Abstract: Integrating Bladder Ultrasound: Into a Urinary Tract Infection-Reduction Project

JoAnne K. Phillips, MSN, CCRN. "Integrating Bladder Ultrasound: Into a Urinary Tract Infection-Reduction Project." American Journal of Nursing Supplement (March 2000).

Objectives:
* To examine the prevention and occurrence of urinary tract infections (UTIs), and to describe a UTI-reduction project which incorporated the use of a bladder ultrasound device.

Methods:
* In order to develop a program for the reduction of catheter-related UTI, a team of nurses and physicians at a surgical intensive care unit analyzed the rate of catheterization, and assessed who was inserting catheters and caring for catheterized patients, what equipment was being used, and when and where catheterization was performed.
* Recognizing that some patients require indwelling catheters, the team combined a list of absolute indications for the use of indwelling catheters with an assessment of mental status, mobility, and skin condition, in order to help the nursing staff determine which patients need indwelling catheters and for how long.
* In order to convince the staff that it was safe to remove a catheter from a patient at an earlier stage without worrying about urinary retention, the team introduced the BladderScan^®. The BladderScan^® was used to assess urine volume four hours after the patient's catheter was removed, and it was recommended that catheterization be performed if the urine volume was more than 300cc. If bladder volume was less than 300cc, the patient was scanned again after two hours.

Results:
* The pilot study was successful: the catheterization rate decreased from 0.89 to 0.81, a difference of high statistical significance. There was a 0% catheter reinsertion rate.
* Catheter-associated UTI dropped from 10 infections per 1,000 device days to 5.4 infections per 1,000 device days.
* "The UTI-reduction Project also helped us identify several other uses for the bladder scanner." These included assessing post-void residual; establishing a voiding schedule based on volume, rather than time, for patients unable to void due to disabilities such as spinal cord injury; and assessing the amount of urine in the bladder of a patient with an indwelling catheter, in order to determine if the catheter was obstructed and needed to be changed.

Conclusions:
* UTIs comprise approximately forty percent of nosocomial infections. Eighty percent of nosocomial UTIs are related to the use of indwelling urinary catheters. UTIs result in extended hospital stays for patients, increased costs, and are associated with an increase in mortality. "Patients with catheter-associated UTIs are three times more likely to die during hospitalization than all other patients."
* "The month before the introduction of the bladder scanner, the unit utilized 118 straight catheterization kits; in the month after the bladder scanner was introduced, that number dropped to two. The dollar savings in catheter kits over one year was $2,784. Far more importantly, approximately 1,392 intermittent catheterizations were avoided in the rehab unit. . . we potentially prevented 27 UTIs."
* "The use of an ultrasound bladder scanner was a critical factor in the success of this project. It enabled clinicians to non-invasively and accurately evaluate the need for catheterization. Our project supports this change as a "best clinical practice" approach."

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