Decreasing preventable hospital-acquired conditions by 40% by the end of 2013 is a goal established by the US Department of Health & Human Services. The initiative to reduce those conditions included a focus on healthcare-associated infections (HAIs), which occur in as many as 10% of hospitalized patients. Urinary tract infections (UTIs) are a leading cause of HAIs, and, according to researchers, most UTIs are related to the use of indwelling urinary catheters.
In 2008, the Michigan Health and Hospital Association Keystone Center for Patient Safety implemented a statewide program to reduce unnecessary use of urinary catheters in Michigan hospitals. Modeled after a successful program at a single Michigan hospital, the Keystone Bladder Bundle initiative (Bladder Bundle) focused on appropriate indications for indwelling urethral (or Foley) catheter use and prompt removal when an appropriate indication no longer exists.
Researchers recently conducted a data analysis to assess the key challenges to implementing the Bladder Bundle program from the perspective of participating hospitals. Analysis results were reported in JAMA Internal Medicine [2013;173(10):881-886].
The analysis assessed data collected through semistructured telephone interviews with key informants at 12 hospitals (study sample) as well as in-person interviews and site visits at 3 of the 12 hospitals. Among the study sample hospitals, 42% (n=5) had an infection control nurse or preventionist as the primary champion for the Bladder Bundle initiative, 25% (n=3) had a nurse or nurse manager, 17% (n=2) had a quality manager, and 8% (n=1) had a hospital epidemiologist or infectious diseases physician. Fewer than half (48%) of the 12 hospitals had a physician as a member of the Bladder Bundle team.
The analysis identified 3 key barriers to implementation of the initiative: (1) difficulty with nurse and physician engagement; (2) patient and family request for indwelling catheters; and (3) catheter insertion practices and customs in the emergency department (ED).
Strategies to address the identified barriers were noted by several of the participating hospitals: (1) incorporating urinary management as part of other patient safety programs; (2) explicitly discussing the risks of indwelling urinary catheters with patients and families; and (3) engaging with ED nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.
In commenting on the study, the researchers stated, “Meeting the goal of decreasing preventable hospital-acquired conditions as set forth by the US Department of Health & Human Services requires a national effort to address catheter-associated UTI (CAUTI). The Bladder Bundle initiative has increased use of key CAUTI prevention practices, reduced indwelling urinary catheter use, and potentially decreased CAUTI rates, thereby providing a foundation for quality improvement efforts to reduce CAUTI. Our qualitative findings—especially the solutions identified to overcome key barriers—can be used to enhance CAUTI prevention-related activities nationwide.”