NURS 8114 Blog Observation of Evidence-Based Practice Walden
CAUTI prevention is an area of focus at my facility as well. Earlier this year, a new bladder management protocol was implemented for non-urologic patients. Most of the elements were already in practice, but there were a few additions. The whole protocol is very comprehensive, so I will just give you some highlights. Before inserting an indwelling catheter, a “Foley Time Out” must be completed. This requires the nurse to ensure an order for the Foley has been entered and includes documentation of an appropriate indication for the indwelling catheter. Once the catheter has been inserted, nursing has to document whether the two-person insertion method was used. Fletcher-Gutowski and Cecil (2019) identified the two-person insertion method as influential in CAUTI reduction as it draws more attention to the use of aseptic technique. The bladder management protocol also includes a nurse-driven Foley removal protocol. Each shift, indications for the Foley are reviewed and if the patient no longer meets indication requirements, the Foley is removed. Nurse-driven protocols for removal have been shown to decrease CAUTI rates (Durant, 2017). This is largely due to the timely removal of the indwelling catheter since it is not necessary to call a physician for a removal order. McNeill (2017) identified the duration of indwelling catheter placement as the greatest predictor of CAUTI. One could infer the “early” catheter removal noted in your post is related to the desire to remove the indwelling catheter as quickly as possible in order to avoid CAUTI.
Similar to what you mentioned is happening in your ICU, we also complete bladder scanning post-removal if patients have been unable to void. The timing of the repeat scan depends on the amount of urine in the bladder. If the bladder contains less than 400 ml, the patient is rescanned in two hours if they have not yet voided. If the bladder contains more than 400 ml, it is emptied via straight catheterization and the patient is rechecked with a bladder scan in four hours. After three straight catheterizations are required, an indwelling is reinserted. Overall, implementation of this protocol has gone well; although, I have not yet seen a comparison of pre-implementation CAUTI rates to post-implementation rates.
Durant, D. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. American Journal of Infection Control, 45(2017), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020
Fletcher-Gutowski, S., & Cecil, J. (2019). Is 2-person urinary catheter insertion effective in reducing CAUTI? American Journal of Infection Control, 47(2019), 1508-1509. https://doi.org/10.1016/j.ajic.2019.05.014
McNeill, L. (2017). Back to basics: How evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 37(4), 204-206. https://doi.org/10.7257/1053-816X.2017.37.4.204