Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units

D G Dumigan, C A Kohan, C R Reed, J F Jekel, M K Fikrig
Clinical Performance and Quality Health Care 1998, 6 (4): 172-8

OBJECTIVE: To reduce catheter-related urinary tract infection rates in three intensive-care units to at or below the National Nosocomial Infection Surveillance System pooled mean for similar units.

DESIGN: A nursing team, physician team, and laboratory team reviewed and revised protocols and procedures for better catheter management.

SETTING: A 500-bed community teaching hospital.

INTERVENTIONS: The teams developed medical indications for urinary catheter placement and criteria that allowed the registered nurse to remove a catheter without a physician's order when no longer medically necessary. They created a computer prompt to assure a urinalysis accompanied all urine cultures.

RESULTS: After introducing the new protocols, the incidence density of catheter-related urinary tract infections fell 17% in the surgical intensive-care unit, 29% in the medical intensive-care acute unit, and 45% in the coronary intensive-care acute unit. The registered nurses' compliance in removing the catheter per protocol was 88%. Physician ordering of a concomitant urinalysis with each urine culture achieved 93%.

CONCLUSIONS: A multidisciplinary approach assisted in reducing catheter-associated urinary tract infections in three intensive-care units, although not to the extent desired. The teams are investigating preconnected and antimicrobial-coated catheters further.

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