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Journal of Trauma Nursing. 25(6):366–373, NOVEMBER/DECEMBER 2018


DOI: 10.1097/JTN.0000000000000403,  PMID: 30395037
Issn Print: 1078-7496
Publication Date: November/December 2018

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Targeting Catheter-Associated Urinary


Tract Infections in a Trauma Population: A
5-S Bundle Preventive Approach
Adel Elkbuli;Ashley Miller;Dessy Boneva;Salomon Puyana;Eileen Bernal;Shaikh Hai;Mark
McKenney;

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Abstract
Complications from catheter-associated urinary tract infections (CAUTIs) can cause morbidity and
mortality. Our institution's Trauma Quality and Improvement Program analysis identified CAUTIs as
an outlier complication in our trauma population. This study aimed to determine whether
implemented measures would reduce CAUTI rates in trauma population. A 5-S CAUTI bundle was
implemented. Its effects were measured on a prospectively collected dataset of adult trauma
patients using our Trauma Registry during the 4-year study period. Implemented measures
included (1) staff education, (2) bladder catheter stabilization, (3) patient and caregiver education,
(4) keeping the collection bag below the bladder and above the floor, and (5) daily evaluations for
discontinuation. Chi-squared and t-test analyses were used with significance defined as p < .05.
Twelve thousand nine hundred and sixty-two trauma patients were admitted to trauma service
during the 4-year study period. Of these, 94 developed CAUTIs, with an average age of 67 years
and 56% were females. The average injury severity score was 16 in patients with CAUTIs compared
with 9 in non-CAUTI patients (p < .0002). In the index year, CAUTIs occurred in 41 out of 3,054
(1.34%), the following year there were 34 out of 3,455 (0.98%), in 2016 there were 11 out of 3,246
(0.33%), and 8 out of 3,207 (0.25%) in 2017 (p < .001). Results demonstrated an 80% reduction in
CAUTI rate. Execution of the 5-S CAUTI bundle resulted in a significant 80% reduction in CAUTI rate
in our trauma population.

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Related Topics
 Urinary tract infections

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