Background
Preventing CAUTI
Methods/Design
Aims
Design
Setting
Health District | Facility | Beds |
---|---|---|
1 | Hospital A | 360 |
Hospital B | 260 | |
Total beds Health District 1 = 620 | ||
2 | Hospital C | 549 |
Hospital D | 318 | |
Total beds Health District 2 = 867 |
Data collection
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Pre and post implementation point prevalence and patient demographics (quantitative)
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Pre and post implementation clinician knowledge and competence (quantitative)
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Post implementation perceived barriers and enablers to implementation (qualitative)
Data | Data collection method | Data source(s) | Data collected | Data collection timepoint(s) |
---|---|---|---|---|
IDC usage rate and incidence of CAUTI | Online data collection tool | - Patient medical records – facility-wide across all four hospitals - Bedside observation - Infection control database | - Urinary catheter presence - Days catheter in situ - CAUTI rate | - Baseline - 4 months post-implementation commencement - 9 months post-implementation commencement |
Patient profile | Data extraction and then merge with data from point prevalence | - Electronic patient management systems | - Patient demographics including age, gender, weight, diagnosis, type of admission | - Baseline - 4 months post-implementation commencement - 9 months post-implementation commencement |
Clinician knowledge and competency | Online survey | - Clinicians (all nurses and medical officers invited from participating hospitals) | - Clinician competency - Clinician knowledge of CAUTI prevention - Perception of unit-based culture | - Baseline - 6 months post-implementation commencement |
Barriers and enablers to implementation | Focus group | - Clinicians (6–8 per facility) (all nurses and medical officers invited from participating hospitals) | - Perceived barriers and enablers to implementation | - 6 months post-implementation commencement |
Exclusion and inclusion criteria
Multifaceted intervention
N | NEED for catheter assessed – refer to indications, scan bladder, consider alternative, document indication. - Scan the bladder to determine bladder volume [7] |
O | OBTAIN patient consent, OFFER patient education including hygiene. - Obtain patient consent and importance of accurate complete documentation. - Provide written and verbal information to patient/carer [49] |
C | COMPETENCY – clinicians who insert catheters must have documented competency |
A | ASEPSIS – maintain asepsis & hand hygiene during insertion and while catheter is in place. - Aseptic technique and sterile equipment must be used for IUC insertion. Hand hygiene “Moment 2” and non-sterile gloves is recommended when manipulation of the IUC or drainage system is required. - Empty the bag when ¾ full and use a clean container for each patient; avoid contact between outlet and container. |
U | UNOBSTRUCTED flow – no kinks or loops, catheter secured, bag below bladder level and off the floor. |
T | TIMELY catheter removal and documentation – may be nurse initiated. |
I | INFECTION risk – daily periurethral hygiene. Collect urine specimen only when clinically indicated. - Infection and catheter specimen urine (CSU) collection: must be collected using aseptic technique, from a newly inserted catheter and before the commencement of antimicrobials |
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IDC insertion criteria guidelines
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Indications for IDC specimen collection
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Nurse-led IDC removal guidelines (Additional file 1)
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Educational resources and compliance auditing tools
No CAUTI Bundle
Implementation strategies
Implementation Strategy | Rationale | Mode of delivery | Delivered by | Delivered to and where | When/how often |
---|---|---|---|---|---|
Education | |||||
Train-the-trainer workshops | To prepare educators to present the “No CAUTI” bundle to ward-based staff, and to train educators to complete urinary catheterisation competency assessments | Face-to-face (group) | Clinical nurse consultant – urology | Nurse educators from across hospital | 1x 2-3 h workshop at each facility at start of intervention |
Ward in-services | To familiarise staff with “No CAUTI” bundle and nurse-initiated removal flowchart To identify champions in each ward | Face-to-face (group) | Nurse educators | Nurses and medical officers from all adult inpatient wards, OTs, and EDs | Minimum 1x 20 min in-service in each ward at start of intervention |
Monitoring and feedback | |||||
Compliance audits and feedback | To monitor compliance with “No CAUTI” bundle and provide strategies to support implementation | Individual patient audit, and feedback face-to-face (group) to clinicians | Champions (clinicians previously identified in in-services) | All inpatient wards | Weekly for first two months and then monthly for remaining 4 months of intervention period. |
Feedback of point prevalence of IDC usage and CAUTI | To focus clinicians on targets and progress | Face-to-face (group) and email | Research project staff | All clinicians at a ward, facility, and district level | Baseline, 4 months, and 9 months |
Resources | |||||
“No CAUTI” bundle posters | Prompt awareness and better documentation | Documents displayed in wards | N/A (passive component) | Nurses and medical officers | Ongoing |
“No CAUTI” bundle badges | Prompt awareness of intervention and identify ward champions | Worn by clinicians and champions | N/A (passive component) | Nurses and medical officers | Ongoing |
Catheter insertion DVDs | Educate nurses about correct catheterisation processes | Available on intranet | N/A (passive component) | Nurses | Ongoing |
Facilitation | |||||
Competency assessments | Increase proportion of clinicians that are competent in urinary catheterisation | Face-to-face (individual) | Nurse educators | Nurses | Ongoing |
Champions | Act as a resource for clinicians and promote the No CAUTI bundle to clinicians; support implementation | Face-to-face (individual and group) | Nurses | Nurses and medical officers | Ongoing |