Inquiry into Quality

Patient Care 531

IQP: Preventing Catheter Associated Urinary Tract
Infection in Clinical Settings
:Presented by
Abdul Albougami
2010
:Introduction

:Brief background›
:Aim and objectives›
:Methodology›
:Implementation›
:Summary ›
:Time to answer questions
:Introduction
Some key findings in the process of addressing how to best
mitigate the prevalence of CAUTI’s in the clinical settings. First
there is the acknowledgement that CAUTI’s are a critical issue
due to the imposed risk for mortality, morbidity, and increased
cost of treatment for those afflicted with a CAUTI. The reasons
for the CAUTI’s appear to be chiefly due to bacterial biofilm
formation on the catheter. Measures to mitigate the growth of
bacteria include aseptic insertion, better sanitation methods,
reduction in catheter use, use of novel types of antimicrobial
catheters, and reduction in the time duration of total
.catheterization
:Literature review
In a study by Saint, Savel, and Matthay (2002) catheter borne infections are a
serious threat to critically ill patients in the clinical setting, and they discuss
prevention methods to address this issue.

Trautner and Darouiche (2004) discuss the pathogenesis and prevention

of catheter associated infections. The authors note that the catheter device
is the most common cause of hospital-acquired bloodstream infection,

leading to an attributable mortality rate of 12% to 25% generally, and less

than 5% specifically being due to CAUTI’s.

Urinary catheterizations are six times higher than intravascular

catheterizations infection.
..…Continue
Corona and Raimondi (2004) report on the strategies that health
care practitioners can utilize in the clinical setting to reduce the
event of CAUTI’s. The two main areas the authors note as
guiding frameworks include using surveillance measures, and
using restrictive antibiotic policies.
Schumm and Lam (2008) report that silver alloy indwelling
catheters were useful for reducing the risk of urinary tract
infections,
Johnson, Kukowski and Wilt (2009) studied the effectiveness of
using nitrofurazone or silver-alloy coated catheters for short
term catheterizations in reducing infections.
..…Continue
- Gendine-coated catheter:
- Silver hydrogel coated catheter:
- Uncoated catheter:
(Hachem, et al., 2009).
:Aim
The purpose is to present a quality improvement project to reduce
the prevalence of CAUTI’s by applying prevention measures in the
clinical settings.

Objectives:
› To measure the number of CAUTI’s in the clinical setting.

To reduce the number of CAUTI’s in the clinical setting ›

.through prevention

To implement low cost surveillance measures among nursing ›

.personnel

.To identify areas of low compliance or non-compliance ›

:Methodology
Participants:
The participants in this quality improvement project are nurses
in an adult surgical care ward at a major hospital. They are a
highly competent and homogenous group similar training,
similar job focus in the clinical setting, and utilizing similar
precaution measures for reducing and preventing infection in
the clinical setting.

Settings:
The setting for this quality improvement project is the adult
surgical care ward in the hospital.
:Methodology
› Approach:
Nurses will be given an information sheet stating the need to
reduce CAUTI’s in the clinical setting , and informed of
enhanced surveillance procedure protocols for managing
urinary catheterizations.

:QI Plan (6 weeks) ›

Design & preparation -
Plan for the Enhanced Surveillance Procedures -
:Methodology

:QI Do (12 weeks) ›

Checking, gathering and entering data -

:QI Study (4 weeks) ›

)%( Analyzing data -

:QI Act (4 weeks) ›

Final report -
:Methodology
Table 1: Budget
 
Time of person serving as QIP coordinator 30x$35 $1050.00

Paper for surveys and reports (est. 4 reams) $5/each $ 20.00

Printing costs $50 $50.00

Timer for each ward $3/each $ 6.00

Lockbox for each ward to collect surveys $25/each $ 50.00

Antiseptic spray (est. 5cans/wk, 12wks, 2 wards) $2/each $ 240.00

One reusable foot pump for the spray $10/each $ 20.00

Chocolates donated no cost

Total QIP Budget $1436.00

:Implementation
Ethical and Other Considerations:

.Approval from Hospital Review Board -

In conducting quality improvement projects, key elements of -

apply ethics to participation and ethical treatment of subjects
.is vital to secure
:Conclusion
CAUTI’s are a leading cause of nosocomial disease, contributing to
morbidity and mortality rates. Issues identified in the causes of
CAUTI’s include overuse of catheterizations, poor aseptic methods in
the catheterization event, lack of surveillance methods in reducing
risk of infection, poor patient compliance, bacterial biofilm growth on
and in the catheter, type of catheter used, and the duration of the
catheterization.
Therefore ,the plan of the QIP is to utilize a low-cost
intervention, that of implementing an enhanced surveillance
protocol among surgical ward nurses who are involved in
managing patient catheterizations. Using long scrub times,
additional application of antiseptic media (alcohol spray), use
of nose/mouth face masks, following strict handling guidelines
of the catheter, and following enhanced aseptic treatment of
the patient prior to catheterization, these are all key elements of
this quality improvement plan.