The Impact of an Evidence-Based Practice Protocol on Catheter-Associated Urinary Tract Infections and Urinary Catheter Days

Abstract

Background: The chronic critically ill are an extremely vulnerable population. Long Term Acute Care Hospitals (LTACH) are the proper venue for these patients. These patients are frequently admitted with urinary catheters, increasing the risk for hospital acquired catheter associated urinary tract infections (CAUTI). Urinary catheters can lead to CAUTI, mortality and increase healthcare cost. Use and duration of urinary catheters are prime risk factors for CAUTI. Purpose: To determine if the implementation of an evidence based urinary catheter protocol (UCP) reduces urinary catheter days, CAUTI rates and the risk of CAUTI’s. Method: This quality improvement project was performed in two LTACH. Online synchronous education was provided to the hospitals leadership team in November 2014. Clinical leaders obtained UCP approval from their governing boards and educated their staff. The UCP was utilized for all patients admitted with a urinary catheter during the protocol implementation period. Patient days, urinary catheter days, and the number of CAUTIs were collected. Data analysis was completed utilizing data from a three-month retrospective period prior to protocol implementation (September-November 2014) and a three-month prospective period post protocol implementation (December 2014-February 2015). Results: Overall urinary catheter days decreased from 2846 to 2383 a 463 day (16.3%) reduction. The incidence of hospital-acquired CAUTIs decreased from 18 to 6, a reduction of 66%. The CAUTI rate decreased from 6.32 to 2.52, a 3.8 (60%) reduction. The absolute risk reduction was 3.81 infections per 1,000 catheter days. The findings were statistically significant (z= 1.82, p<0.03). Therefore this suggests that an evidence based UCP can reduce catheter days and CAUTI rates.