Catheter-Associated Urinary Tract Infection in Evidence-Based Practice

Why I choose this PICOT question

Catheter-associated urinary tract infection (CAUTI) is still a prevalent device-associated issue in healthcare institutions all over the world. This type of infection commonly occurs as a complication of inpatient hospitalization. The leading causes of CAUTI are contamination of the catheter upon insertion, catheter infection with some bowel movement bacteria, and the backward flow of urine into the bladder (Meddings et al., 2017). Moreover, the absence of timely drainage bag maintenance and not regular catheter cleaning can also lead to the infection of the patient. All of these reasons have practical origins, which means that most of them take place due to the mistakes and incompetency of healthcare staff. The proposal is aimed to address the catheter insertion issue seen as a part of CAUTI prevention to find the most suitable guideline for acute care hospitals to decrease the rate of healthcare-associated infections. The most appropriate EBP will be found after presenting and analyzing peer-reviewed external sources.

PICOT question

In hospitalized adult patients with indwelling urinary catheters, how does the sterile technique in urinary catheter insertion compared to non-sterile technique affect the CAUTI rate within hospitalization days?

Summarization and Synthesis of journal articles

Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. (December 2018)


CAUTI reached fourth place in the top of the most frequent infections that occur in acute care hospitals within the U.S. CAUTI is an infection that patients can contract in the hospital due to insertion of urinary catheter needed for patients who undertook surgery or for those who are not able to control bladder function. Indwelling catheters and mistakes made by nurses and other caregivers are the main causes of this clinical issue. Approximately 25% of patients who receive treatment in acute care hospitals are expected to be at risk due to catheter usage (Ferguson, 2018). Moreover, CAUTI is responsible for 13, 000 deaths per year, and for inducing secondary bloodstream infections. This type of clinical infection increases the health care costs for hospitals, which are not reimbursable. It also hurts the patients, including the longer length of hospital stay, higher discomfort, and mortality rate.


The nurses from two units of the acute care hospital underwent a CAUTI prevention educational program, which was given in an interactive and multifaceted way. Then the nurses’ knowledge of urinary catheter care and CAUTI occurrence was examined with the help of pre/post-survey design.


The interactive and multifaceted educational program involved 59 nurses from two units of the hospital with the highest urinary infection rate. Following three months, they completed the program, and findings demonstrated the overall increase in nurses’ knowledge. The program contributed to the significant reduction of CAUTI occurrence in both units. In one of them, the rate shrank to zero per 1,000 catheter days, in comparison to 7.49 before the program initiation.


This quality improvement project shows that a CAUTI avoidance program can help to improve the knowledge of nurses about modern indwelling catheter care and to decrease infection rates. Ferguson (2018) statistically proved that evidence-based practice, together with a proper educational program, can significantly improve patient care in hospitals. The author pointed at such methods as covering catheters in antimicrobial substances before insertion and adding them to the drainage bag. Nevertheless, the findings stated that the number of nurses who perceived those measures as useful was 10% lower than before the intervention. However, it could be explained by the CDC recommendation to use antimicrobial-covered catheters if the infection rate does not drop after establishing the CAUTI prevention program.

Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices. (March 2019)


There are multiple ways for a patient to be infected during urinary catheterization. Some of them include catheter contamination by the practitioner’s unclean hands and the collection system manipulation. According to Hernandez et al. (2019), all evidence-based strategies to avoid CAUTI can be grouped into a bundle of care which consists of four components: minimized application of catheters, insertion of the clean catheter, strict catheter maintenance in accord with guidelines, and continuous monitoring of catheter usage necessity.


This research is aimed to assess the impact of CAUTI education on nurses’ catheter management practice. Fifty nurses, allocated in different focus groups, were examined by researchers. The study was conducted in New Zealand in two surgical wards of the same hospital. The primary tool to gather data was the daily and self-administered Catheter Maintenance Checklist, which was used by nurses during the pre-intervention stage. Data was collected by checklists and then analyzed with the help of Microsoft Excel.


One of the checklist’s sub-headings was “catheter insertion,” and its findings showed that 58% of nurses successfully utilized the aseptic technique, applied sterile equipment, put lubricant, and prevented catheter movement. The findings also point to the importance of catheter usage education for both nurses and doctors to ensure quality improvement. The audit revealed that 82% of urinary catheters were detached during the first day after the surgery, and checklists helped to assess patients’ need for it. Moreover, enhanced hand hygiene among practitioners can effectively avert hospital-acquired infections.


Another study proves that urinary catheter care education is essential to decrease CAUTI incidence. The authors insist that multifaceted intervention is the only way to bring change to clinical practice. It consists of special guidelines for nurses, decision-making algorithms, and the daily catheter checklist application. This study provides excellent recommendations to educate nurses on the CAUTI prevention bundle and enhance hospital documentation by the implementation of the catheter maintenance checklist.

The strategy applies to improve and modify the practice

This evidence-based finding showed that some changes should be made in my practice area to improve patient outcomes. The risk of a patient getting CAUTI increases in cases when the urinary catheter usage is extended for a long period. It reaches a 100% probability after one month of usage (Meddings et al., 2017). Despite the limited evidence that aseptic insertion is useful, it is recommended to be used instead of clean, non-sterile insertion because it reduces CAUTI incidence in the long run. Hence, a quality improvement project (QIP) in acute hospitals has to be initiated to educate nurses and doctors. The sound clinical practice guideline should include sterile catheter insertion, proper catheter maintenance and removal, methods to minimize its usage, and proper process documentation. The bundle of CAUTI prevention care should be assessed and controlled with special checklists.

Barriers to change

  • Lack of knowledge of some nurses
  • Lack of skills and experience to apply the new EBP
  • Absence of proper EBP guidelines for nurses
  • Possible doctors’ resistance to change and being involved in the QIP

Factors that facilitate the modification of practice

  • Increased awareness of positive outcomes
  • Improved knowledge about urine catheter insertion
  • Well-designed education program about EBP
  • The checklist system provides the ability for nurses to self-check and to gather needed information for the future appraisal of the program.


I learned from this EBP research that clinical issues should be addressed and modified to increase care efficacy and patient safety, decrease health care costs by application of more effective and appropriate practice. CAUTI is still an important issue, and only a comprehensive approach to change clinical practice can decrease its rate. I realized that it is not often enough to alter one element of care, such as the catheter insertion approach, to address the clinical problem.


Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing, 38(6), 273-281.

Hernandez, M., King, A., & Stewart, L. (2019). Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices. Nursing Praxis in New Zealand, 35(1), 29-42.

Meddings, J., Saint, S., Krein, S. L., Gaies, E., Reichert, H., Hickner, A., McNamara, S., Mann, J. D., & Mody, L. (2017). Systematic review of interventions to reduce urinary tract infection in nursing home residents. Journal of Hospital Medicine, 12(5), 356-368.

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