Implementation of A Nurse-Driven Educational Intervention for Prompt Removal of Urinary Catheters in the Neuro ICU

Background: Catheter-associated urinary tract infections (CAUTIs) are the most prevalent, yet preventable hospital acquired infections that are associated with adverse outcomes. CAUTIs have been linked to increased morbidity and mortality; increased healthcare cost, and extended hospital stays. Patients in the neurological intensive care units are at higher risk of acquiring CAUTIs due to their complex conditions requiring extended hospital stay and prolonged use of an indwelling urinary catheter. Purpose: The purpose of this quality improvement project was to implement a unit-wide nurse-driven educational intervention using recommended guidelines to improve best practices related to prompt removal of the indwelling urinary catheter. Methods: A quasi-experimental design was used to test the impact of nurse-driven educational intervention on practices related to prompt removal of the urinary catheter in the neuroscience intensive care unit. Records of patients admitted between August 1st 2016 and October 30th, 2016, were randomly reviewed retrospectively. Staff was educated on the importance of adherence to unit CAUTI bundle with emphasis on prompt removal practices. A 3-month post implementation chart review was conducted for comparison with pre-intervention data. Results: Mean duration of time to urinary catheter removal post order for removal (n = 54 pre-intervention, n=54 post intervention) decreased from 241.26 minutes to 104.07 minutes. Although not statistically significant, the mean rate of CAUTIs decreased from 5.8 to 1.5 per 1,000 catheter days. Catheter reinsertion rates increased from 3.1 to 4.6 percent. Conclusion: Nurse-driven educational intervention led to a decrease in time to urinary catheter removal. Based on these findings, emphasis should be placed on decreasing the duration of catheterization which is the single most important risk factor for CAUTI particularly in at risk group such as patient with neurological injuries who require vigilant monitoring to prevent CAUTIs.Doctor of Nursing Practic