APRNs Develop Institutional Bladder Irrigation Guideline That Dramatically Reduces CAUTI Rates

May 31, 2023 by Elisa Becze BA, ELS, Editor

Implementing intermittent bladder irrigation (IBI) guidelines reduces catheter-associated urinary tract infection (CAUTI) rates by more than 80%, ONS member Christine Wallace, MSN, APRN-CNS, said during a podium presentation (https://doi.org/10.1188/23.ONF.E1) at the 48th Annual ONS Congress® in April 2023.

Researchers conducted a retrospective chart review from 2020 and found that 15% of their institution’s CAUTI cases were associated with bladder irrigation. Their subsequent literature review revealed that nursing and provider national standards are lacking, no closed irrigation system is currently approved in the United States, and manufacturers of indwelling Foley catheters do not recommend using the sample port for IBI.

They initiated an advanced practice RN (APRN)-led quality improvement project to reduce CAUTI rates to zero by creating and implementing a guideline for a manual aseptic IBI procedure for patients with cancer. The APRNs crosswalked findings from the limited literature to identify a mix of sterile and aseptic techniques for the procedure, Wallace said, then simulated the procedure under both conditions. Because sterile IBI required two practitioners, their final recommendation was aseptic technique.

The APRNs drafted an IBI guideline for final approval from senior nursing and provider leadership in both the medical center and system-level committees. All inpatient oncology nurses completed mandatory education in November 2021 and receive a didactic practice review during their annual competencies.

Six months after implementing the IBI guidelines and education, CAUTI rates dropped dramatically—by 83%, Wallace said.

“The lack of clear, evidence-based practice guidelines for an IBI procedure has potential to negatively affect the care of immunocompromised patients with cancer and warrants future research,” Wallace said. “A systematic process that included literature reviews, outreach to professional organizations and manufacturers, simulation of proposed guidelines, and comprehensive nursing education was an effective method to reduce CAUTI rates. Our future initiatives include ongoing surveillance of practice and an electronic medical record order set for IBI to support practice.”

Learn more about bladder cancers and preventing infections in immunocompromised patients with cancer through the ONS resources listed in the sidebar.

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