title: An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure.
abstract: BACKGROUND
  Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality.
  
  
  OBJECTIVE
  The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates.
  
  
  METHODS
  This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure.
  
  
  RESULTS
  The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days.
  
  
  CONCLUSIONS
  The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes.
authors.affiliation: Stony Brook University School of Nursing, United States; Long Island Jewish Medical Center, United States. Electronic address: Janet.Galiczewski@stonybrook.edu.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Galiczewski
authors.affiliation: Stony Brook University School of Nursing, United States.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Shurpin
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D019370:Observation / Q000379:methods*; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000451:nursing / Q000592:standards*; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology*
keywords: Catheter Associated Urinary Tract Infection (CAUTI); Direct observation; Intervention; Protocol based-care intensive care unit (ICU)