ÌìÃÀ´«Ã½

Newswise — Exchanging indwelling catheters after an initial positive urinalysis improved diagnostic accuracy and contributed to two consecutive quarters with no catheter-associated urinary tract infections (CAUTIs) in a step-down unit at a New York specialty hospital.

“” details a nurse-led quality improvement project at Memorial Sloan Kettering Cancer Center, New York. The study is published in Critical Care Nurse ().

The quality improvement initiative led to a new evidence-based workflow that included replacing an indwelling catheter when a urinalysis came back positive for bacteria, nitrates and leukocytes and then immediately collecting a urine culture from the sample port of the newly replaced urinary catheter.

In 2020, during the COVID-19 pandemic, the 36-bed mixed medical/surgical and step-down unit was converted to a popup COVID-19 intensive care unit (ICU). The change in patient population resulted in a dramatic increase in indwelling urinary catheter use and placement duration, followed by a seven-fold increase in CAUTI rates.

A formal diagnosis of CAUTI is made when a urinary catheter has been in place for at least two consecutive days, and the microbiological evaluation of urine cultures reveals specific quantities of bacteria. The presence of the patient’s symptoms is recommended to determine the need for urine cultures, since a positive microbiological finding can easily confuse catheter-associated asymptomatic bacteriuria (CA-ASB) as CAUTI.

Adopting the catheter exchange workflow in adult patients helped improve diagnostic distinction between CA-ASB and CAUTI and reduce false-positive test results, thus improving patient care and safety.

“This project highlights the value of having frontline staff members drive change and promote clinical buy-in,” said co-author Kathleen Romano, DNP, RN, PCCN, a nurse leader in the step-down unit. “Interprofessional collaboration was a key element to developing the revised workflow and remains crucial to its successful implementation.”

The pilot program ran over three consecutive quarters through the end of 2021 in both the step-down unit and an 18-bed ICU. The full catheter exchange workflow was used for seven patients in the step-down unit; all had positive urinalysis results from existing catheters (in place for more than 24 hours) and negative urine culture results after the catheter was exchanged. Data from the ICU were excluded from the final review due to poor workflow adherence during the study period.

Further confirming the benefits of the new workflow, a review of a reported CAUTI case during the pilot period revealed that the initial sample collected did not follow the new workflow and tested positive. During the next shift, a second urine culture was collected after catheter exchange and was found to have no bacteria present, with no intervening changes in patient care or antibiotic therapy.

Implementation of the new protocol resulted in a major reduction in the diagnosis of CAUTI, with no incidents occurring for two consecutive quarters. Based on these results, the evidence-based workflow has been formally incorporated as the standard of care for all adult patients with indwelling urinary catheters.

As AACN’s bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at .

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at .

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme