Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

Objectives: (1) Decrease use of indwelling urinary catheters.(2) Limit the number of overall catheter days.Design: Prospective cohort study. Population, Sample, Setting, and Years: Patients requiring indwelling urinary catheters admitted to general medical units at Yale-New Haven Hospital were included. Patients with chronic catheters were excluded. Data were collected in spring 2002 and repeated in spring 2003.Intervention and Outcome: A physician-nurse protocol was developed to allow physicians to select, via a computerized order-entry system, one the following options: (1) discontinue catheter, (2) maintain catheter for 48 hours, or (3) maintain chronic device. The protocol permits nurses to independently remove urinary catheters for patients meeting established criteria. Outcome measures included calculated device days (CDD), calculated infection rates (CIR), and device utilization ratio (DUR).Methods: During 53 consecutive days in 2002, all patients (n = 883) were assessed for occurrence, duration, and appropriateness of catheter use. Patients with catheters were assessed for infection. This procedure was repeated 1 year later postintervention (n = 894). Data were analyzed using descriptive and inferential statistics.Findings: Compared to baseline, there was a 51% reduction in catheter use post intervention (164 versus 81) among all four patient units. Although the outcome variables were not statistically significant, they were clinically significant. The CDD declined from 892 to 521 days, a 42% reduction, while the CIR decreased from 36 of 1000 to 19 of 1000 patient days (47% reduction). The DUR (device days/all patient days) fell from 16% to 10%. One unit demonstrated a statistically significant decrease in CIR (p < 0.05).Conclusions: Results of this study demonstrate that use of a collaborative practice model reduces indwelling urinary catheter use and risk for nosocomial urinary tract infections.Implications: This protocol will heighten clinicians' awareness of the appropriate use of catheters and parameters to guide decision-making regarding their removal.

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors’ baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

No abstract