Original article
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm

https://doi.org/10.1016/j.ajic.2014.03.355Get rights and content

Preventing catheter-associated urinary tract infection (CAUTI) remains a significant challenge for US hospitals. The “On the CUSP: Stop CAUTI” initiative represents the single largest national effort (involving >950 hospitals) to mitigate urinary catheter risk. The program brings together key organizations to assist state hospital associations and hospitals by providing education and coaching support, addressing both the technical aspects of preventing CAUTI and CAUTI-specific socio-adaptive challenges. At the local level, engaging health care workers, from physicians and nurses to other ancillary services, is critical. This includes (1) making the importance of addressing CAUTI stakeholder specific, (2) ensuring support from leaders of essential disciplines, (3) underscoring the importance of the collaborative nature of CAUTI prevention, and (4) identifying champions within the organization to lead and be accountable for the work. Sustainability is ensured by integrating the process into the health care worker's daily routine activities.

Section snippets

CAUTI prevention

Much of the effort to prevent CAUTI has been geared toward reducing device use.1, 8 In 2009, the Centers for Disease Control (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) issued new guidelines for CAUTI prevention, including consensus-based indications for appropriate use.9 Although based on expert opinion, the recommended indications are largely viewed as acceptable indications for catheter use, and hospitals have been encouraged to adopt them. The 6 appropriate

National collaboration between various stakeholders

Drawing on a successful effort at a hospital,24 the MHA Keystone Center implemented a process to reduce inappropriate catheter use in 163 units from 71 acute care hospitals in the state of Michigan. This program resulted in a 25% relative reduction in catheter use and a 30% improvement in appropriate use,8 which also corresponded with a 25% reduction in CAUTI rates in the state of Michigan during a period in which the nation saw only a 6% decline.26 The Michigan work used a bladder bundle that

Technical and socio-adaptive components

The On the CUSP: Stop CAUTI effort is initiated for groups of states at a time (or cohorts), beginning with the engagement of the various state leads who serve as a liaison with the hospitals. Interested hospitals are expected to obtain leadership support and identify specific units for their improvement work. Hospitals are also provided with tools to help them assemble their CAUTI prevention teams and resources to support their efforts. The importance of addressing both the technical and

Engaging HCWs and the ideal team

As an important element of socio-adaptive change, HCW engagement at the hospital level is an essential component for successful implementation of the CAUTI prevention work. This includes the range of HCWs and potential stakeholders who provide patient care and are expected to incorporate the implementation of the CAUTI prevention practices into their daily work. The engagement process includes the following: (1) making the case for the importance of addressing CAUTI for different stakeholders,

Sustainability

For successful results, hospital teams need to have a plan to sustain the improvements. Sustainability is achieved if the improvements are maintained or augmented after implementation; for CAUTI prevention, the improvements are reflected in an increase in appropriate catheter use and a reduction in CAUTI events. Sustainability is promoted when the daily evaluation of urinary catheter use and necessity becomes integrated into the HCW's routine, and the hospital has built capacity for continued

Conclusions

Although reducing the risk of CAUTI involves a collaborative effort between different stakeholders, engaging HCWs at the hospital and unit level is critical. Although national engagement is helpful, perhaps the most important ingredient of success is engaging HCWs at the unit and hospital level, thereby providing the ability to implement changes that will enhance patient safety.

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  • Cited by (0)

    Name of AHRQ-funded HAI project: Demonstration of CUSP to Reduce Catheter-associated Urinary Tract Infections (CAUTI).

    Funding/Support: This project was supported by a contract from the Agency for Healthcare Research and Quality HHSA290201000025I/HHSA29032001T.

    Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ).

    Conflicts of interest: Dr Fakih receives support for the development and implementation of the “On the CUSP: Stop CAUTI” initiative serving as a member of the National Leadership Team and from the Ascension Health Hospital Engagement Network effort to prevent healthcare-associated infections and Michigan Health & Hospital Association Hospital Engagement Network to reduce CAUTI. Dr Saint has received numerous honoraria and speaking fees from academic medical centers, hospitals, group-purchasing organizations (eg, Premier, Veterans Health Administration), specialty societies, state-based hospital associations, and nonprofit foundations (eg, Michigan Health and Hospital Association, Institute for Healthcare Improvement) for lectures about catheter-associated urinary tract infection, implementing change, and leadership. This project was funded through a contract from the Agency for Healthcare Research & Quality to the Health Research & Educational Trust. No other potential conflicts of interest are noted.

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