Evidence-based prevent catheter-associated urinary tract infections guidelines and burn-injured patients: a pilot study

J Burn Care Res. 2015 Jan-Feb;36(1):e1-6. doi: 10.1097/BCR.0000000000000193.

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Burn Units
  • Burns / therapy*
  • Catheters, Indwelling / adverse effects*
  • Child
  • Clinical Protocols
  • Evidence-Based Medicine*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pilot Projects
  • Practice Guidelines as Topic*
  • Urinary Catheterization / adverse effects*
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / prevention & control*
  • Young Adult