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Gary Evans writes Hospital Infection Control & Prevention (HIC), Hospital Employee Health (HEH) and contributes to IRB Advisor (IRB). As senior writer at AHC, Evans has written numerous articles on infectious disease threats to both patients and health care workers, including pandemic influenza, MERS and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.
There are two angles of attack to cutting catheter-associated urinary tract infection (CAUTI) rates, and the harder approach involves changing provider behavior.
“One of the things we find in the literature is that changing the mindset of people really takes time,” says Linda Greene, RN, MPS, CIC, one of the six representatives of the Association for Professionals in Infection Control and Epidemiology (APIC) on the national faculty of the On the CUSP: Stop CAUTI initiative.
A preliminary report released last fall showed a 16% decrease in CAUTI. These results were mostly achieved through technical changes, following the evidence, Greene notes. Changing practices involving technique is the low-hanging fruit. Staff can learn to insert properly, use antiseptic technique, and make sure the bag is secured and below the bladder, she says.
Many hospitals have made these evidence-based practice changes already, and that’s why initial results look good. Bridging the gap between 16% and the national goal of a 25% reduction will be more challenging. The next step is to tackle socio-adaptive, behavioral changes.
“How do we get evidence to the bedside, and how do we make sure doctors and nurses are very engaged, making urinary tract infection prevention a priority?” Greene asks. “Not every patient needs a urinary catheter, so how do we find ways to initiate physician reminders or protocols that instruct the nurse to pull the catheter when it’s not needed?”
To illustrate the challenges of changing culture and behavior, Greene offers an example of ICU practice. “In the CDC guidelines one of the indications for urinary catheter is output monitoring of a critically ill patient,” she explains. “For years, people thought if you were in the ICU you needed a catheter to see how much [urine] you’re putting out,” she adds. “But now we know that many ICU patients don’t need to be monitored that closely, or they can be monitored by other means.”
For more on this story see the October 2014 issue of Hospital Infection Control & Prevention