Catheter-associated urinary tract infections (CAUTIs) were on the rise in Carilion Clinic’s Roanoke Memorial Hospital (a teaching hospital with more than 800 beds), and particularly in the Intensive Care Units (ICUs), where the rate peaked at 9.1, well above the internal target of 2.8.
Prior standard means to educate—including live-in services, policies to read and sign, assigning online modules—did not affect CAUTI rates. One ICU, led by the educator from Human Resources (HR), listened to the staff’s request for hands-on learning. They designed and delivered education with the format of staff demonstrating their practice. The unit leaders, who were up to date with policy and evidence, gave them feedback in real time regarding those things they did right, as well as correction needed. That unit had five CAUTIs in the three months prior to the education and none in the three months after.
Program Details
Carilion Clinic’s Infection Control Department requested this education be replicated throughout the ICUs and other units. The education was based on the idea that one-to-one demonstration creates an environment in which the participant must “own” his or her practice, yet can be corrected in private. A team of three educators and a trainer from the EMR set up train-the-trainer sessions, initially for the ICUs, and later for the Progressive Care Units (PCUs) and Med-Surg units. Education sessions were one hour and had a maximum capacity of four participants, during which the participants moved through four stations in no particular order for 15 minutes each. The four stations included:
- Feedback scripts and advice on replicating this training format on their units
- Demonstration of processes that are outlined in policy
- Discussion and demonstration of concerns not specifically outlined in policy
- Demonstration of correct and consistent urinary catheter documentation in the electronic medical record (EMR)
Documentation would not prevent an infection, but it could help identify problems when investigating a CAUTI that could help to prevent the next one. Pelvic mannequins were used in the education and made available for units to borrow. To standardize the education for the trainers, a script was developed with scenarios specific to the level of care, including questions to ask and answers outlined.
Results
The ICUs were educated throughout the month of May 2014. Thirty staff members attended the training. The PCU and Med-Surg units were educated in July 2014. Thirty-two nurses received that training. Participants filled out evaluation forms upon completing the education and these demonstrated enthusiasm about the format, as well as new learning. The ICU CAUTI rate for Roanoke Memorial Hospital decreased from the peak of 9.1 in March 2014 to 6.6 in July 2014. Carilion Clinic has five outlying facilities that requested this education, and plans were in place to educate other facilities last fall.
