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best practice guideline, catheter-associated urinary tract infection, clinical nurse specialist, quality improvement



  1. Pajerski, Dawn M. DNP, RN, AGCNS-BC
  2. Harlan, Melissa D. DNP, RN, ACNS-BC
  3. Ren, Dianxu PhD, MD
  4. Tuite, Patricia K. PhD, RN, CCNS


Purpose: The purpose of this clinical nurse specialist-led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit.


Description of the Project: Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits.


Outcomes: Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output.


Conclusion: This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.