A program to stop catheter-associated urinary tract infections (CAUTIs) at one neurosurgical intensive care unit (ICU) has been a resounding success. By mid-May, the unit hadn't seen an infection in nearly 8 months.

Before the program was implemented, there was typically at least one infection a month in the ICU at the North Shore University Hospital in Manhasset, New York. This was the highest rate in the entire North Shore–LIJ Health System, reported Sherley John, RN, one of the leaders of the anti-CAUTI team.

The neuro-ICU population, 45% of which is stroke patients, is particularly challenging, said Merin Thomas, RN, another anti-CAUTI team leader.

"They have neurogenic bladder, they tend to retain urine, and they are on hypertonic solutions," she told Medscape Medical News. "From 2011 onward, we could tell that CAUTI, of all the quality data, was screaming out that it needed help."

The team described their anti-CAUTI program at the American Association of Critical-Care Nurses (AACN) 2015 National Teaching Institute and Critical Care Exposition in San Diego.

The strategy involved clinical and cultural changes. First, the team developed clear protocols related to the earlier removal of catheters. To reduce the likelihood of burnout, assistants were hired to help the nurses with the resulting incontinence.

Visual cues were introduced to promote the program. On "Foley Fridays," nurses wore T-shirts emblazoned with "Nurses Stopping CAUTI Usage (NSCU)." Soon, physicians and staff in other ICUs were wearing the T-shirts and answering questions from staff, patients, and families who saw them in the hallways. They also created a smiling sunflower at the nurses' station, to which a leaf was added for every CAUTI-free day. At the time of presentation, the sunflower was adorned with 236 leaves.

We could tell that CAUTI, of all the quality data, was screaming out that it needed help.

Over the course of a year, the team reduced the infection rate by 26% and reduced device days by 31%. One infection costs about $6900 to treat, so cost savings were substantial.

John said she was skeptical that early removal could work. "It was a big cultural change," she explained. Adding assistants was a big help in making the transition, and designating "champions" who could explain the project was key to staff buy-in.

Nurses at the North Shore Hospital were involved in the 2014 AACN Clinical Scene Investigator program, in which teams of four nurses tackled the problem they deemed most important, with AACN support and guidance. Three of the seven teams at New York Hospitals focused on CAUTI.

This work by the team at the North Shore Hospital has important lessons for all hospitals, said Marian Altman, RN, a clinical practice specialist for the AACN.

CAUTIs are the most common type of hospital-associated infection, and about one-quarter of all in-hospital patients have a urinary catheter inserted in their bladder, typically for a short time, she told Medscape Medical News.

"Much of the time it doesn't have an appropriate indication; it's just part of a protocol," Altman explained. But every day that a patient has the catheter increases the risk for infection, and even death. According to the Centers for Disease Control and Prevention, 13,000 patients die because of CAUTIs each year.

Efforts at the North Shore Hospital are part of a nationwide push to eradicate CAUTIs. Establishing better guidelines within hospitals is an important first step.

"First off, you want to identify the patients who absolutely need a Foley," Altman said. "Then you want to have criteria to take it out."

This program has implications beyond the reduction of infections; it bolstered the confidence of nurses when interpreting data and led to an innovation that has now spread across North Shore.

"These nurses have become change agents throughout their organization. They translated their project not just for their unit but also for the whole hospital," Altman said.

Ms John, Ms Thomas, and Ms Altman have disclosed no relevant financial relationships.

American Association of Critical-Care Nurses (AACN) 2015 National Teaching Institute and Critical Care Exposition. Presented May 21, 2015.


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