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Background/Description
(CDC, 2009)
Since nurses directly interact with caring for the catheter, they are crucial for identifying the
signs of a CAUTIs.
Since nurses are at the frontline of care, providing education to these professionals can aid in
faster diagnosis of CAUTIs, and ultimately reduce the rate of occurrence.
PICOT
In adult patients, will mandated professional
development education for registered nurses on catheter
related infection prevention and catheter care, compared
to no supplemental education, reduce the prevalence of
CAUTI in a cost effective manner in the acute care
setting?
Statistics
Current Practice
Appropriate use of urinary catheters:
Obtaining urine for culture or other diagnostic tests when the patient can voluntarily void
(CDC, 2009)
Current Practice
Primary CAUTI Prevention Measures
(CDC, 2009)
The Standardized Infection Rate for CAUTI at Arizona hospitals is 11 percent higher than the
national baseline, according to data released by the CDC in March 2014
The Arizona Hospital and Healthcare Association (AzHHA) launched a collaborative effort with
member health organizations across the state to reduce CAUTIs in May 2014
Local
In an article from the Arizona Daily Star in 2015, according to the U.S. Centers for Medicare &
Medicaid Services (CMS) Banner-University Medical Center Tucson, Carondelet St. Josephs
Hospital and Tucson Medical Center were in the worst-performing 25 percent of hospitals
nationwide on a matrix of hospital-acquired conditions
(Azhha, 2014); (Innes, 2015)
Training was provided to 64% of hospitals on aseptic technique and CAUTI prevention
at time of initial nursing hire
Only 47% annually validated competency of indwelling catheter insertion
28% of respondents reported having no CAUTI prevention policy at all
Promoting Indwelling Urinary Catheter (IUC) tags: Tags use went from 4
as more education sessions occurred. Prevalence of CAUTIs went from 1
one year
Clinical Nurse Specialist and physician on team to assess urinary catheter utilization: It
was found effective to address misinformation about use at meetings and on the
clinical units
CAUTI education fair: Reduced rates of CAUTI from 4.71 to 1.29 per 1000 patient device
days. This fair increases the understanding and adherence to EBP surrounding CAUTI
prevention. In-service education was implemented every year to reinforce EBP
Strengths of Articles
Limitations of Articles
Based on the findings from the studies, we suggest that the hospital provides
a supplemental nursing education event annually to maintain competency of
nurses in the management of urinary catheters
This education event will include specific education on:
How to use the Bladder Bundle protocol, including improvement to the bundle system
The purpose of indwelling catheters and consequences of inappropriate use
The importance of protocol compliance in an engaging way
How to use tools and qualifications to determine when a catheter should be removed
Implementation
When: Bi-annual education (January and July), Everyone attends one hour
before or after their shift
Where: conference room within the hospital
How: Nurse educators will organize prior to the education fair and base
education material off of best evidence based practice (CAUTI bundle). Nurse
educators will be present at each booth of fair and present information to
the nurses, a quiz will be implemented directly after completion of the
education session to evaluate competency
Application
Timeline
-
Cost Analysis
Average hourly wage per nurse X # of nurses employed X 1 hr = total cost per session
According to the Bureau of Labor Statistics (2012), the average nursing hourly wage in Arizona is
$34.78.
Hypothetically, if there were 342 acute care nurse being educated, the total hospital cost would be:
$34.78 X 342 nurses X 1 hr = $11,894.76 per education session
There is no data regarding what it has cost other facilities to implement this EBP because no other
facilities have implemented this exact EBP.
As previously stated, one CAUTI costs an extra $1,000 per patient. Therefore, in the reduction of
just 24 CAUTIs the hospital would have made their money back. (*the 24 is based on the
hypothetical hospital cost per year*)
Nurse educators will not be included in the cost analysis because nurse education is included
within their job.
Risk vs benefit
Risks
The education requires the staff to set aside separate time to have urinary catheter education reinforced,
which can result in negative staff attitudes.
Staff does not comply with the education even after receiving it.
Staff fails the mandatory quiz after the education
Having too many qualifications for the use of a urinary catheter to reduce CAUTIs could prevent patients
who could benefit from the use of a urinary catheter from receiving proper care.
Benefits
The increased education would result in improved confidence of nurses when caring for patients with
indwelling catheters and making decisions related to indwelling catheters.
Reduces the long-term costs to the hospitals by preventing CAUTIs.
Reduces the length of time patients have an indwelling catheter which can be an uncomfortable
experience.
Reduces the cost for patients by preventing treatment costs of CAUTIs and lowering length of stay.
Evaluation of Intervention
1. Estimate CAUTI rates prior to implementation of education intervention
2. Follow up staff education with a quiz on CAUTI prevention protocol. After
training sessions are complete, examine quiz scores for competency
3. Six months following education intervention, administer a survey to
ascertain if nurses felt that they were more aware of following catheter care
protocols, as compared to before the education intervention was
implemented.
4. Compare statistics of how many CAUTIs occurred since educational
program (CAUTI fair)
Summary
Occurs when germs, usually bacteria, enter the urinary tract via urinary catheter and cause infection.
Description of Issue:
Indwelling catheters are inserted in between 25-33% of patients admitted to the hospital
Supportive Studies:
Main points:
Summary Continued
Summary Continued
Risk
Non-compliance
Staff satisfaction
Benefit
Reduce rates of CAUTI saving lives, complications, and money
?????
References
Arizona Hospital and Healthcare Association. (2014). Hospitals Seek Reduction in Catheter-Associated Urinary Tract Infections, 2014. Retrieved from http://www.azhha .org/wpcontent/ uploads/2014/11/ AzHHA
_Announces _Statewide_Patient_Care_Initiative
Bureau of Labor Statistics (2012). Occupational employment and wages, May 2011. Occupational Employment Statistics. Retrieved from http://www.bls.gov/oes/2011/may/oes291111.htm
CDC. (2009). Guideline for prevention of catheter-associated urinary tract infections, 2009. Retrieved from http://www.cdc.gov/hicpac/cauti/005_background.html
Dols, J.D., White, S.K., Timmons, A.L., Bush, M., Tripp, J., Childers, A.K., Mathers, N., Tobias, M.M. (2016). A Unique Approach to Dissemination of Evidence-Based Protocols: A Successful CAUTI Reduction
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Kennedy, E.H., Greene, M.T., Saint, S. (2013). Estimating hospital costs of catheter-associated urinary tract infection. Journal of Hospital Medicine, 8(9), 519-522. doi: 10.1002/jhm.2079.
Krein, S. L., Kowalski, C. P., Harrod, M., Forman, J., & Saint, S. (2013). Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA internal medicine, 173(10), 881-886.
Mori, C. C. (2014). A-voiding Catastrophe: implementing a nurse-driven protocol. Medsurg nursing, 23(1), 15-21. Retrieved from
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Purvis, S., Gion, T., Kennedy, G., Rees, S., Safdar, N., VanDenbergh, S., and Weber, J. (2014). Catheter-associated urinary tract infection: A successful prevention effort employing a multipronged initiative at an
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Saint, S., Greene, T., Kowalski, C., Watson, S., Hofer, T., and Krein, S. (2013). Preventing catheter- associated urinary tract infection in the United States. Jama Internal Medicine 173(10), 874-879. doi:
doi:10.1001/jamainternmed.2013.101
Yoon, B., McIntosh, S., Rodriguez, L., Holley, A., Faselis, C., and Liappis, A. (2013). Changing behavior among nurses to track indwelling urinary catheters in hospitalized patients. Interdisciplinary Perspectives
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