A Bundle-Based Approach to Prevent Catheter-Associated Urinary Tract Infections in the Intensive Care Unit.

Catheter-associated urinary tract infections are the second most common health care-associated infections, occurring most frequently in intensive care units. These infections negatively affect patient outcomes and health care costs.

The targeted institution for this improvement project reported 13 catheter-associated urinary tract infections in 2018, exceeding the hospital's benchmark of 4 or fewer such events annually. Six of the events occurred in the intensive care unit. Project objectives included a 30% reduction in reported catheter-associated urinary tract infections, 20% reduction in urinary catheter days, and 75% compliance rating in catheter-related documentation in the intensive care unit during the intervention phase.

This project used a pre-post design over 2 consecutive 4-month periods. The targeted population was critically ill patients aged 18 and older who were admitted to the intensive care unit. A set of bundled interventions was implemented, including staff education, an electronic daily checklist, and a nurse-driven removal protocol for indwelling urinary catheters. Data were analyzed using mixed statistics, including independent samples t tests and Fisher exact tests.

No catheter-associated urinary tract infections were reported during the intervention period, reducing the rate by 1.33 per 1000 catheter days. There was a 10.5% increase in catheter days, which was not statistically significant (P = .12). Documentation compliance increased significantly from 50.0% before to 83.3% during the intervention (P = .01).

This bundled approach shows promise for reducing catheter-associated urinary tract infections in critical care settings. The concept could be adapted for other health care-associated infections.

Critical care nurse. 2021 Apr 01 [Epub]

Holly N Shadle, Valerie Sabol, Amanda Smith, Heather Stafford, Julie A Thompson, Margaret Bowers

Holly N. Shadle is a nurse practitioner, Neurosurgery Department, Neuroscience Center, UPMC Susquehanna, Williamsport, Pennsylvania., Valerie Sabol is a professor and chair, Division of Healthcare in Adult Populations, Duke University School of Nursing., Amanda Smith is a clinical education specialist, Intensive Care Unit, UPMC Susquehanna., Heather Stafford is Director of Nursing Education and Director of Infection Prevention and Control, Wound Center, Infusion Center, and Diabetes Nutrition Care Center, UPMC Susquehanna., Julie A. Thompson is a clinical research associate and statistical consultant, Duke University School of Nursing., Margaret Bowers is an associate professor and lead faculty cardiovascular specialty, Duke University School of Nursing.

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