Utilizing a Central Line and Foley Catheter Daily Indicator to Decrease Central-line Associated Blood Stream and Catheter-associated Urinary Tract Infections

Abstract

ISSUE: Central lineeassociated blood stream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are two types of hospital-acquired infections (HAI) that greatly impact the health and lives of patients. These types of HAI increase both the length of hospital stay and the cost of hospitalization. 65% to 70% of CLABSIs may be prevented by implementing evidence-based strategies. A multi-pronged effort has been successful to reduce the incidence of CLABSI and CAUTI. PROJECT: The forms purpose is to 1) inform the healthcare team of the appropriate and inappropriate indications for the device; 2) fulfill National Patient Safety Goals (NPSG 07.04.01, 07.06.01); and 3) stimulate discussion among the health-care team to determine daily necessity. All nursing staff were educated on the need and the process to complete the data. The night shift unit nurse places the form on the appropriate chart and is responsible for completing. If an appropriate indicator is not determined, the form is reviewed at change of shift during report. Further information/orders may be required by contacting the attending physician. RESULTS: The form was trialed in the intensive care unit (20 bed) for three months. The measure of success of the trial was a utilization ratio decrease of both indicators; central lines 0.05 and foley catheters 0.12. The use of daily indicator forms was shown to increase awareness to nursing and physicians to the presence of the device. Daily discussions occurred with physicians and nurses regarding the indication for the device. This heighted awareness resulted in lower CAUTI and CLABSI utilization rates, and a decrease (raw number) of infections. LESSON LEARNED: Ensure physicians and leadership at all levels assist in the development and implementation of the new process. Keep everyone 'in the know' at monthly intervals to show the progress towards the end goal of decreased hospital-acquired infections. Rounding daily with bedside nurses/lead nurses will greatly improve compliance and accuracy of choosing the appropriate indicators.