Portal de Periódicos da CAPES

Reduction in Catheter Associated Urinary Infections in a Neurological and Neurosurgical Population Through A Sustained Focus on Catheter Appropriateness

2015; Elsevier BV; Volume: 43; Issue: 6 Linguagem: Inglês

10.1016/j.ajic.2015.04.123

1527-3296

Kimberly Schelling, Janet Palamone, Kathryn Thomas, Angelita Oquendo, Christina Silkaitis, Teresa Zembower, Maureen Slade,

Urinary Bladder and Prostate Research

Traditional methods to reduce Catheter Associated Urinary Tract Infection (CAUTI) addresses clinical management of the catheter, but lacks focus on necessity of indwelling urinary catheters (IUC). In any one patient’s care, indications for IUC may vary widely throughout the duration of device. Though a nurse-driven catheter removal protocol has been implemented, a knowledge gap is identified regarding appropriate IUC indications and alternatives. The purpose of this project is to reduce CAUTI by increasing knowledge surrounding appropriate indications. A consensus was developed based on literature and expert opinion on appropriate indications for IUC. Through chart review and surveys, an analysis was performed to identify knowledge of indications. The units were selected for this project based on CAUTI rates. Interventions performed included: weekly chart audits for consistent documentation, education, data transparency, and real-time discussions regarding appropriate IUC indications. Outcome measures included documented IUC indications, percent of appropriate indications, catheter utilization, CAUTI rate, and Standardized Infection Ratio (SIR). During the 2-month baseline period, nursing documentation for IUC indication was consistent with guidelines in 25% of 21 records. In the 3 months following the intervention, this increased to 41%. Catheters present for an appropriate indication increased by 46% from baseline. Combined CAUTI rate for the two units decreased from 3.89 infections per 1000 catheter days at baseline to 0.87. The SIR for neurosurgery decreased from 1.13 to 0.49 and the SIR for the neurology unit decreased from 2.53 to 0. Catheter utilization for both units combined decreased from 0.22 to 0.16, a 29% reduction. Using a comprehensive intervention focused on appropriateness of the IUC, it is possible to decrease CAUTI and catheter utilization. Continued emphasis on critical thinking and removal of unnecessary catheters can successfully change the culture of the unit to create a safer environment for patients.