The Cost of Consistency

In 2014, a group of UB School of Nursing RN-BS students, Ann Duignan, RN; Naghma Mustafa, RN; Michelle Poole, RN; Leah Puckett, RN; and Jacqueline Somma, RN, PCCN, used their quality improvement project as an opportunity to attack an issue that is common and costly in terms of both lives and resources, for individuals and institutions – catheter-associated urinary tract infections (CAUTI), the most frequently reported health condition acquired at hospitals, according to the American Nurses Association (ANA).

The Centers for Disease Control suggests that as many as 70 percent of all CAUTI cases are preventable and indicates that the annual cost to the United States is between $400 and $500 million and an estimated 13,000 lives. Mustafa also notes that CAUTIs can extend a patient’s hospital stay by two to four days.

“Besides the financial burden, CAUTIs take a physical and emotional toll on patients and their families – all for an infection deemed preventable by following evidence-based guidelines,” Mustafa says.

The team, studying the North Shore Long Island Jewish Health System adult telemetry unit in Nassau County, N.Y., examined the question, “What can nurses do to decrease the number of CAUTIs in a hospital setting?” and determined that a CAUTI prevention bundle – a structured small set of practices that, when performed consistently, improves patient outcomes – should be implemented for all clients in an inpatient setting regardless of age.

“CAUTIs are prevalent in the hospital and community and have such devastating effects, especially on the elderly, as they often lead to sepsis,” Duignan explains. “We wanted to know if there was evidence that showed whether a specific protocol for inserting a Foley catheter was associated with lower rates of infection.”

Though there was not one particular protocol that was more effective than others, Duignan notes, “Institutions adhering to their own consistent protocols have lower CAUTI rates, which seems to indicate that a consistent protocol is most effective.”

The group indicates that with the annual estimated cost of implementing a CAUTI prevention bundle at about $16,500, doing so would certainly be cost-effective when an institution considers the cost of CAUTIs without such a protocol.

“Nurses should participate actively towards implementation of evidence-based practice (EBP) in their respective organizations,” Mustafa says. “The number of research studies in databases is overwhelming, so the real challenge is filtering the information and coming up with EBP interventions that are practical, cost effective and sustaining.

“The EBP project has ignited in me the spirit of inquiry, and I hope to continue to act as an EBP mentor, leader and innovator.”

- SARAH GOLDTHRITE