title: Evidence-based prevent catheter-associated urinary tract infections guidelines and burn-injured patients: a pilot study.
abstract: The objective of this pilot study was to describe effectiveness of an evidence-based guideline designed to prevent catheter-associated urinary tract infection (CA-UTI) in reducing CA-UTI in the burn-injured patient population. The study used a pre- and post-bundle implementation comparison design. Inclusion criteria included burn-injured patients of all ages with an indwelling urinary catheter. Patient demographic data were collected by medical record review when informed of a CA-UTI. The Rosswurm-Larrabee Model six-step process model guided implementation of practice change. The sample included eight burn-injured patients (7-88 years). Catheter day range was 1 to 27 days. Each patient had a clear indication for an indwelling urinary catheter; the need for accurate urinary output measurement in a critically injured patient. Four patients had a catheter placed twice during the stay. Nurses reported using a bladder scanner to assess bladder volume for post-operative patients with urinary retention avoiding use of an indwelling urinary catheter in some cases. Integration of evidence-based guidelines in practice resulted in a reduced CA-UTI rate, reduced catheter days, increased days between CA-UTI, and outperformance of the national benchmark statistic. In 2013, the burn unit reduced catheter days by about 75% and reduced infection incidence by >90% in three quarters after implementation of the practice changes. The unit was able to sustain a CA-UTI rate of zero for 248 days.
authors.affiliation: From the *Akron Children's Hospital, Ohio; and †Walsh University, North Canton, Ohio.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Christ-Libertin
authors.forename: Sharon
authors.initials: S
authors.lastname: Black
authors.forename: Theresa
authors.initials: T
authors.lastname: Latacki
authors.forename: Tina
authors.initials: T
authors.lastname: Bair
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002053:Burn Units; D002056:Burns / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult