A Sunquest-Powered Practice Change to Reduce CAUTI Rates
Benjamin Anderson, Madison Brown, Alex Depew, Ajitha Poluri
Abstract
Background: CAUTI rates continue to be one of
the leading HAIs in the healthcare system.
Through our research and discussions with
clinical experts, we have found that a large
portion of CAUTIs are actually false positive
results stemming from issues with UA draws
being taken off of Foleys >3 days old.
Setting: St. Mary’s Hospital, a medium sized
nursing magnet hospital in Richmond, Virginia
Proposal: Our primary proposal is to implement
a Best Practice Alert (BPA) within Sunquest,
reminding nurses to ensure their practice
follows the hospital policy when collecting urine
analysis (UA) cultures.
Recommendation: We recommend that the
hospital leadership work with other Bon Secours
facilities to implement this change system wide
which will be necessary due to software version
compatibility issues.
Introduction and Description of the Issue
Macro Description: Catheter-associated urinary
tract infection (CAUTI) continue to rise overall
(American Nurses Association, (n.d.)) despite the
fact that they are up to 69% preventable (Centers
for Disease Control and Prevention, 2015).
Significant financial and human costs are incurred
treating these infections.
Micro Description: A number of units in St. Mary’s
have failed to meet the magnet mean for CAUTI
prevention. Nurses are extremely busy and
sometimes make judgement errors involving
catheter insertion, usage, UA sample collection and
patient hygiene to prevent infection. These errors
are all factors contributing to infection rates but
are difficult to control because of the nature of the
workload present in nursing today.
Bon Secours Memorial College of Nursing
Data and Analyis of the Issue
Mutability of bacteria is a problem as the rate of
mutations almost parallels the rate at which we use
antibiotics. Resistance to these antibiotics, and
prevalence of bacterial infections in a clinical setting
lead to a high risk of obtaining an infection in a
hospital. Studies have shown up to a 62% rate of
false positives for CAUTIs by pulling off Foleys older
than 7 days and up to 34% in >3 day old Foleys. This
data proves a need for an intervention in how we
draw urine cultures off of indwelling Foley catheters.
Root Cause
While a number of potential explanations were
considered, root cause analysis in collaboration
with clinical nursing specialists determined that
increased CAUTI rates at St. Mary’s Hospital are in
large part due to false-positive urine analysis
cultures taken off of Foleys that have been in
patients >3 days. This is due to biofilm formation
within the tubing of the catheter that will show up
on the UA but not necessarily be present inside the
patient.
Hypothesis: If CAUTI rates are related to
inappropriate UA collection, then a change in
specimen collection will prevent false positive
cultures and therefore we propose creating a BPA
pop-up in Sunquest for UA collection will help drive
the change practice and lower CAUTI rates in St.
Mary’s Hospital.
AIM - Proposed Solution
Our goal is a 20% reduction in CAUTI numbers
per 1,000 catheter days, within the treatment
population at St. Mary’s Hospital, by one year of
the intervention implementation.
Our primary intervention proposal is the
inclusion of a Best Practice Alert linked to UA
orders within Sunquest, reminding the nurse of
the policy that under most circumstances if a UA
needs to be drawn and the Foley has been in
place for longer than three days the Foley needs
to be replaced before the specimen is collected.
Logistics
● System-wide software version
compatibility
● Potential to increase alarm fatigue
Stakeholders
● Nurses
● Sunquest
● Administration
Potential costs
● Short training session on new
Sunquest pop-up
● Increased number of Foley kits used
Timeline
● One year from implementation with
ongoing quarterly review
Data Collection
● Quarterly CAUTI reports
Conclusion
Our idea was based on conversations with
clinical nurse specialists at St. Mary’s who had
found that in 100% of the last five instances of
CAUTI in the hospital for which there was a root
cause determined, that root cause was found to
be that a UA sample had been drawn off a Foley
which was in place for >72 hours. This
observation is supported by literature. Our
proposed solution is simple and easily
implemented with minimal costs involved. Best
Practice Alerts have proven effective at
improving clinical decision making in similar
instances (Bejjanki et al, 2018).
One drawback is that because the entire
ministry uses the same Sunquest system there is
no method for unrolling our proposal on a small
scale. We are hopeful an administrative solution
to this hurdle will be possible.
References
American Nurses Association. (n.d.). ANA CAUTI Prevention Tool.
Nursingworld.org. Retrieved October 7, 2021, from
https://www.nursingworld.org/practice-policy/work-environment/health-safety/infection-p
revention/ana-cauti-prevention-tool/.
Bejjanki, H., Mramba, L. K., Beal, S. G., Radhakrishnan, N., Bishnoi, R., Shah, C.,
Agrawal, N., Harris, N., Leverence, R., & Rand, K. (2018, October 8). The role of a best
practice alert in the electronic medical record in reducing repetitive lab tests.
ClinicoEconomics and outcomes research : CEOR. Retrieved October 14, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181108/.
Centers for Disease Control and Prevention. (2015, November 5). Background.
Guideline for Prevention of Catheter-Associated Urinary Tract Infections . Retrieved
October 7, 2021, from
https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html#:~:text=An%20e
stimated%2017%25%20to%2069,per%20year%20could%20be%20prevented.
Pender, S., Phillips, M., & Stachel, A. (2018). 2112. Assessing the Accuracy of
Catheter-Associated Urinary Tract Infections (CAUTI) Identification Using Urinalysis
Results. Open Forum Infectious Diseases, 5(Suppl 1), S620.
https://doi.org/10.1093/ofid/ofy210.1768