A Nurse Driven Foley Catheter Removal Protocol Proves Clinically Effective to Reduce the Incidents of Catheter Related Urinary Tract Infections

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Issue

The Centers for Disease Control (CDC), attributes catheter associated urinary tract infections (CAUTIs) to 30% of the infections in acute care hospitals. CAUTI causes major complications resulting in longer hospital stays, increased healthcare costs and mortality. This hospital implemented a nurse driven urinary catheter removal protocol the first in Kentucky to reduce urinary catheter associated infections in the intensive care units and general floor units. The Infection Control Team, along

Project

In 2011 the hospital infection prevention team implemented an evidence based nurse driven urinary catheter removal protocol that identified indicators for urinary catheter insertion, maintenance, and discontinuation. The protocol empowered nurses to communicate with physicians to determine the medical necessity for the catheter, and remove the urinary catheter within 24 hours unless contraindicated (Figure 1). The Nurse Epidemiologist received electronic reports of all urinary catheters in the

Results

Data collected prior to the nurse driven protocol demonstrated physicians ordered Foley catheters for inappropriate reasons (Graph 1). Physicians misunderstood criteria for catheter use for patients requiring comfort care at the end of life. Nurse educators and the Infection Control (IC) team provided educational sessions to staff about appropriate urinary catheter uses. The IC team rounded reinforcing proper catheter use. After implementation of the protocol, the facility found a decrease in

Lesson Learned

Medical providers now look at catheter use seriously. Many alternatives to a catheter exist such as a bedpan, bedside commode, in and out catheterization of the patient, and adult diapers. Nurses' exhibit empowerment to remove the catheter when no longer needed.

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