Take on UTIs with a bundled approach
After reading this article, you will be able to:
- Describe the bundled approach to preventing UTIs used at Memorial Hospital in York, PA
Urinary tract infections (UTI) might not be the most expensive or life-threatening infections, but at many facilities they are the most common.
This was the case at Memorial Hospital in York, PA, and the reason staff members adopted a UTI bundle—training, standardized techniques, and a push to get Foley catheters out as quickly as possible. The bundle was developed as part of a performance improvement project that began in summer 2007, says Diana S. Scheide, RN, CIC, BA, an infection prevention and control practitioner at Memorial.
At Memorial, UTIs were a topic that resonated with staff members, which made them a solid starting point for Scheide’s first improvement initiative at the facility.
About the bundle
To begin the initiative, Scheide convened a group of frontline nurses and attempted to establish what the current Foley catheter practices were and how nurses were being trained on this topic.
“We sent out a survey,” Scheide says. “We also asked, ‘Did you know that most of our infections are UTIs, and why do you think that is happening?’ ” (See p. 4 for the survey they used.)
Scheide and her team also reviewed medical literature on preventing catheter-associated UTIs and putting together best practices that were supported by scientific evidence.
When they compared their internal information with best practices, there were striking differences. Nurses were primarily training other nurses on catheters, and practices varied greatly, Scheide says. Many nurses were not aware that the facility possessed a policy on Foley catheters; others knew the policy existed but had trouble accessing it.
The performance improvement team also uncovered problematic system issues. For example, two types of catheter bags were being used at the facility: one with a meter and one without. If a Foley was inserted in an emergency room patient, nurses might have to break the sterile closed system to attach the needed urine collection bag, introducing a risk of infection. There were also some issues about who was qualified and properly trained to insert and secure catheters.
The performance improvement team addressed the system issues by putting procedures in place to ensure that patients were fitted with the correct catheter bag upon arrival. The team also established that only nurses were permitted to perform the procedure. All nurses were retrained and encouraged to study videos on proper Foley insertion techniques.
Constant repetition of the bundle components and reinforcement of the new procedures’ importance was critical to the success of the improvement effort, Scheide says.
One of the last pieces of the bundle—and one that has proven to be among the most important—was implemented in May: removing catheters as soon as they were no longer necessary. Each day, nursing staff members and physicians assess patients to determine whether the catheter can be removed.
The number of infections had previously been hovering between six and nine infections per month, but since the facility began pushing to remove catheters as quicklyas possible, that number has dropped significantly. In May, the facility had only one UTI, and there were none in June.
Adapted from Briefings on Infection Control, September 2008, HCPro, Inc.