Purpose

Items to Implement
Limitations / Lessons Learned
Statistics
Using EBP to Prevent CAUTIS
Olivia Aili Juola, SN

The purpose and goal of this project is to decrease the
number of, as well as prevent all together, CAUTIs
throughout Sarasota Memorial Hospital, but specifically on
the oncology unit- Eight Waldemere


Unfortunately, there have been a lot of CAUTIs
throughout Sarasota Memorial Hospital (SMH) over this
past year, resulting in a large amount of money not
being reimbursed to SMH.

Reimbursement is not the only reason that this is an
issue, but rather it also is a problem for patients for other
reasons. CAUTIs not only affect the length of time that
people have to stay in the hospital (research shows by
at least two days), but cause an additional problem on
top of the reason they were in the hospital, and can add
medications to their already hefty regimen.
Not being able to collect data quickly, it takes time to
get results.
Physicians or other personnel inserting foley catheters
are not looked at.
Eight Waldemere: Oncology and Medical Surgical Overflow Unit
There are many evidence based practices shown
through research that can be put into place to help
decrease the number of CAUTIs:
During rounds review if a catheter is still necessary.
Every day a catheter is left in, the risk of infections
increases 3-7 %
Ensure Stat lock is in place and the catheter is still
stable with minimal range for movement, as movement
increases risk for irritation and infection.
Always keep the bag below bladder level, and empty it
every eight hours, if the bag is two thirds full, or prior to
the patient is being transferred off the unit.
Use a bladder scan to test regularly to test for urinary
retention instead of basing foley catheter use off of just
the number on one scan.
Having a yearly education session for staff to ensure
proper sterile technique is being used as well as the kit
is being used in proper sequence.
Reviewing new and up to date evidence based practice
and protocols after each measurement reading.

References

Dumont, C, (2010). Preventing catheter-associated UTIs.
Nursing2010 40(10).
Magers, T. L., (2013). Using evidenced-based practice to
reduce catheter-associated urinary tract infections. American
Journal of Nursing 133 (6). 34-42.
Meddings J, Rogers MA, Macy M, Saint S. (2010). Systematic
review and metaanalysis: reminder systems to reduce
catheter-associated urinary tract infectionsand urinary
catheter use in hospitalized patients. Clin Infect Dis 51(5):550-
560.
Oman, K.S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett,
T., Keech, T., Wald, H. (2011). Nurse-directed interventions to
reduce catheter-associated urinary tract infections. American
Journal of Infection Control 1(6).
Welden, L. M., (2013). Driving evidence based catheter-
associated urinary tract infections (CAUTI) care practices.
Online Journal of Nursing 18(3).
Background
Overall, Eight Waldemere has done well in recent months,
having no CAUTIs since September 2013. In the June of
2013 however, the unit had up to 13.9 infections per 1000
catheter days. The average over a year is 1.9 CAUTIs per
1000 catheter days
Overall at Sarasota Memorial there were 3.361 CAUTIs per
1,000 catheter days in Sarasota Memorial Hospital
The nationwide average was 3.1 to 7.5 CAUTIs per 1,000
catheter days in acute care hospitals in 2006 (Dumont 2010)
this makes the average about 5.3 overeall.

Team Members
Measures
Look at the number of CAUTIs at 30 days, 90 days, and
180 days to see if there is continued improvement.
Audit catheter documentation every 30 days to see if
there were any reasons why a catheter should not be
used.
Use a scorecard to keep track of the units progress on
these measures.
When to Use Foley Catheters
Do NOT use a catheter only because of patient comfort
when giving a diuretic.
DO use them to measure output in critically ill patients.
Do NOT use a catheter only for incontinence. If
incontinence is an issue, try a non-invasive approach
such as a condom catheter for males.
DO use them to assist in healing of open perineal
wounds in incontinent patients.
DO use them for acute urinary retention or obstruction.
DO use them in certain perioperative situations: i.e.
urologic surgery or large volume infusions are used
during operations.
DO use them when long bed rest is prescribed, such as
back or spinal surgeries or end of life care.
All Registered Nurses on Eight Waldemere Tower:
Oncology and Medical Surgical Unit
All Patient Care Technicians on Eight Waldemere Tower:
Oncology and Medical Surgical Unit
Infection Control Team