NURSES' ADHERENCE TO A NURSE-DRIVEN CAUTI PREVENTION PROTOCOL
Creators: name: Tomta, Odette Njecheu
Publisher: name: Zenodo
Year: 2021

description: Catheter-associated urinary tract infections (CAUTI) are the most frequent healthcare-acquired infections and account for up to 80% of all these infections. Evidence supports that the development of a standardized and systematic approach to CAUTI prevention using a bundle of interventions to supplement a nurse-driven protocol is effective in reducing indwelling urinary catheter (IUC) utilization rates, and days. The purpose of this DNP project was to decrease IUC utilization rates and IUC days in the Intensive Care Unit (ICU) by improving nurses’ adherence to a nurse-driven CAUTI prevention protocol. The project was an evidence-based improvement project which included a survey, observations, and audits. The project setting was an ICU, in a non-profit acute care hospital. The project had a convenience sample of 47 frontline registered nurses and a consecutive sample of 138 patients with Foley catheter. This project was conducted in two phases, pre and post implementation. The pre-implementation phase included an 11-item nurses’ survey used to identify barriers to nurses’ adherence to the nurse-driven CAUTI prevention protocol. Post-implementation included a 10-item and seven-item checklists respectively used to conduct daily ICUs rounding and electronic chart reviews. Additionally, a manual IUC removal reminder was used. On day one of IUC insertion or an IUC patient admission, a standardized evidence-based educational handout was used to perform patient/family education on proper IUC maintenance and CAUTI risks. Pre- and postimplementation protocol adherence rates, IUC days and IUC utilization rates were evaluated and compared. A Chi-squared, Fisher exact, and Poison exact tests were conducted to determine if there were statistically significant changes in the post-implementation findings when compared to the pre-implementation results. Most commonly reported barriers to nurses’ adherence to the CAUTI prevention protocol included heavy nursing load (72,7% of respondents), fear of spending more time charting (70%), lack of timely physician order for Foley catheter removal (59.1%), and lack of time (56.8%). Post-implementation, there was a statistically significant increase in nurses’ adherence to the overall CAUTI prevention protocol (55.3%, p &lt; 0.001) from 40.8 to 96.1%. Unadjusted, IUC days seemed to have decreased post-implementation from 519 to 406. However, when adjusted with patient days, there was no statistically significant change between the pre- and post-implementation IUC utilization rates (816.04 vs 816.90/1000 catheter days, p = 1.000). Supplementing a bundle of activities to an evidence-based nurse-driven protocol improved nurses’ adherence to the CAUTI prevention protocol even though IUC utilization rates did not decrease. Exogenous factors (Covid-19 pandemic surge) appeared to be a threat that negatively impacted the project findings. Providing a clear pathway for nurse driven IUC removal along with an ongoing CAUTI prevention protocol, and adherence monitoring is essential to ensure that safe practices are fully embedded in IUC patient care and sustained. Continuous evaluation and monitoring of barriers to CAUTI prevention protocols are crucial to decrease IUC use and improve IUC care in hospital settings. Keywords: adherence to a nurse-driven CAUTI prevention protocol, adherence rate, chart review, chart review checklist, catheter associated urinary tract infection prevention (CAUTI), iv CAUTI prevention, daily rounding, daily rounding checklist, Foley catheter, Nurse-driven protocol, nurse-driven protocol for CAUTI prevention, nurse-driven protocol for Foley catheter removal.