Using The Evidence To Reduce Catheter Associated Urinary Tract Infections

A basic tenet of Western medicine is that science holds the answers. We discount the beliefs of individuals if scientific evidence contradicts those beliefs. In the 20th century we were not as quick as we should have been, however, in banding together to assure that every patient benefited from medical care that was based on the evidence of what works best. Too often we let people do things “the way they were taught”, “the way that worked for them”, or the way that was quickest and most convenient for an individual practitioner, even if it was not the way that the evidence showed was best. Most often, the people who were not doing things “the best way” didn’t even know that there was a best way. Well, things are changing dramatically for the better.

Our latest example of this at GBMC is our reduction of Catheter Associated Urinary Tract Infections…otherwise referred to as CAUTI’s (where would we be without our acronyms!). A CAUTI is when a patient gets an infection in their bladder and urinary tract because they have a catheter placed in their bladder to drain urine. As you can see from the annotated run chart below, not too long ago we had 6-7 per month (and there were probably many more before we started measuring them.) In the old days we would consider CAUTI’s just a natural by-product of our care. We don’t anymore. We now look at CAUTI’s as defects in our care and in the spirit of continual improvement we ask what we can do to prevent them. We consider this our ethical duty. If it was our loved one who was the patient, we would be pretty upset if he or she got a CAUTI.

So GBMC put together a team that began learning from the literature about the evidence on how to prevent CAUTI’s. The team included Lynn Marie Bullock, Erin McCoy and Susan Collins from Nursing Education; Cherie Christopherson from Unit 58; Sheila Eller from Unit 25/26; Monica Niedermeyer from Unit 38; Jade Santiago from Unit 35; Linda Henderson, the ACE Clinical Program Manager/Unit 35,; Concetta Jackson, the Nurse Manager of Unit 58; Dr. Aaron Charles, the Medical Director of Unit 35; Phyllis Tyler from Infection Prevention; Cate O’Connor Devlin, Nursing Administrative Director; Jody Porter, our Chief Nursing Officer; and Carolyn Candiello, our Vice President for Quality and Patient Safety.  

They studied indications for using urinary catheters in the first place and alternative strategies for avoiding their use. They made some progress. They then studied the evidence around how to best put in a urinary catheter and started to disseminate this information to the broader GBMC clinical community. But as you can see from the annotations, it wasn’t until they began using a standardized checklist for catheter insertion, that they began to see a major improvement. Using the checklist as a way to assure that catheters only go in using the best technique is powerful. We know that humans often forget things and the checklist helps them avoid bad technique that leads to infections.

High reliability means: What should happen, happens and what should not happen, doesn’t. In this case, using a checklist has helped us get to higher reliability in urinary catheter use.

I am very grateful to our CAUTI Team and all of our hard-working nurses and physicians for standardizing care when it should be standardized. Our patients are benefiting from it and they thank you, too!