1. Painter, Julie RN, MSN, OCN
  2. Ferguson, Debra MSN, RN, CCRN, CNRN

Article Content


The aim of this study was to reduce indwelling urinary catheters and incidence of nosocomial urinary tract infections (UTIs) through a collaborative systematic effort. The goal of the project was to achieve zero nosocomial UTIs.



Urinary tract infections are one of the most common culprits of nosocomial infections, accounting for 20% to 40% of hospital-acquired infections. Literature indicates that 80% of nosocomial UTIs are correlated with the utilization of indwelling urinary catheters. Foley catheter-related UTIs have been noted to increase the length of stay from 2.4 to 4.5 days and are associated with increased hospital mortality. The financial burden of each UTI diagnosis costs approximately $8,000 to treat, and if urosepsis occurs, the cost escalates to more than $40,000 per case.



The utilization of urinary catheters has become commonplace, without the critical thinking of the infectious processes and risks. The over utilization of indwelling urinary catheters, marked increase in UTI rates, and changes within the current reimbursement system related to nosocomial infections drove this network to commission a process improvement team, championed by CNSs and involving infection control nurses, to facilitate immediate change. Network findings to date indicate that 70% of the inpatients who enter through the emergency department had an indwelling urinary catheter in place upon arrival to the inpatient setting, regardless of policies, tools, education, or current resources based upon CDC recommendations.



This presentation will review the processes of data review, practice audits, product reviews, and collaboration with the product companies to help improve outcomes. Tools utilized to survey and assess all nurses about their critical thinking will be presented, along with the evidence-based decision making and critical thinking education that was implemented. All of the findings within this presentation can be easily adapted and are applicable across multiple hospital settings.



Outcomes will be determined by rates of UTIs and ongoing collection of data related to number of indwelling urinary catheters. The financial outcome will be evident through cost avoidance for treatment of UTIs and urosepsis.



Utilization of indwelling urinary catheters has become common regardless of the CDC guidelines. The sense of urgency to address this problem took on new life as regulatory agencies and insurers became more focused on the issue. Findings will be generalizable to any healthcare setting.


Implications for Practice:

The topic is timely and part of the national safety goals, as well as numerous regulatory agency surveys. The culture of care must change to reduce utilization and incidence. The findings in this presentation will give details and examples of ways to reduce utilization of urinary catheters and decrease nosocomial UTIs by using sound evidence.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.