Proper Maintenance and Routine Evaluation of Catheter Necessity

QI CAUTI Scenario

Catheter-acquired urinary tract infections (CAUTI) are one of the most prevalent hospital-acquired infections adding to morbidity and mortality among patients. The most common causes of CAUTI include extended period of catheter use and poor catheter care (Rubi et al., 2022). To address this issue, a QI initiative was developed and implemented by a team of nurses and doctors using the Plan-Do-Study-Act (PDSA) cycle. The main goal was to reduce CAUTI rates in the ICU by 25% within six months, with the ultimate goal being to eliminate CAUTI altogether.

Plan Phase

The team collaborated on coming up with a plan consisting of guidelines for when catheter insertion is necessary, options for condom catheters and PureWick devices; and maintenance—daily review of whether there is still need for the catheter; hand hygiene; proper positioning (below the bladder level, off the floor), regular evacuation, and aseptic techniques for sampling at the port). These guidelines were based on best practices (Lim, 2023).

Do Phase

The approved protocols and care bundles were implemented, and all ICU staff members took part in training on the new procedures. Training helped with making sure everyone knew and understood the new protocols and the need to follow them.

Study Phase

An infection preventionist conducted daily rounds during the first two weeks post-implementation to monitor compliance and address any questions the staff had. Compliance with the new insertion and maintenance protocols rose from 55% to 100%. The impact of these changes was reflected in the monthly CAUTI rates, which decreased from 7.6 infections per 1,000 device days to 3.9 infections per 1,000 device days.

Act Phase

Despite the notable improvement, the team saw that there was need for more interventions if the ultimate goal of zero CAUTI was to be achieved. The data and the feedback received from the initial QI phase indicated that there could still be more evidence-based ways to address the CAUTI problem. Thus, for the next PDSA cycle, the following steps are recommended: first, improve staff education and training but holding continuous education sessions and hands-on workshops to drill it into staff that these protocols are serious and necessary and also to keep staff updated on best practices. Second, there should be a dedicated team of nurses who will conduct daily reviews of reviews regarding catheter necessity and to also make sure that protocols for maintenance of catheters are being followed. Third, there needs to be a monitoring measure in place, such as alerts in electronic health records, so that staff are reminded to conduct catheter reviews and adhere to care protocols. Fourth recommendation is to educate the patient and the family about the risks associated with catheters and the importance of reporting any discomfort or issues with catheter care. Removing ignorance is good risk prevention (Lim, 2023). Fifth, there should be a process or channel for staff to report catheter issues (Parker et al., 2020). Following upon this, there should be regular audits of compliance with feedback given to nurses.