Reducing Catheter-Associated Urinary Tract Infections: Beyond the Bundle

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) are preventable but are still the most common healthcare-associated infection (HAI) worldwide, encumbering the health of patients and escalating financial burden on society (CDC, 2021; Shadle, 2021). PICOT: In adult patients with spinal cord injury, does direct observation of urinary catheter insertion, compared to the standard of care, reduce the rate of catheter-associated urinary tract infections, within ten weeks of implementation? Evidence: Multiple factors contribute to Healthcare-Associated Infections (HAIs), but hand hygiene is the most important prevention measure to decrease contact transmission (Gould et al., 2017). The Centers for Disease Control (CDC) clinical guidelines stressed the importance of hand hygiene before urinary catheter insertion, along with maintaining aseptic technique during insertion (HICPAC, 2019). Intervention: A two-person catheter insertion protocol utilizing a standardized checklist was implemented to increase compliance with CAUTI infection prevention measures and to validate that hand hygiene and aseptic technique were performed before and maintained during catheter insertion. Outcome: There was no change in CAUTI rates after implementing the two-person insertion protocol. Rates reported two months before the intervention were zero and remained zero for the two-month implementation period. It can be noted that the intervention bared no negative effects on the CAUTI rates. The outcomes warrant further monitoring as the sample size was small and the implementation period was limited to ten weeks. Conclusion: A two-person catheter insertion protocol utilizing a standardized checklist proved to be clinically significant as it caused no adverse effects on CAUTI rates and may have attributed to decreasing the risk of CAUTI infections upon insertion.