Prevention of Catheter-Associated Urinary Tract Infection in Orthopedic Patients

Abstract

Catheter Associated Urinary Tract Infection (CAUTI) is one of the most common nosocomial infections. In Male orthopedic ward of Khon Kaen Hospital, the rate of CAUTI in 2010 and 2011 was 6.46, 8.07 per 1,000 urethral catheterization days, respectively, and the infection began at 13 to 15 days after catheter insertion. Mistakes associated with catheter insertion, out-of-date practice guideline, urine draining procedure, and lack of care giver’s participation were identified as the main causes of CAUTI. The objective of this study was to develop and implement a program to prevent CAUTI among patients with retained urethral catheter in the male orthopedic ward, Khon Kaen Hospital. It was conducted in 3 phases from April 2011 to September 2012. Phase 1: situation analysis on CAUTI situation by qualitative study with 22 participants. Phase 2: development and implementation of CAUTI prevention strategy based on important findings in phase 1. There were 4 steps: (1) planning to set goal and bundle of care, (2) implementing bundle of care, improving staff competency, empowering patients and care givers, adjusting working environment to facilitate infectious control measures and developed innovation, (3) collecting data through direct observation using checklist on 22 participants, and (4) reflecting on the guideline and adjusting for further improvement. Phase 3: evaluation on the incidents of urinary tract infection using nosocomial infection diagnosis’s criteria, with the target of less than 5 infections per 1,000 urethral catheterization days. As for the phase 1, the problems identified included non-specific hospital policy on patient safety goal, out-dated existing guideline, insufficient infection control nurses, varying health education programs, lacking of patients’ and care givers’ empowerment, inappropriate zoning, sharing equipments among patients, and no guideline for caring patient retaining catheter. During phase 2, CAUTI was selected as a part of patient safety goals; the bundle of care for CAUTI prevention was developed and was used as a framework for nursing competency improvement. The uniform guideline for patient and care giver education was used to educate and empower them. The environment was adjusted and the innovation was created to facilitate the infection control measures. After the implementation, it was found that there was full compliance of the practices on assessment of indication for retaining urinary catheter, the use of appropriate catheter size, and patient and care giver education. The percentage of correct practices on proper catheter insertion technique, proper urine drainage, and urinary catheter care were 95.1%, 94.2% and 94.2% respectively. The CAUTI rate was reduced to 3.94 per 1,000 urethral catheterization days. Time to develop the first CAUTI was increased from 15 to 25 days (range 3-102).