Practice Tip of the Week | A Journey to Zero Harm

By Emefa Arnaout, DNP, MHA, RN, NE-BC  Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent healthcare-associated infections, contributing to increased morbidity, extended hospital stays, and elevated healthcare costs. In acute care settings, CAUTIs often arise from the use of indwelling catheters, particularly when their use is prolonged or maintenance practices are inconsistent. Although guidelines stress the importance of sterile techniques, they frequently overlook the value of an interdisciplinary approach. A team-based strategy, incorporating roles from physicians, nurses, infection prevention specialists, and support staff, ensures comprehensive care, vigilant monitoring, and timely intervention—critical elements in reducing CAUTI rates. Problem Our facility, a 457-bed, Magnet®-designated acute care hospital, identified an opportunity to reduce CAUTI rates, which were exceeding the national baseline as per the National Healthcare Safety Network (NHSN) Standardized Infection Ratio (SIR) in April 2019. Purpose/Aims The goal of our initiative was to assess the effectiveness of an interdisciplinary approach in eliminating CAUTIs within an acute care setting. We aimed to implement evidence-based protocols, improve communication among healthcare team members, and cultivate a culture of accountability focused on CAUTI prevention. We hypothesized that enhanced collaboration and consistent adherence to best practices could lead to a significant reduction in CAUTI rates. Literature Review The Centers for Disease Control and Prevention (CDC, 2020) identifies CAUTIs as largely preventable, yet they remain prevalent due to prolonged catheter use and inadequate adherence to infection control practices. Medina and Castillo-Pino (2019) emphasize the significant burden of urinary tract infections (UTIs), including CAUTIs, on global healthcare systems. Faulkner and Franks (2013) underscore the importance of involving both clinical staff and senior leadership in CAUTI prevention. Their AHRQ webinar advocates for integrating CAUTI prevention into broader quality improvement initiatives, stressing the role of frontline staff empowerment, fostering a culture of safety, and leveraging data to support continuous performance feedback. Clinician education, accountability, and visible leadership support are crucial for sustaining adherence to best practices. Methods/Approach Over a three-year period, interventions were implemented at our 457-bed acute care hospital, aiming to shift team culture. An interdisciplinary team—comprising nurses, physicians, infection control specialists, and hospital administrators—was formed. Using the ADKAR® methodology, the team initiated evidence-based protocols targeting CAUTI prevention at every stage of catheter management. Key interventions included a nurse-driven catheter guideline, re-education on CAUTI etiology and symptomology, guidance on early catheter removal, event analysis meetings, and routine catheter maintenance audits. In addition to these procedural changes, the team held monthly meetings to review data, address protocol deviations, and apply quality improvement tools such as Plan-Do-Study-Act (PDSA) cycles. These meetings facilitated the identification of challenges and the adjustment of strategies in real time. Results By the end of fiscal year (FY) 24, CAUTI rates at the hospital were reduced to zero. Since FY19, the hospital observed a steady decline in the CAUTI Standardized Infection Ratio (SIR) alongside a reduction in catheter utilization rates. Staff surveys and observations indicated heightened awareness of CAUTI prevention practices, along with increased vigilance in assessing catheter necessity. Compliance with insertion and maintenance protocols rose to 90%, and catheter removal times were significantly shortened, with most catheters removed within 48 hours unless medically necessary. These improvements underscore the effectiveness of a coordinated, interdisciplinary approach to catheter care. Conclusion Our initiative demonstrates that an interdisciplinary approach is highly effective in reducing CAUTI rates in acute care hospitals. By fostering collaboration across healthcare roles, enhancing communication, and adhering strictly to evidence-based protocols, hospitals can achieve notable improvements in patient safety and infection control. Implications for Practice This approach to CAUTI prevention highlights the critical role of teamwork and accountability in infection control. Interdisciplinary collaboration enables real-time problem-solving and ensures adherence to protocols. Hospitals should prioritize team-based strategies for CAUTI prevention, including regular training, ongoing communication, and continuous monitoring to sustain low infection rates. This model can be adapted to address other healthcare-associated infections, ultimately improving patient outcomes and reducing healthcare costs. 

REFERENCESCenters for Disease Control and Prevention. (2020). Catheter-associated urinary tract infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html Faulkner, K., & Franks, M. (2013). Preventing CAUTI: Engaging Clinicians and Senior Leadership to Implement Change (webinar). AHRQ. https://www.ahrq.gov/hai/cauti-tools/archived-webinars/preventing-cauti-engaging-clinicians-transcript.html Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., … & Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35 (5), 464-479. https://doi.org/10.1086/675718 Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of urinary tract infections. Therapeutic Advances in Urology, 11, 1756287219832172. https://doi.org/10.1177/1756287219832172