ANA CAUTI Prevention Tool

The Partnership for Patients (PfP) is focused on quality improvement, patient safety and cost-effective patient care. Launched in 2011, PfP convened health care providers, hospitals, patients, and government and other stakeholders in a quest to reduce preventable hospital-acquired conditions (HAC) by 40% and 30-day admissions by 20% by the end of 2014. The program is funded by the Centers for Medicare and Medicaid Services (CMS) through the end of 2014.

Through the PfP, 26 Hospital Engagement Networks (HEN) are working to reduce HACs. Over 3,700 hospitals are currently operating within HEN as part of PfP. These organizations help identify, disseminate and engage interprofessional teams to use effective solutions that are reducing HACs. The PfP stakeholder partners work together to disseminate these findings to other hospitals and clinicians.  As an early and active partner of PfP, ANA leads multiple efforts with nurses to reduce HACs. In these efforts, ANA works closely with the ANA’s organizational affiliates.

Information for Patients and Families - What is CAUTI?

A urinary tract infection (UTI) is an infection in the urinary system, which includes the bladder and the kidneys. If you have a urinary catheter, bacteria or yeast can travel along the catheter and cause an infection in your bladder or kidney (also called Catheter-Associated Urinary Tract Infections [CAUTI]).

Urinary catheters should only be used when absolutely necessary and should be removed as soon as possible.

The Partnership for Patients (PfP) and the Centers for Disease Control and Prevention (CDC) have reported that although most HAC are improving, the rates for CAUTI are rising. According to the CDC, CAUTIs are the most commonly reported HAC to the National Healthcare Safety Network (NHSN) in the United States. Among urinary tract infections acquired in the hospital, approximately 75% are associated with urinary catheters. Therefore, it is important that the overuse of urinary catheters is reduced, and should be removed per nurse-driven evidence-based protocols. Nursing research has found there is no universally accepted evidence-based tool to reduce CAUTI as there are for other HAIs. As a partner of PfP, ANA took note of this tool gap and offers nurses an evidence-based, user-friendly tool to help prevent CAUTI in hospitals.

There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (1) prevention of inappropriate short-term catheter use, (2) nurse-driven timely removal of urinary catheters, and (3) urinary catheter care during placement. Nursing screening and assessment and evidence-based management of urinary retention and incontinence is essential to reduce catheter overuse. ANA identified the opportunity to fill the tool gap and develop a steam lined evidence-based tool to reduce CAUTI.

Using a consensus process, ANA assembled a technical expert panel (TEP) of nursing clinical experts to develop and disseminate an evidence-based CAUTI reduction tool for nurses with support by PfP. TEP members include ANA members, representatives from its specialty nursing organizational affiliates, infection control specialists and patient safety authorities.

Nurse consultants from the PfP team and representatives from CDC were included in the panel. After extensive review of evidence-based guidelines, existing CAUTI reduction tools, and a focused review of the literature, ANA and other TEP members developed a two-part multi-factorial CAUTI reduction tool designed for nurses (link to tool here). The one-page tool is based on the CDC’s 2009 “Guideline for Prevention of Catheter-Associated Urinary Tract Infections.” (Guideline for Prevention of CAUTI - CDC) The evidence-based tool incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments, as well as alternatives for retention and incontinence; timely removal; and a checklist on catheter insertion, cues for essential maintenance and post-removal care.

It is important that hospitals implement multiple successful “levers” that have been identified by the PfP and in the literature to successfully reduce CAUTI in addition to consistent use of the ANA CAUTI Prevention Tool. The ANA tool is essential to use as an effective practice change lever and is an important innovation to drive evidence-base care. In addition, additional levers have been identified including a safety culture, nurse-driven catheter removal (standing orders per protocols), incorporation of health information technology (e.g., clinical decision support and nurse protocols seamlessly cued to nurses in electronic health records), consultation by specialty nurses (e.g., nurses certified in wound, ostomy and continence nurses, urology, rehabilitation, infection control, geriatrics), and effective team-based programs such as Comprehensive Unit-based Safety Program (CUSP). By using multiple levers simultaneously, a tipping point to achieve reduction in the nation’s CAUTI rate can be achieved to save lives, prevent harm and reduce cost.