Catheter-associated urinary tract infections (CAUTIs) occur frequently in Intensive Care Unit (ICU) patients, who are hospitals' most vulnerable population. This quality improvement project is the evaluation of 2 interventions used in one acute care facility's ICU to decrease CAUTI rates over a 3-year timeline. The 2 interventions used for the project were 1) an evidence-based guideline developed from the Comprehensive Unit-based Safety Program and 2) simulation-based education for teaching the guideline. Using the Iowa model and Havelock's theory of planned change as a framework, the 2 interventions were evaluated over a 3-year timeline: 2014 pre- intervention, 2015 intervention, and 2016 post-intervention. The results were compared quarterly for the 3 years using the standardized infection rate (SIR) and standard utilization ratio (SUR), which show the effectiveness of preventative activities. Data were obtained from the National Healthcare Safety Network and the results from the project showed an 82.46% decrease in SIR from 2014 through 2016 in Baseline 1, and a 71.33% decrease in SIR from 2015 through 2016 in Baseline 2. This is statistically significant for CAUTI reduction over a 3-year period (p < 0.001). For the SUR there was a 14.29% decrease from 2014 to 2016 in Baseline 1 and no statistically significant difference from 2015-16 in Baseline 2. It can be concluded that an evidence-based guideline taught through simulation significantly reduces SIR and has a positive effect on catheter use. This study contributes to positive social change because it promotes decreased patient length of stay and cost of care and decreases morbidity and mortality for patients. It also has a positive effect on health behavior-related outcomes for the ICU nurses for CAUTI prevention.

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Background: Catheter-associated urinary tract infections (CAUTIs) are a major source of avoidable hospital-acquired infections. The scientific evidence supports utilization of nurse-driven protocols to reduce CAUTIs. Purpose: The purpose of this quality improvement project was to update and implement an evidence-based CAUTI prevention protocol for the nursing staff on a medical-surgical unit in an adult acute care hospital to decrease the utilization of indwelling urinary catheters and CAUTIs. Theoretical Framework: Donabedian’s structures, processes, and outcomes (SPO) model was utilized as the framework for this project. Donabedian’s SPO model focuses on strong healthcare structures and processes to improve nurse, patient, and organizational outcomes. Methods: This project utilized a quantitative design. A convenience sample of 28 nurses from the medical-surgical unit of a South Florida hospital participated in the project. An educational intervention was delivered on CAUTI prevention based on guidelines from regulatory agencies, and the hospital existing protocol was updated and revised to reflect the guidelines. The sample was administered a short demographic survey, and 10-item pretests and posttests on CAUTI prevention before and after implementation of the standardized evidence-based protocol. To determine possible differences in nurses’ knowledge and perceptions of indwelling urinary catheters before and after the implementation, paired t tests were conducted. To determine if the proportions of days with urinary catheters were statistically significantly different 30 days before and after implementation of the standardized evidence-based guideline, a 2-proportion z-test was conducted. Results: On analysis of the pretests and posttests, a statistically significant difference was found in 6 of the 10 questions, indicating that nurses’ knowledge and perceptions of CAUTIs improved after the intervention (p < .001 to p < .043). After the intervention, urinary catheter days relative to patient days also decreased significantly (z = 5.562, p < 0.001). Conclusion: Implementation of an evidence-based nurse-driven protocol in a hospital in South Florida improved nurses’ knowledge and perceptions of CAUTI prevention. Nursing practice and healthcare delivery can benefit from development of such guidelines and educational interventions to empower nurses to better manage patients’ indwelling urinary catheters, and decrease the incidence of CAUTIs in hospitals.

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians’ perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants’ frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson’s chi-square test for independence indicated a significant correlation (p < .05) between physicians’ perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples' health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost and Utilization Project (HCUP) agency. According to the findings, males (n = 61,040) were at a higher risk of developing CAUTI compared to female (n = 66,792) (p < .001) in New York and North Carolina between 2012 and 2014. The odds of getting CAUTI were much higher among age > = 45 compared to the < 17 years. These findings fit in with previous literature identifying age and gender as having a significant relationship with CAUTI occurrence. The outcomes in this study may guide the formulation of policies that are age-appropriate, gender-specific, and facility-tailored to reduce the incidence of CAUTI.

Research Abstract Purpose: to explain how there is a direct correlation between nursing staff ratios and patient results regarding mortality, infection, poor patient safety, and other sentinel events. Aims: how is patient care compromised by nursing staff shortage? Methods: observational studies from public information records such as Medicare patient claims, AHA, and surveys from RNs working at acute care hospitals. Results: certain groups are more susceptible to sentinel events. Patients with chronic diseases, elderly, patients needing intensive care, or overall unstable patients are examples of patients who fall under this category. Studies show that patients are at higher risk for receiving detrimental care due to poor nurse to patient ratio. Conclusions: adding to a nurse’s workload increases patient mortality in length of stay in hospitals due to hospital administration only needing to meet the minimum staffing requirements. The minimum staffing required for operations still does not meet the recommendations provided by the Safe Staffing Act. Key Words: nurse shortages, patient safety, patient outcomes, healthcare quality, workload, hospital acquired infections, staffing, CAUTI, VAP, CABI

Hospital-acquired infections (HAI) are not uncommon in healthcare facilities. They are usually prevented by sanitation techniques and by maintaining a high standard of care. Catheter-associated urinary tract infections (CAUTI) make up a large percentage of hospital-acquired infections and are often the most preventable type of HAI. Patterns in infection rate could provide new ideas on prevention techniques, which might further reduce infection rate, saving lives and cutting costs. CAUTI infection rate was measured from January KJIY to September KJIL and was differentiated based on hospital ward as well as month and season. Overall, ICU units tended to have a higher CAUTI infection rate than ward units, particularly in January, February, April, and May. The CAUTI infection rate was highest in the ICU units during spring and May, and lowest during fall and October. In the ward units, the CAUTI infection rate was highest during summer and March, and lowest during winter and February.

More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.