1. Murray, Kathleen DNP, ARNP, NE-BC

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Using EBP to take down CAUTIs

Q My CCU has struggled to decrease our number of catheter-associated urinary tract infections (CAUTIs). What evidence-based practice (EBP) initiatives can help?

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First, I recommend that you take a proactive approach to CAUTI reduction by completing a gap analysis, with a focus on National Patient Safety Goal (NPSG) 07.06.01: Implement EBP to prevent indwelling CAUTIs. The gap analysis should include assessment of patient/family education; appropriateness of catheter placement; appropriate use of indwelling catheters; use of proven guidelines to prevent urinary tract infections caused by catheters; urinary catheter insertion, maintenance, and removal practices; documentation; and staff education specific to urinary catheter use. You may find that there are no standard order sets for appropriate insertion protocols or discontinuing urinary catheters in surgical patients and no nurse-driven protocols for removal. Focus your search on EBP based on the identified issues from your unit's gap analysis.


If you aren't already, get involved with your organization's CAUTI taskforce or quality committee and then implement a unit-based interdisciplinary taskforce. Make sure that you're aligned with the organization's CAUTI reduction initiatives and have a physician champion. Review existing policies and infection control plans related to urinary catheters, and revise to reflect EBP CAUTI reduction strategies.


A key component of a CAUTI reduction strategy is education, including patient indication before catheter insertion, appropriate care and maintenance of a urinary catheter, a safety checklist for staff with a trained observer ensuring that there's no break in defined technique during urinary catheter insertion, evaluation of continued need daily, a nursing protocol for discontinuing catheter use as soon as possible, and patient education. In addition, you'll need to implement a process for validation of indwelling catheter care competency for all RNs, unlicensed assistive personnel, procedural areas, physical therapy, and transport.


Review your electronic health record (EHR) for current interdisciplinary documentation and alignment with EBP regarding guidelines for urinary catheter insertion, indwelling catheter care, and catheter discontinuation. Most organizations have developed an EBP bundle for the EHR. You'll need to implement a defined process if you don't have a nurse-driven protocol for catheter removal.


Develop an audit tool based on NPSG 07.06.07-use proven guidelines to prevent infections of the urinary tract that are caused by catheters-utilizing the following 10 domains.


1. The order for the indwelling catheter.


2. Was the indwelling catheter insertion procedure documented in the EHR?


3. Documentation of patient education utilizing your organization's approved education for indwelling catheters.


4. Is the indwelling urinary catheter and drainage bag connection seal intact?


5. Is the indwelling urinary catheter cleaned daily and after incontinent stool?


6. Are soap and water used for indwelling urinary catheter care?


7. Is the drainage bag positioned lower than the patient's bladder?


8. There are no kinks present in the tubing.


9. The bag isn't in contact with the floor.


10. There are no dependent loops.



Define audit compliance process responsibility, such as the unit's nurse will compile the trends, and where the data will be reported, such as at staff, physician, and leadership meetings.


For additional resources, the Agency for Healthcare Research and Quality offers the Toolkit for Reducing CAUTI in Hospitals, and the Association for Professionals in Infection Control and Epidemiology provides the Guide to Preventing Catheter-Associated Urinary Tract Infections.


Finally, start a campaign and set a CAUTI and number of catheter days reduction goal. Remember to celebrate successes and remind your staff members that they can be part of preventing 380,000 infections and 9,000 deaths related to CAUTIs per year. Good luck!