Preventing CAUTI during staffing shortages: 4 success factors

Consider this: A recent survey by McKinsey & Company found that 1 in 3 registered nurses who provide direct patient care may quit their jobs in the next year. The current shortage is causing many nurses to leave the bedside due to burnout and frustration, opportunities for more compensation as a travel nurse or retirement.¹

Though short-staffed, you’re dedicated to providing the best care to patients. This includes working to prevent healthcare-associated infections (HAIs) such as catheter-associated urinary tract infections (CAUTIs). But how do you bring new hires and travel nurses up to speed quickly?

When you put the right success factors in place, you can COPE. Let’s take a look at how to do it.

You wouldn’t bring passengers onboard a leaky ship, right? Before you consider what new and travel nurses need, you should have a solid infrastructure in place for catheter care.

“You need a good core champion in each unit to be on your CAUTI team,” says Mary Pat Eble, MSN, RN, Medline National Clinical Product Specialist, Urology. “Look to nurses who are very engaged in the nursing process. They want to be champions and be on committees—be the go-to person in the unit.”

What about processes and protocols?

“I’m continuing to see high rates of unnecessary Foley use,” says Jean Ferguson, BSN, CCRN, VA-BC, Medline Manager of Clinical Resources – Acute Care. “Many facilities have said they’ve implemented a nurse-driven protocol. But people aren’t necessarily following it.”

Why? A lot of gaps are because leadership has created the protocols without input from the frontline staff using them, according to Eble.

“They have all these protocols that allow the nurse to practice with more autonomy so they don’t have to wait for a physician’s order,” says Eble. “It’s great that leadership is involved, but when they make decisions and push them downstream, staff are confused and less engaged.”

A transformative leader will allow change to come from the bottom up, where the boots are on the ground. When staff are encouraged to provide input, they’ll be your champions, Eble adds.

Eble and Ferguson emphasize the importance of providing the “whys” for every task and process, for example, why using Foley alternatives helps drive CAUTI rates down and why it’s so important to remove a catheter as soon as it’s no longer needed.

“Onsite, make sure to have posters and cheat sheets available where they’re easily accessible and easy to view at a glance,” Eble adds.

These educational pieces also can be used for new full-time nurses. When possible, try to provide ongoing education to full-time and travel nurses together to help them build a rapport and learn from each other.

Let’s take a closer look at the nurse-driven protocols that were mentioned earlier.

“You’ll want to follow the American Nurses Association (ANA) evidence-based tool for CAUTI prevention and develop your nurse-driven protocol from it,” says Eble.

The ANA tool includes best practices for determining if an indwelling urinary catheter is necessary, catheter insertion and maintenance, bladder scanning and straight catheterization.³

You can use process and product bundles in your protocol to promote standardization in care. For example, it’s important to document catheter insertion and removal dates as well as indications and reminders for removal in your electronic medical record (EMR). Bundles in the EMR, which include catheter insertion, management and surveillance guidelines, make a positive difference. In fact, they were associated with a 37% reduction of ICU CAUTI rates in developing countries.²

“I recommend creating bladder, insertion, and care and maintenance bundles,” says Eble.

The bladder bundle is about bladder scanning, straight cathing, and Foley alternatives such as external catheters. Then you have your insertion bundle for Foleys. The care and maintenance bundle includes perineal care, catheter care, sampling, removal and positioning.

“A shortage of nurses means a shortage of nurse educators,” says Ferguson. “That leads to less time for onboarding.”

When you collaborate with an industry partner, you’ll get help with education, bundles, products and more. For example:

• A discovery assessment with actionable recommendations
• Online, in-person and train-the-trainer education
• Products such as a Foley insertion kit that streamlines the IUC insertion process
• Products such as bladder scanners and today’s external catheters that enable staff to use a Foley only when it’s needed

All to help you in the fight for zero CAUTIs.

It’s challenging to get travel nurses up to speed when you’re already short-staffed. If you can COPE—use champions, onboarding, protocols and bundles, and an engaged partner, you’ll be better positioned to get the whole nursing staff up to speed on CAUTI prevention.