Running head: PREVENTING CAUTIS IN ACUTE CARE FACILITIES

Preventing CAUTIs in Acute Care Facilities

Melanie Goo
Kapiolani Community College, ADN Program
Spring 2013

PREVENTING CAUTIS IN ACUTE CARE FACILITIES

Catheter-associated urinary tract infections (CAUTIs), a common occurrence in many
health care facilities, can be avoided by using discretion and proper hygiene and technique to
prevent these incidences. More than 50,000 CAUTIs occur each year making them a costly
health care concern (Oman et al., 2012). This may be due to its unnecessary or prolonged use,
improper insertion and maintenance techniques, as well as misinformation of the nurse or doctor
that can lead to these conditions. Many health care professionals are trying to find ways to lower
these incidences to improve the quality of care, cost and stay of patients. They are attempting to
implement plans to educate and inform its employees on proper protocols and techniques to
prevent CAUTIs.
Oman et al. (2012) designed a non-experimental study to develop and implement nursedriven interventions to improve current conditions and ultimately decrease the incidence of
CAUTI. Putting best evidence into practice can significantly improve patient outcomes and
quality of care. This study was done at the University of Colorado Hospital on the general
surgery and pulmonary units on all patients, except those having urologic surgery, with
indwelling catheters. Interventions were done in 3 phases, each about 3 months long, using a
pre/post intervention design. Phase 1, conducted from January to March 2009, was used to
collect baseline data from the two medical/surgical units. During February and March (Part 1 of
Phase 2) house-wide interventions were put into place and data collection on the impact of those
interventions was done from April to June 2009 (Part 2 of Phase 2). These interventions included
revising hospital policy to include best evidence-based practice and education of these revisions
to all providers of care. Phase 3, August to October 2009, consisted of the unit-specific
interventions and the last data collection period. These included education sessions, increased

PREVENTING CAUTIS IN ACUTE CARE FACILITIES

availability of bedside commodes, a readily available bladder scanner, informational fliers posted
around the unit, charge nurse catheter care rounds and patient and family education.
To collect data, electronic medical records (EMR) were used. This allowed access to
identify patients using indwelling catheters, duration of catheterization and their length of stay.
CAUTI rates were monitored by the hospitals infection control nurse. Results indicated a
decrease in catheter duration and incidence of CAUTI. This also shortened a patients length of
stay and a significant annual cost savings for the hospital. Overall, providing educational
opportunities for nurses and other health care providers regarding urinary catheters, and making
supplies readily available on the units can help to reduce CAUTI rates in the hospital (Oman et
al., 2012).
Rothfeld and Stickley (2010) also designed a non-experimental study similar to the one
previously discussed. This study was aimed at reducing the use of indwelling catheters and
limiting them to patients with urinary tract obstruction, orders for hourly output measurements,
and skin breakdown or irritation in areas exposed to urine. The observation and telemetry units
were used for the purposes of this 7 month study. Interventions included education on adult
briefs and pads to nursing staff in place of the catheters and physician removal orders were
recommended unless indicated by the above criteria. Data of CAUTIs were collected by
infection prevention nurses. It showed a 42% decrease in catheter use and 57% decrease in
incidence of CAUTI during the intervention period (Rothfeld & Stickley, 2010). This study
showed that by reducing indwelling catheter use there could be a significant reduction in CAUTI
rates.
Another study, done by Gotelli et al. (2008), aimed at lowering the overall use of
indwelling catheters in hopes of reducing the rates of CAUTI. They did this by implementing a

PREVENTING CAUTIS IN ACUTE CARE FACILITIES

quality improvement project that managed unnecessary use of the devices. It allowed RNs to
assess the continued need for the catheters and discontinue them if criteria were not met without
a physicians order. This study was done at the University of North Carolina Healthcare,
Memorial Hospital in their acute are for the elderly unit and general medicine unit. Initial
baseline data was collected for one year and then interventions were put into place over a 5month period. Final data that was collected included the duration of the catheters and indications
for its use on each patient. It was found that the number of patients with indwelling catheters
dropped from 24% to 17 % and the majority of the 17% who had them met the criteria for its
continued use (Gotelli et al., 2008).
Other resources also emphasize the prevention of CAUTI with education and bestpractice nursing interventions. An education project was implemented at the University
Hospitals emergency department with the goal of informing nursing staff of the prevalence of
CAUTIs and proper insertion techniques. PowerPoint presentations, handouts, posters and
multiple-choice questionnaire were used (Parnell Burnett et al., 2010). This study showed that by
educating nursing staff CAUTI rates can decrease due to best-practice techniques. Similar to the
previous studies, this non-experimental study compares the before and after results of the
education.
Berman (2012) mentions catheter care and best-practices to prevent CAUTIs. Emphasis
is placed on prevention by following protocols for insertion and removal of indwelling catheters,
as well as recognizing potentially harmful situations that could cause problems for the patient.
Proper hygiene of the perineum and proper placement of the drainage bag to ensure no back flow
and obstructions was also mentioned. This type of evidence can be comparable to the previous
journal studies. It is strictly informational but was influenced by evidence-based practice.

PREVENTING CAUTIS IN ACUTE CARE FACILITIES

The underlying issue related to CAUTIs is its unnecessary use in acute care patients. Best
nursing practice, indicated by these resources would be to limit indwelling catheter use. All of
these studies seem to have the same idea that education is a key component. Educating health
care professionals on the availability of other resources to limit catheter use, such as bed side
commodes or using adult briefs and pads for incontinence instead can reduce its use and
ultimately CAUTI incidences. By setting guidelines or criteria to follow regarding who would be
a candidate for an indwelling catheter could be important in reducing its use. Those patients with
urinary tract obstructions, need hourly output measurements and/or have skin irritation in the
perineum area are eligible for these devices; all others should consider other alternatives to
reduce the risk or CAUTI. Education should also be focused on monitoring and maintenance of
indwelling catheters as well. They should be discontinued as soon as possible to decrease the
number of catheter days to reduce the risk of infections and proper cleaning techniques should be
directed towards all nursing staff.
Based on the evidence presented in these studies, the main goal is to reduce the use of
indwelling catheters to decrease the risk for CAUTIs. As an aspiring nurse, I would keep this
concept in mind when caring for my own patients. I would follow proper protocol implemented
at my place of employment to reduce unnecessary indwelling catheter use. Also, I would
evaluate the need for catheters on my patients and recommend discontinuing them if criteria are
not met. By being more aware of CAUTIs and its prevalence in acute care facilities, I can better
my practice as a registered nurse and provided quality care and a shortened hospital stay for my
patients.

PREVENTING CAUTIS IN ACUTE CARE FACILITIES

References
Berman, A., & Snyder, S. (2012). Kozier & Erbs fundamentals of nursing: concepts, processes
and practice, (9th ed.). Upper Saddle River, NJ: Pearson Education.
Gotelli, J., Merryman, P., Carr, C., McElveen, L., Epperson, C., & Bynum, D. (2008). A quality
improvement project to reduce the complications associated with indwelling urinary
catheters. Urologic Nursing, 28(6): 465-473.
Oman, K., Makic, M., Fink, R., Schraeder, N., Hulett, T., Keech, T., Wald, H. (2012). Nursedirected interventions to reduce catheter-associated urinary tract infections. American
Journal of Infection Control, 40(6): 548-553.
Parnell Burnett, K., Erikson, D., Hunt, A., Beaulieu, L., Bobo, P., Shute, P. (2010). Strategies to
prevent urinary tract infection from urinary catheter insertion in the emergency department.
Journal of Emergency Nursing, 36(6): 546-550.
Rothfeld, A., & Stickley, A. (2010). A program to limit urinary catheter use at an acute care
hospital. American Journal of Infection Control, 38(7): 568-571.