2/11/20 Johns Hopkins Nursing Center for Evidence-based Practice 1

http://www.hopkinsmedicine.org/institute_nursing/ebp/
Problem

• In our unit, the number of catheter associated urinary tract infections

(CAUSTI) is increasing thus impacting the wellbeing of patients, their
length of stay in hospital, and costs of seeking medication. The current
urinary maintenance bundle does not give nurses the authority to
remove urinary catheter from patients when there are no signs of
CAUSTI.
Question

• Does applying HOUDINI protocol for patients with urinary catheters

increase the autonomy of nurses in making decisions for removal of
urinary catheter and subsequently reduce CAUSTI rate?
Evidence Level and Quality

Level of Evidence Number of Articles Overall Quality

Level I 6 High quality

Level II 2 Good quality

Level III 1 Low quality

Level IV

Level V
 Evidence Synthesis

• The use of urinary catheters is associated with increased cases

of CAUSTI.
• Nurse-driven protocols have proven to be effective in reducing
the use of indwelling catheters.
• HOUDINI nurse-driven protocols make physicians and nurses
aware of new standards and tools which reduce insertion of
urinary catheters in the body thus giving them the autonomy to
make medical decisions.
• The HOUDINI nurse-driven protocol is an acronym that helps
nurses remember removing catheters from the body of patients
based on various indications.
• The HOUDINI protocol has been important in reducing cases of
CAUSTIS in the hospital setting.
Recommendations

• I recommend my organization to adopt and implement the use of the

HOUDINI nurse-driven protocol for patients with indwelling urinary
catheters.
• I also recommend reducing the unnecessary use of urinary catheters
where other alternative techniques can be used.
Translation

• The HOUDINI nursing-driven protocol is significant in reducing CAUSTI

rates in the hospital setting.
• Implementing this protocol in the hospital will give nurses the autonomy
to make timely informed decisions.

Next Steps
• Inquire about the HOUDINI protocol
• Learn more about HOUDINI
• Practice the protocol in real life situations