For SoutheastHEALTH in Missouri, adding an infection preventionist to multidisciplinary rounds has resulted in zero catheter associated urinary tract infections (CAUTI) since February 2021.
The hospital’s quality improvement goal has always been to achieve and sustain CAUTI rates at zero, said Shelly Dooley, BSN, RN, CIC, Infection Preventionist at SoutheastHEALTH. The hospital’s journey to zero went over the top in January 2021 when their Zero Hero’s team met to review how two infections occurred. Dooley said a new infection preventionist (Leah Calla, BSN, RN, CIC), who is very passionate about removing catheters, had recently joined the staff and made it her mission to achieve zero CAUTIs.
“Leah joined the multidisciplinary team making rounds and developed a rapport with our staff,” Dooley said. “She has the confidence to address staff and physicians and is able to get them to buy into her reasoning.”
Another key component that led to the removal of catheters from patients, Dooley added, is that the infection preventionist has the support of the Intensive Care Unit (ICU) and Cardiothoracic Unit (CTU) managers and hospital administration. Trust and understanding need to be built between staff, Infection Prevention, and leadership to have the sometimes-challenging discussions about whether to remove a catheter or keep it in place.
Like many facilities in the United States, staffing numbers are tight at SoutheastHEALTH and that hardship only increased with the presence of COVID-19. Once a catheter is in place, staff who are short on time sometimes prefer to leave them in, said Dewayne Whitener, CPHQ, ASQ – CSSBB, CQE, CQA, CMQ/OE, Performance Improvement Specialist at SoutheastHEALTH.
The resolve of the new infection preventionist with the backing of leadership became a game changer for the hospital. Staff working with patients already know the protocols and have tools like a Clinical Pathway for Bladder Management and Urinary Catheter Decision Tree but having someone push for the removal of catheters made the difference, Dooley said. Leah would listen to the staff’s reasoning for retaining a catheter and then use the protocols and tools already in place to educate the staff and guide them to make a decision to remove a catheter when possible.
The new infection preventionist began asking that patients who did not meet criteria to maintain a catheter have a “foley vacation,” a trial period that hopefully becomes a permanent solution.
“You can’t get a CAUTI if you don’t have a catheter,” Whitener said.
The trust built between the new infection preventionist and the staff has been sustained. There is buy in to the long-term importance of removing catheters as soon as possible instead of finding reasons to leave them in.
Urinary catheters are also being discussed in Start-Up Safety Huddles on other units outside of critical care. There has been a reduction of catheter days in SoutheastHEALTH’s critical care units, and the hospital has not had a CAUTI since this change was implemented. SoutheastHEALTH is planning to expand these changes outside of the critical care units in 2022.