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Prevent catheter UTIs with practical measures


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Strategies for increasing patient safety and improving your numbers

Catheters are ever-present in the hospital environment; according to a recent study in the Journal on Quality and Patient Safety, one in four patients receive a catheter, typically following surgery.

But with Medicare ceasing to pay for urinary tract infections (UTI) acquired during hospitalization under the new Centers for Medicare & Medicaid Services law set to take effect in October, educators and organizations as a whole are looking for ways to track catheter usage and reduce their facility’s infection rates.

This will help them provide quality care and avoid costly penalties. A report published in Clinical Infectious Diseases found that 56% of hospitals do not have a system for monitoring which patients have urinary catheters and 74% do not monitor catheter duration.

As hospitals focus on reducing their infection rates, designing systems and protocols to track these patients becomes paramount.

“UTIs are costly, and the significance of prevention is real,” says Teresa Eberhart, RN, BC, MSN, continuing nursing education coordinator for the North Shore-LIJ Institute for Nursing in New Hyde Park, NY. By having their nurses follow best practices and by strategically developing protocols, staff educators can save their patients from unnecessary infections—and save their hospital money.

“Getting everyone on board and working toward a protocol can increase the standard of care,” says Joan M. Lorenz, MSN, APRN, BC, clinical specialist of nursing education for Bay Pines (FL) VA Healthcare System. “Educators have the job of revising the education process.”

One educator’s findings

When Eberhart’s student Lorraine Giacopelli looked at decreasing catheter UTIs in the critical care area of Franklin Hospital in Valley Stream, NY, the facility’s results were extremely noteworthy.

“Over six months in 2006, we went through the significance of taking certain steps to prevent UTIs,” says Eberhart.

The steps they took were:

Investing in a catheter stabilization device. This device limits the in-and-out motion of a catheter, preventing bacteria from moving into the patient’s urethra. “We attribute a lot of the prevention directly to this device,” says Eberhart.

Tracking the length of time a patient has had a catheter. Researchers in an Alabama Nurse article reported that “the longer a hospitalized patient has an indwelling urinary catheter, the greater the risk of developing a urinary tract infection.”

Encouraging early discontinuation of catheters. A patient’s need for a catheter should be reassessed every 48 hours. The Alabama Nurse researchers recommended instituting written assessment reminders to physicians.

Taking these measures over the six-month period decreased the hospital’s catheter UTI rates from 3.11% to 0.52%, says Eberhart.

“People moved numbers,” she says. “It dramatically decreased the incidence of UTIs in critical care.”

Developing a protocol at your facility

When Bay Pines revised its urinary catheterization protocol in June 2007, one of the main steps it took was to provide more direction for nurses. “When the protocol was noted as needing to be revised, I pulled together staff nurses from every nursing service: acute care, ambulatory care, geriatric extended care, and mental healthcare,” says Lorenz.

This team, led by resident assessment coordinator Cynthia Adams, MSN, RN, NHA, helped to lead the hospital’s Standards of Care committee, which took the following steps in developing the new protocol:

1. Each of the four staff nurses reviewed literature to see what needed to be written in the protocol.

2. After acquiring evidence on UTI prevention, the committee worked together to revise the education process. “They had the job of saying how the protocol needed to be laid out and discussed evidence-based practice,” says Lorenz.

3. The protocol was edited and finalized by committee members.

Lorenz views the revised protocol as highly practical and an effective way of preventing catheter UTIs. “The most important thing is that we made the development of the protocol a team effort,” says Lorenz, adding that the more staff nurses you get involved in the process, the better. “You’re shooting yourself in the foot otherwise.”

References

“Written reminders can reduce the length of time patients have urinary catheters,” Alabama Nurse March–May 2006.

Saint, S. et al. (2005). “A reminder reduces urinary catheterization in hospitalized patients,” Journal on Quality and Patient Safety 31 (8): 455–462.

Saint, S. et al. (2008). “Preventing hospital-acquired urinary tract infection in the United States: A national study,” Clinical Infectious Diseases 46: 242–250.

Urinary catheterization protocol

Purpose: To outline the nursing management and responsibilities for patients with urinary catheters.

Supportive data: External incontinence devices and urinary catheterization provide for urinary drainage and to determine accurate measurements of urinary output. Urinary catheterization relieves acute or chronic urinary retention and provides an avenue for bladder irrigation and instillation of medications. Indwelling urinary catheter–associated infection represents the most common nosocomial infection in acute and other healthcare facilities. Strict sterile and aseptic techniques are used to minimize the risks of infection.

Distribution: All patient care areas where nursing care is delivered.

1. Assess inpatient at least once per eight-hour shift or at each outpatient encounter for:

a. Bladder distention, spasm, and/or complains of pain

(1) A bladder scanner may be used to assess urinary retentions.

(2)
If bladder distention is present, reposition patient and check tubing for kinks or clots, especially if there is a decrease in urinary output. Irrigation may be indicated.

b. Characteristics of urine

c. Urine leakage or bleeding around the urinary meatus or catheter insertion site

d. Skin condition under external incontinent devices or around urinary meatus or the indwelling catheter insertion sites

e.
Tubing and drainage bag are intact and patent; empty drainage bag at least once per eight-hour shift

f. Intake and output

2. Monitor:

a. Fluid and electrolyte balance

b. For any signs/symptoms of urinary tract infection

PATIENT/SIGNIFICANT-OTHER EDUCATION:

Obtain needed nursing education information for urinary catheterization, educate and print care notes for patient/significant other. Document patient education in the medical record, making sure what is printed is correct and appropriate for the individual.

APPROVAL:

Associate director for patient/nursing services Date

Distribution: All patient care areas where nursing care is delivered.