Thursday, January 3, 2013

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!


  1. Since CAUTI is a NEVER event it must be taken seiriouly or no be look at at all. It seens to hage gotten worse no bretter' When we get recognized fom the failures it makes us feel like dirt. It is time for some great recogition. Maybe save recognized instead of big complaints. We recently lost a fireman who was a great man- he heard it very few times before he died but he knew dying the way he did made a difference. We need that type of feeling instead of whatever happens happens because we don't care anymore. All we will hear is the negative from the leaders. What incentive is that? None

    1. Thanks, Anonymous. While we must always be working towards Zero catheter associated urinary tract infections, CAUTI is not a "Never Event" like wrong site surgery, for example.

      I am not sure how you can say that the rate of CAUTI has gotten worse from our data (?)

      This blog is precisely about saying "Thank you" to our great staff for their work so again, I am confused about the "All we hear is negative" comment. Did you read the blog or are you angry about something else?

  2. I don't put in foleys regularly....but would like to know where the checklist is posted, for refernece and for when I might be called on when floor nurses have difficulty inserting. Thanks.

    1. Thanks for your patience, Anonymous. The checklist is now posted on the Nursing home page on our Infoweb at: http://infoweb/body.cfm?id=481.


  3. I don't use foleys very often. I do use a urinary catheter which I use extreme caution because I wouldn't want to get a urinary tract infection. That would be the last thing that I would want to have happen.

  4. This assumes that the FDA would listen. There is no accompanying design incorporating this suggestion in the uti home remedies for men guidance as was done for CABP and HABP/VABP briefing documents for the AIDAC meeting in November 2011.


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