The Intern Intervention: The Effect of Daily Rounding on Reducing Indwelling Urinary Catheter Device Utilization

Abstract

BackgroundUrinary tract infections (UTIs) are the 4thleading type of healthcare-associated infection. According the Centers for Disease Control and Prevention, catheter associated urinary tract infections (CAUTIs) account for 75% of healthcare-associated UTIs with approximately 15–25% of patients receiving urinary catheters (UCs) during their hospital stay.PurposeTo determine the effect of daily line assessment rounds and education on increasing appropriate use of UC indications and reducing urinary catheter use in hospitalized patients.MethodsThe infection prevention and control department (IPand C) was assigned an intern from January 30, 2017- May 15, 2017. The IP&C educated her on the basics of indwelling UCs, the hospital’s nurse driven protocol for removal of indwelling UCs, and the location of the patient’s charted indication for the UC. The intern was asked to use a daily list of patients with indwelling UCs generated by the facility’s electronic medical record and to verify the patient had a daily indication for the UC. After verification, the intern contacted every nurse caring for a patient with a UC. Patients with UCs in place > 5 days, those lacking indications, and those with inappropriate indications were specifically targeted. During daily rounds, the intern questioned the necessity for the UC, provided education on appropriate indications, as well as reminding about the importance of UC documentation. Monthly device utilization ratio (DU) was calculated (urinary catheter days / patient-days) and analyzed using Statistical Analysis Software (SAS).ResultsHospital wide urinary catheter (DU) decreased 33% from January to April. ICU DU decreased 19% and non ICU DU decreased 32% in the same time span. Overall hospital CAUTI rate decreased 94%. This change was determined to be statistically significant.ConclusionDaily inquiries into the necessity of UCs and performing one on one education with nurses dramatically decreased our DU over the 3 month study period. Due to this rounding, IP&C was able to target nurses that consistently failed to document in a timely manner, provide education on the nurse driven protocol to remove UCs along with appropriate indications for UC use. No other practice changes took place during the study period.Disclosures All authors: No reported disclosures.