Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital

Background: Catheter-associated urinary tract infections (CAUTIs) are the second most common health care-associated infection. CAUTIs represent a serious threat to chronic critically ill patients in long-term acute care hospitals (LTACHs). Evidence-based guidelines have been shown to reduce the risk of infection in acute care settings but are not well documented in LTACHs. Method: An evidence-based urinary catheter protocol was developed and implemented across three units in a large LTACH. RNs were oriented to the new protocol through online educational modules. During the evaluation period, 120 patients were admitted with a urinary catheter who qualified for chart review for CAUTI incidence. Overall catheter-days and CAUTI rates were compared, and changes in practice were noted. Results: After the education intervention, overall urinary catheter-days decreased by 10.1%, and CAUTI incidence decreased by 74% (4.82 CAUTI per 1,000 patient-days to 1.24). The absolute risk reduction was 3.58 infections per 1,000 catheter-days. The findings were statistically significant (z = 1.00, p<.03). Conclusion: Significant reductions were noted in total catheter-days, and CAUTI rates improved after implementation of an education program and an evidence-based urinary catheter protocol in an LTACH.