Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units.
OBJECTIVE
To reduce catheter-related urinary tract infection rates in three intensive-care units to at or below the National Nosocomial Infection Surveillance System pooled mean for similar units.


METHODS
A nursing team, physician team, and laboratory team reviewed and revised protocols and procedures for better catheter management.


METHODS
A 500-bed community teaching hospital.


METHODS
The teams developed medical indications for urinary catheter placement and criteria that allowed the registered nurse to remove a catheter without a physician's order when no longer medically necessary. They created a computer prompt to assure a urinalysis accompanied all urine cultures.


RESULTS
After introducing the new protocols, the incidence density of catheter-related urinary tract infections fell 17% in the surgical intensive-care unit, 29% in the medical intensive-care acute unit, and 45% in the coronary intensive-care acute unit. The registered nurses' compliance in removing the catheter per protocol was 88%. Physician ordering of a concomitant urinalysis with each urine culture achieved 93%.


CONCLUSIONS
A multidisciplinary approach assisted in reducing catheter-associated urinary tract infections in three intensive-care units, although not to the extent desired. The teams are investigating preconnected and antimicrobial-coated catheters further.
Dumigan
D G
DG
Hospital of Saint Raphael, New Haven, CT 06511, USA.
Kohan
C A
CA
Reed
C R
CR
Jekel
J F
JF
Fikrig
M K
MK
D002408:Catheters, Indwelling / Q000009:adverse effects*; D003237:Connecticut / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D017408:Guidelines as Topic; D006746:Hospital Bed Capacity, 500 and over; D006764:Hospitals, Community / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009730:Nursing Assessment; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*