• D G Dumigan, C A Kohan, C R Reed, J F Jekel, and M K Fikrig.
• Hospital of Saint Raphael, New Haven, CT 06511, USA.
• Clin Perform Qual Health Care. 1998 Oct 1;6(4):172-8.

ObjectiveTo reduce catheter-related urinary tract infection rates in three intensive-care units to at or below the National Nosocomial Infection Surveillance System pooled mean for similar units.DesignA nursing team, physician team, and laboratory team reviewed and revised protocols and procedures for better catheter management.SettingA 500-bed community teaching hospital.InterventionsThe teams developed medical indications for urinary catheter placement and criteria that allowed the registered nurse to remove a catheter without a physician's order when no longer medically necessary. They created a computer prompt to assure a urinalysis accompanied all urine cultures.ResultsAfter introducing the new protocols, the incidence density of catheter-related urinary tract infections fell 17% in the surgical intensive-care unit, 29% in the medical intensive-care acute unit, and 45% in the coronary intensive-care acute unit. The registered nurses' compliance in removing the catheter per protocol was 88%. Physician ordering of a concomitant urinalysis with each urine culture achieved 93%.ConclusionsA multidisciplinary approach assisted in reducing catheter-associated urinary tract infections in three intensive-care units, although not to the extent desired. The teams are investigating preconnected and antimicrobial-coated catheters further.

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