Reducing Catheter-Associated Urinary Tract Infections on a Medical-Surgical Unit: An Evidence-Based Practice Proposal
Clinical Problem
Catheter-associated urinary tract infections (CAUTIs) remain among the most common health care–associated infections in U.S. hospitals. Each CAUTI can lengthen a patient’s stay, increase antibiotic exposure and raise the risk of complications such as bacteremia. Because the leading risk factor is simply the duration of catheterization, CAUTI is widely considered a preventable harm — and one in which bedside nurses hold significant influence.
PICOT Question
In adult medical-surgical inpatients with indwelling urinary catheters (P), does a nurse-driven catheter removal protocol (I), compared with physician-order-dependent removal (C), reduce CAUTI rates (O) over a six-month period (T)?
Synthesis of the Evidence
National prevention guidance from the Centers for Disease Control and Prevention (CDC) emphasizes inserting catheters only for appropriate indications and removing them as soon as they are no longer needed. Nurse-driven removal protocols put that principle into practice: a nurse assesses each catheter daily against a list of appropriate indications and removes it without waiting for a separate order when no indication remains. Across quality-improvement reports, these protocols are consistently associated with shorter catheter dwell times, and shorter dwell times are associated with fewer infections.
Implementation Plan
The proposal follows a Plan-Do-Study-Act (PDSA) cycle. Key steps include securing support from the unit manager, infection prevention team and hospitalist group; educating nursing staff on the indications checklist; adding a daily catheter necessity prompt to the electronic health record; and tracking catheter days and CAUTI rates monthly. Staff feedback sessions at 30 and 90 days allow the protocol to be refined before hospital-wide adoption.
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