Preventing catheter associated urinary tract infections: implementation of a nurse driven catheter removal protocol and education program

The purpose of this project is to reduce the catheter associated urinary tract infection rates (CAUTI) in a 209 bed acute care facility located in California’s central valley. Catheter associated urinary tract infections are responsible for up 380,000 infections, 9,000 deaths and $451million in health care costs per year in the United States. It is also estimated that up to 50% of urinary catheters are used unnecessarily. Nursing driven discontinuation protocols are an effective means of decreasing catheter days and subsequently decreasing CAUTI rates. Each day a catheter remains in place the risk for infection increased by 7%. The CAUTI rates for the project facility have been ranked as the fourth worst in the state of California. To promote CAUTI prevention an online education module is introduced. The education module includes proper techniques for catheter insertion and maintenance, patient education strategies and the directions for using the nursing driven catheter discontinuation protocol. The online module is mandatory paid training. Nurses must complete a learner pre-test, assessment, and post-module competency. Supplemental education is provided for all staff during rounds and staff meetings using simulation and case studies. Education has also been provided for physician staff during unit rounding, online forum and presentation at physician meetings. Future CAUTI prevention strategies to enhance prevention at this facility will include policies and education to improve emergency department catheter utilization, critical care catheter utilization and nursing assistant education.