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Striving to meet the national benchmark for catheterassociated urinary tract infections (CAUTIs) remains a struggle. This project demonstrates how a daily line huddle led by hospital leadership and a pre-insertion stop huddle reduced device utilization by over 50% and subsequently influenced a reduction in CAUTI rates.
Key Words
Catheter-associated, urinary, catheter, bundle, Foley, nurse-driven, device utilization.
Background and Significance of the Problem
Catheter-associated urinary tract infections (CAUTIs) are considered a preventable hospitalacquired infection (HAI) and are not reimbursed by the Centers for Medicare and Medicaid Services (CMS). The Centers for Disease Control and Prevention (CDC) (2017) states a urinary tract tion any part of the urinary system, and urinary catheters account for 75% of all urinary tract infections and 40% of all HAIs (Institute for Healthcare Improvement [IHI], 2020). About 15% to 25% of patients within a hospital setting have an indwelling urinary catheter, and catheterization and prolonged duration are risk factors for CAUTI (CDC, 2017). The average expense from a single CAUTI can range from $867 to $10,197, depending on population and bed location within the hospital setting (Hollenbeak & Schilling, 2018). In 2009, the CDC published recommended guidelines for prevention of CAUTIs, which include appropriate indications for catheter insertion, use of alternative devices, proper sterile technique for insertion, education, documentation, maintenance bundles, and use of quality improvement (QI) programs. Indications for catheter use include acute urinary retention, critically ill and need for accurate measurement, select surgical procedures, to assist with wound healing, prolonged immobilization, and to improve comfort during end of life (CDC, 2009). Alternative devices refer to products that assist with accurate measurement of output that is non-invasive. These items include external female incontinence devices, male urinary pouches, and condom catheters. Intermittent catheterization is another alternative to utilizing an indwelling device. Maintenance bundles refer to daily care provided to the patient in efforts to reduce the chance of acquiring a CAUTI (CDC, 2015). These measures include maintaining a closed drainage system, unobstructed urine flow with no kinks or dependent loops, empty the catheter bag regularly, standard precaution with any care or manipulation, routine hygiene care to include twice-daily catheter care, catheter care with a bath and with any incontinence episode, and to maintain the seal between the catheter and bag tubing....