Prevention of

Catheter-
Associated Urinary
Tract Infection
A PDSA Cycle Approach to Reduce
Hospital-Associated Infections

Presented By:
University of Arizona BSN-IH Students
Diana Garcia, Caroline Manrubia, Ashley Pena, & Alexis Watson
Opening Mindful Moment
 Objectives

Case Study Concept Connections

1 Meet our patient and

learn the situation
4 CAUTI Prevention related to
integrative nursing and
health care issues

Terms & Definitions Model for Improvement

2 Introduction to
important concepts
5 How to implement improved
CAUTI rates in hospitals using
the PDSA cycle

Literature Review Summary & Reflection

3 Background significance
and synthesis of literature
6 What we’ve learned and how
we’d change our PDSA cycle
A Case Study of Whitney Ross
Partnering To Heal1

A patient down the hall has Whitney eventually

MRSA and through a becomes septic and
series of missteps, MRSA dies in the ICU
is introduced to Whitney

Whitney is in post-op Whitney begins to show

after an appendectomy signs of infection, but due
and receives a new IV to poor communication, the
infection goes untreated
 Terms and Definitions
HAI2 Healthcare-Associated Infection
Refers to infections that were obtained from a healthcare related intervention
including IV’s, catheters, surgical sites, and ventilators.

CAUTI3 Catheter-Associated Urinary Tract Infection

An infection of the urinary tract that was obtained due to the presence
of an indwelling urinary catheter.
4 phases of a QI Innovation-Pilot-Implementation-Spread
project4
Run Chart5 Data plotted on a graph to clearly demonstrate a change over time.

Common Variation that is inherent to the system, due to regular, natural or

Variation5 ordinary causes, affects all the outcomes of a process.
Special Cause Not inherent to the design process, due to irregular or unnatural causes, results in an
Variation5 unstable process that is not predictable, also known as non-random or assignable variation.
Background &
Significance
 Background

HAI Rates6 CAUTI Rates7 CAUTI Prevention8

On any given day, about 1 in Among UTIs acquired in the Continuing education on hand
31 hospital patients has at hospital, approximately 75% hygiene for nurses showed a
least one healthcare- are associated with a urinary reduction in CAUTI Rates
associated infection catheter.
 Literature Synthesis
Hand Hygiene + CAUTI

Increased hand hygiene due to covid,

Patient Centered Care
decreased rates of HAI overall.9

Hand Hygiene is one of the main ways Lack of standardized procedures is

that CAUTI is prevented.10 a barrier for HCP to include
patients in catheter care.12

Patients and caregivers who

practiced hand hygiene had fewer
Continuing Education
rates of CAUTI.8
Sterile technique compliance falls
within just one month of training.11 Educated patients and caregivers
decreased rates of CAUTI.13
Educating patients and caregivers on
hand hygiene helps to reduce CAUTI.12
 Making the Connection
● Safety issue:
○ Diagnostic error
● Potential errors & compromised quality
○ Ex: lack of adherence to newborn
jaundice protocol14
● Errors in practice of CAUTIs
○ Importance of protocols
○ Stress continuing education/training

Eisenberg, M. (Director). (2019). To Err is Human [Video file]. Gravitas Ventures.

Retrieved August 29, 2021, from Kanopy.
Concept Map + Integrative Nursing
 Patient-Centered Concept Map

In CAUTIs, potential for error and Integrative Nursing Principle Applications:

compromised quality…
○ Integrative nursing principle #1: human
● Structures beings are whole systems inseparable
● Processes from their environments15
○ Nursing team part of the system in
● Predicted outcomes
patient care
Potential malfunction and safety concerns:
● Integrative nursing principle #6: focus on the
● Training health and well being of caregivers15
● Protocols→ hygiene
○ Provider accountability and reducing HAI
events to improve care
Selected topic: Prevention of CAUTIs via hand
hygiene training and compliance
 Patient & Informatics
Complex Adaptive Systems (CAS)

“Systems within systems” When not

functioning optimally:
● Patient’s health as ● Poor connections within and
a system
between systems
● Maintain safety
and quality ● Patient risk for suboptimal safety
and quality of care
 Health Care Issues

Safety Issues:
- Patient infection risk related to poor training on hand hygiene
- Poor adherence to protocols for sterile technique
INP#1: human beings are whole systems inseparable from their environments 15
INP#6: focus on wellbeing of caregivers as well as those they serve 15
QI Project: Risk of patient infection related to poor training on hand hygiene
Rational: Decrease patient CAUTIs risk by implementing rigorous hand hygiene through
supplemental sterile glove training
 How to Improve with the
Model for Improvement (MFI)
Model for Improvement
Overview

Aim Measure Change

How will we know this What changes can we make
What are we trying
change is an that will result in
to accomplish?16
improvement?16 improvement?16
 How will the study
PLAN be conducted?

What can we ACT

do next?
PDSA
Cycle DO What are the
expected
results?
STUDY
How do the results
compare to the
predictions?
 CAUTI Prevention via Increased Hand
Hygiene Education for Nurses

Objectives:

What do we want to learn from this PDSA cycle?

● Learn the effects of increasing hand hygiene on
CAUTIs.
What question do we intend to answer?
● How do nurses describe their experience with the
education program; what barriers, facilitators, and
recommendations are offered?
● Does providing a nurse sterile glove training program
affect CAUTI rates?
Healthcare issue recommended
for Improvement:
Catheter Associated Urinary Tract Infections
(CAUTIs) are common healthcare associated
infections (HAIs) that can be prevented in part by
implementing rigorous hand hygiene.
PDSA – Plan the Test of Change

What change will we test? Who will perform the test?

New hand hygiene training and Med/surg nursing staff at Banner

compliance program Baywood

Where will the testing When will the testing

take place? take place?
Banner Baywood, Med/surg October 1st - October 24 st
department in Mesa, AZ
 PDSA – Plan the Test of Change
Data Collection Plan
Key processes are we
How will the data collection
seeking to improve in this
take place?
PDSA cycle?
Training surveys will be completed by
Hand hygiene and sterile gloving
nurses and any confirmed CAUTI infections
procedure while lowering CAUTI rates
will be reported to unit manager
What
qualitative/quantitative
data are we collecting? Who will analyze the data
and share the findings?
Nurses’ experience with hand Quality improvement team
hygiene and sterile gloving training members will analyze the results
and the number of CAUTI’s after and report findings to director of
training during the month of October nursing and unit manager

Predictions?
 PDSA – Do

Expected qualitative results Expected quantitative results

We hope to see increased levels confidence By the end of the month, we
amongst nurses when inserting, removing, and hope to see a reduction of
maintaining proper catheter care after hand incidences of CAUTI’s
hygiene and sterile gloving training
Run Chart
 Run Chart Analysis
Run Chart Component What that component tells us Absent or Present in our run
chart (if present, how
many?)

Shift(s) A shift is either 8 or more points Absent

consecutively above or below the
median line.17
Trend(s) A trend is 6 or more consecutive Absent
points on the chart that either all go
upwards or all go downwards.17
Number of Run(s) A run is defined as a series of points 10 Key findings
(if any, indicate too on one side of the median.17 ● Are the run chart
many or too few status)
results signaling that
change is occurring?
○ No17
Astronomical point(s) An astronomical data point is a data Absent ● Why or why not?
point that is “out of the norm” from
the rest of the data points and can
○ No signals of real
be seen on its own within the chart. change are
17
occuring
 PDSA – Study

Prediction Theoretical Finding

Providing a sterile glove training program for nurses the Nurses were proficient in sterile gloving practices
CAUTI rates will decrease. throughout the 30 day test period and ultimately resulted in
fewer new cases of CAUTI.

The nurses will describe their experience with the training As the 30 days went on, the nurses felt more confident in
program as beneficial. themselves completing their sterile gloving correctly and
felt confident educating their patients on good practice and
why it helps prevent infection.

Summary
● Yes, the change will lead to improvement
● Sterile gloving will be more heavily focused on
 PDSA - Act

Recommendation informed by qualitative data

Nurse proficiency and confidence, test more subjects

Recommendation informed by quantitative data

Add a different unit within the hospital every 30 days and
see if the numbers are still decreasing
 Summary, Questions
to Class,
Reflections, and Pearls
of Wisdom
 Summary
Overall Thoughts
IN principles considered
● Challenging
● INP #1 and #615
● Eye-opening

● Informational
 Discussion Questions

● Is it more beneficial to continue

training on hand hygiene/sterile
gloving or should furthering
education be focused upon a
different aspect to reduce CAUTI?

● Should patient education and the

relationship between the patient and
the nurse be focused upon
prevention of infection techniques or
managing infection? Keeping IN#4 in
mind.15
 Reflection

Supporting Facilitators Barriers

● PDSA Worksheet ● How to implement integrative
approaches into the solution
● INP # 115
15 ● Proposed method/solution
● INP #6
 Pearls of Wisdom

Improving the Project: Integrative Nursing Principles:

● Space out due dates of project steps ● Balance medicinal and integrative approaches

● Multiple solutions narrowed down to one ● Start out with principles in mind
Closing Mindful Moment
 References
1. Stanford Childrens. (2021, July 21). Partnering to heal. YouTube. Retrieved October 23, 2021, from
https://www.youtube.com/watch?v=LKgfJ1aQIro&t=294s.
2. Centers for Disease Control and Prevention. (2014, March 26). Types of healthcare-associated infections. Centers for
Disease Control and Prevention. Retrieved October 23, 2021, from https://www.cdc.gov/hai/infectiontypes.html.
3. Centers for Disease Control and Prevention. (2015, November 5). CAUTI background. Centers for Disease Control
and Prevention. Retrieved October 23, 2021, from
https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html.
4. Advanced Solutions International, I. (n.d.).QI 105: Leading Quality Improvement. Retrieved October 23, 2021, from
https://education.ihi.org/topclass/topclass.do?CnTxT-200468562-contentSetup-tc_student_id=200468562-item.
5. Advanced Solutions International, I. (n.d.).Changes for Improvement. Retrieved October 23, 2021, from
https://education.ihi.org/topclass/topclass.do?CnTxT-212639639-contentSetup-tc_student_id=212639639-item.
6. Centers for Disease Control and Prevention. (2018, October 5). Hai Data. Centers for Disease Control and Prevention.
Retrieved October 23, 2021, from https://www.cdc.gov/hai/data/index.html.
7. Centers for Disease Control and Prevention. (2015, October 16). Catheter-associated urinary tract infections (CAUTI).
Centers for Disease Control and Prevention. Retrieved October 23, 2021, from https://www.cdc.gov/hai/ca_uti/uti.html.
8. Gad, M. H., & AbdelAziz, H. (2021). Catheter-associated urinary tract infections in the adult patient group: A qualitative
systematic review on the adopted preventative and interventional protocols from the literature. Cureus.
https://doi.org/10.7759/cureus.16284
9. Roshan, R., Feroz, A. S., Rafique, Z., & Virani, N. (2020). Rigorous hand hygiene practices among health care workers reduce
hospital-associated infections during the COVID-19 pandemic. Journal of Primary Care & Community Health, 11.
https://doi.org/10.1177/2150132720943331
 References
10. Roshan, R., Feroz, A. S., Rafique, Z., & Virani, N. (2020). Rigorous hand hygiene practices among health care workers
reduce hospital-associated infections during the COVID-19 pandemic. Journal of Primary Care & Community Health, 11.
https://doi.org/10.1177/2150132720943331
11. Mutlu, E. Y., & Senturan, L. (2017). Effects of hickman catheter care training on practices of nurses. International Journal
of Caring Sciences.
12. MacEwan, S. R., Beal, E. W., Gaughan, A. A., Sieck, C., & McAlearney, A. S. (2021). Perspectives of hospital leaders
and staff on patient education for the prevention of healthcare-associated infections. Infection Control & Hospital
Epidemiology, 1–6. https://doi.org/10.1017/ice.2021.271
13. Mangal, S., Carter, E., & Arcia, A. (2021). Developing an educational resource for parents on pediatric
catheter-associated urinary tract infection (CAUTI) prevention. American Journal of Infection Control.
https://doi.org/10.1016/j.ajic.2021.09.006
14. Eisenberg, M. (Director). (2019). To Err is Human [Video file]. Gravitas Ventures. Retrieved August 29, 2021, from
Kanopy.
15.University of Minnesota. (2021). Principles of integrative nursing. Center for Spirituality & Healing.
https://www.csh.umn.edu/education/focus-areas/integrative-nursing/principles-integrative-nursing
16. Institute for Health Improvement. (n.d.). Science of improvement: How to improve.
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx
17. Institute for Healthcare Improvement. (2020). QI 104: Interpreting data: Run charts, control charts, and other
measurement tools. https://education.ihi.org/topclass/searchCatalog.do?catId=0
 Images Used

● Slide #2: https://www.freepik.com/

● Slide #9:
https://www.nap.edu/catalog/9728/to-err-is-human-building-a-safer-he
alth-system

● Slide #31: http://www.thevailvoice.com/mini-mindful-moments/

● clip art images: https://slidesgo.com/