American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Prevention of Post Op Catheter Associated Urinary Tract Infections (CA UTI) in Gynecology Surgery from the British Columbia Collaborative Hospital

April 16, 2014

Royal Inland Hospital joined ACS NSQIP in April of 2011 to improve surgical outcomes for its patients. Royal Inland Hospital implemented an initiative to reduce catheter associated UTI (CAUTI) project in May of 2012. Since the start of this work they have seen their UTI rates drop from 8% to fewer than 2%. They have also had 11 of 13 months without any CAUTI for their gynecology patients.

What Was Done?

Problem Addressed

Global Problem
CA UTIs are a leading cause of nosocomial infections in both medical and surgical patients. Risk assessment, preventative strategies, and surveillance can reduce rates of catheter-associated urinary tract infections (CAUTIs)

Identification of Local Problem
Post Op CA UTI in Gynecology Surgeries at RIH were identified as an opportunity for improvement. In the RIH SAR report dating January–December 2011 the Gynecology UTI was in the 10th decile and rated as High.

How Was the QI Activity Put in Place?

Context of the QI Activity

  • RIH is a 239-bed community hospital.
  • RIH joined NSQIP in April 2011 to improve surgical outcomes for its patients. NSQIP data provided opportunities for improvements that were not identified prior to joining the program.

Planning and Development Process

The first step was to bring together a multidisciplinary team to discuss the NSQIP data. The team was comprised of: QI, SCR, NSQIP Surgeon Champion, Gynecologist, Infection Control, OR Nurses, Gynecology Ward nurses, Patient Care Coordinator for Day Care Surgery (DCS) and Nurse Educators.

A project charter was developed with the Aim to Reduce post op Catheter Associated Urinary Tract Infections in Gynecology Surgery by 30% by March 31, 2013. QI project was based on the Model of Improvement.

Action Plan: Review what has already been done; other NSQIP sites, IHI and Best Practices.

A process map following a gynecology patient through the OR to discharge was conducted to determine gaps or barriers to best practice care.

The team reviewed the data and process map, spoke with additional staff members and determined, based on consensus of what they have observed, three areas of improvement were identified. Sterile insertion technique in the OR, Securement of the catheters post operatively and patient education regarding going home with a catheter (DCS patients).

Members of the team engaged staff members in their area with quick in-services and huddles.