Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Sandra Cleveland

Second Advisor

Dr. Brandee Temmis

Third Advisor

Dr. Melanie Brewer

Abstract

Problem: Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections in intensive care units (ICUs), contributing to increased morbidity, prolonged hospital stays, and elevated healthcare costs. Despite established prevention guidelines, inconsistent practices in catheter removal and gaps in daily necessity reviews persist. At the project site’s 24-bed ICU, the CAUTI rate was 1.9 per 1000 catheter days, which exceeds the national benchmark of 1.0. Gaps in consistent assessment of necessity and delays in removal contributed to an elevated infection risk.

Aim of the Project: This project aimed to reduce CAUTI rates in the ICU through evidence-based interventions focused on daily catheter necessity assessments and nurse-driven removal protocols.

Review of the Evidence: The current evidence supports the necessity of daily catheter assessment and nurse-driven removal as key interventions to reduce CAUTI rates. Implementing a bundled approach that combines education, standardized tools, and timely feedback has been shown to improve adherence to best practices and reduce infection rates.

Project Design: This quality improvement project used the Plan-Do-Study-Act (PDSA) framework and OhioHealth Change Management (OHCM) model to guide an eight-week intervention. Baseline data and readiness assessments informed implementation. CAUTI rates, catheter utilization, and compliance with assessment and removal protocols were measured both before and after the intervention.

Intervention: The intervention included staff education on CAUTI prevention strategies, implementation of a standardized catheter necessity assessment tool incorporated into daily workflow, and a nurse-driven removal protocol. Real-time audit tools were provided to track compliance, inform PDSA cycles, and provide feedback, promoting sustained adherence.

Significant Findings/Outcomes: The intervention led to a reduction in CAUTI rates, improved accuracy and consistency in catheter necessity documentation, and increased nurse engagement in catheter management. Process measures demonstrated sustained improvements in compliance, and balancing metrics confirmed that there were no adverse effects from early catheter removal.

Implications for Nursing: This project highlights the crucial role of nurse-led interventions in reducing CAUTI rates, enhancing patient safety, and fostering a culture of accountability. Embedding nurse-driven protocols into ICU workflows fosters sustainable practice change and supports the achievement of institutional quality and safety goals. Ongoing education, leadership support, and continuous monitoring are key to sustaining improvements.

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