M., Kowalski, C., Saint., S., Forman, J., Krein, S. (2013) Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic. BMC Health Services Research. 13(151). P.1 -11.  Institute for Healthcare Improvement. (2011). How-to Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA.  Janzen, J., Buurman, B. M., Spanjaard, L., de Reijke, T. M., Goossens, A., & Geerlings, S. E. (2013). Reduction of unnecessary use of indwelling urinary catheters. BMJ Quality & Safety, 22(12), 984-988 5p. doi:10.1136/bmjqs-2013- 001908  Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., &... Yokoe, D. S. (2014). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infection Control & Hospital Epidemiology, 35(5), 464-479 16p. doi:10.1086/675718  Mori, C. (2014). A-Voiding Catastrophe: Implementing a Nurse-Driven Protocol. MEDSURG Nursing, 23(1), 15-28 14p.

10.  Meddings, J., Rogers., M., 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 2010;51(5):550–560. DOI: 10.1086/655133  Wald, H., Ma, A., Bratzler, D., & Kramer, A. (2008). Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg. 143(6):551-7.doi: 10.1001/archsurg.143.6.551. Arch Surg.