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Introduction

• Catheter-associated urinary tract infections (CAUTI) are common, yet preventable healthcare-associated infections¹.
• In the Medical-Surgical Intensive Care and High Dependency Units (MSICU-HD), the average CAUTI rate was 2.73 per 1000 catheter days over three years.
• While lower than the national average at 3.17 per 1000 catheter days, there was room for improvement .
• This quality improvement project aimed to empower nurses to make clinical decisions on indwelling urinary catheter (IDC) removal, a responsibility historically helmed by physicians only.
• This project aims to reduce the CAUTI rate to below 2.0 per 1000 catheter days over the next 12 months.

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Methodology 

• A quality improvement framework Plan-Do-Study-Act cycle was adopted since October 2023.
• An algorithm-based stepwise protocol was developed (Figure 1).
• The protocol underwent peer review by both senior nursing staff and MSICU-HD physicians to ensure its safety and relevancy.
• During the initial roll-out, nurses were briefed on the interventions.
• Regular feedback was gathered, specifically stemming from timing for catheter removal, patient routine care, consumables accessibility, and logistic planning and arrangements that were resolved swiftly.

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Fig 1. Nurse-led on IDC removal protocol

Results

• After 6 months of trial, it revealed the protocol is safe, feasible and effective in promoting early IDC removal (Figure 2).
• There was no adverse event during the pilot phase.
• The impact of the implementation of nurse-driven in IDC removal was evaluated over the next six-month.
• The findings revealed a significant reduction of 35% in CAUTI rate was observed, reaching a new low of 1.90 per 1000 catheter days for year 2024 (Figure 3).
• CAUTI rate for Jan-Mar 2025 is 1.19 per 1000 catheter days.

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Fig 2. Nurse-led IDC Removal ilot

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Fig 3. CAUTI rate for MSICU-HD

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Discussion

• The nurse-driven protocol has clearly demonstrated its efficacy in promoting early IDC removal, thus preventing CAUTI rate.
• To ensure sustainability and long-term success in CAUTI prevention, the nurse-driven protocol may need to extend beyond MSICU-HD nursing leaders and to all bedside ICU/HD nurses to benefit more patients.
• This intervention revealed the vital role nurses play in reducing CAUTI rate.
• The success of the nurse-driven protocol in MSICU-HD suggests potential applications in other clinical settings.

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Conclusion

• The implementation of a nurse-led protocol in promoting early removal of urinary catheter had reduce CAUTI rate in the MSICU-HD.

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