NURSING ECONOMIC$/November-December 2015/Vol. 33/No. 6320 C ATHETER-ASSOCIATED urinary tract infections (CAUTI) continue to challenge com- munity hospitals. Hospital- acquired urinary tract infections account for 40% of hospital-ac quir - ed infections, with 80% of those in - fections related to use of a urinary, or Foley, catheter (Gokula, Smolen, Gaspar, Hensley, Benninghoff, & Smith, 2012; Hanchett, 2012). Given the rising cost of treating CAUTI, the Centers for Medicare & Medicaid Services (CMS) identi- fied hospital-acquired CAUTI as one of eight conditions for which hospitals would no longer receive reimbursement as of October 1, 2008 (Milstein, 2009). Community hospitals, therefore, are charged with implementing innovative strategies that will reduce the inci- dence of hospital-acquired CAUTI. A variety of strategies have been explored in nursing and other scientific literature for decreasing the incidence of CAUTI. Practical suggestions, such as stickers on pa - tients’ medical records or comput- er-generated reminders, along with implementation of evidence-bas - ed guidelines for Foley cathe ter maintenance, have been offer ed as potential solutions (Bruminhent, Keegan, Lakhani, Roberts & Passalacqua, 2010; Gokula et al., 2012; Wilson et al., 2009). The majority of literature, however, has been focused on tertiary or academic medical centers and long-term care facilities White Plains Hospital is a 301-bed non-academic communi- ty hospital in the suburbs of New York City that has implemented a nurse-driven process that reduced the incidence of CAUTI 50% within 1 year of implementation. The incidence of CAUTI contin- ues to decline to date with the goal of eventually having zero hospital- acquired CAUTI events. Further, with the decline in the incidence of CAUTI, costs decreased sub- stantially. White Plains Hospital’s nurse-driven, cost-effective pro - cess for reducing CAUTI is des - cribed. The ideas and steps taken to implement and sustain the process are outlined, along with suggestions for how nurse leaders in similar clinical settings can replicate the process. Background In 2007, White Plains Hospital experienced a transition in its sen- ior nursing leadership that reor- ganized the roles and responsibil- ities of the directors of nursing. The incoming chief nursing offi- cer launched the nursing division on its Magnet® journey and creat- ed an innovative role for the organization: the director of nurs- ing quality. This senior nursing EXECUTIVE SUMMARY Due to treatment costs and lack of reimbursement, community hospitals are charged with imple- menting innovative strategies that will reduce the incidence of hos- pital-acquired catheter-associated urinary tract infections (CAUTI). A nurse-driven system for decreasing the number of hospi- tal-acquired CAUTI is effective and useful for a community hos- pital. One nurse with accountability for implementing a simple evidence- based protocol can dramatically decrease the t ...

1. NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6320
C
ATHETER-ASSOCIATED urinary
tract infections (CAUTI)
continue to challenge com-
munity hospitals. Hospital-
acquired urinary tract infections
account for 40% of hospital-ac quir -
ed infections, with 80% of those in -
fections related to use of a urinary,
or Foley, catheter (Gokula, Smolen,
Gaspar, Hensley, Benninghoff, &
Smith, 2012; Hanchett, 2012).
Given the rising cost of treating
CAUTI, the Centers for Medicare
& Medicaid Services (CMS) identi-
fied hospital-acquired CAUTI as
one of eight conditions for which
hospitals would no longer receive
reimbursement as of October 1,
2008 (Milstein, 2009). Community
hospitals, therefore, are charged
with implementing innovative
strategies that will reduce the inci-
dence of hospital-acquired CAUTI.
A variety of strategies have
been explored in nursing and other
scientific literature for decreasing

2. the incidence of CAUTI. Practical
suggestions, such as stickers on pa -
tients’ medical records or comput-
er-generated reminders, along with
implementation of evidence-bas -
ed guidelines for Foley cathe ter
maintenance, have been offer ed as
potential solutions (Bruminhent,
Keegan, Lakhani, Roberts &
Passalacqua, 2010; Gokula et al.,
2012; Wilson et al., 2009). The
majority of literature, however,
has been focused on tertiary or
academic medical centers and
long-term care facilities
White Plains Hospital is a
301-bed non-academic communi-
ty hospital in the suburbs of New
York City that has implemented a
nurse-driven process that reduced
the incidence of CAUTI 50%
within 1 year of implementation.
The incidence of CAUTI contin-
ues to decline to date with the goal
of eventually having zero hospital-
acquired CAUTI events. Further,
with the decline in the incidence
of CAUTI, costs decreased sub-
stantially. White Plains Hospital’s
nurse-driven, cost-effective pro -
cess for reducing CAUTI is des -
cribed. The ideas and steps taken
to implement and sustain the
process are outlined, along with

3. suggestions for how nurse leaders
in similar clinical settings can
replicate the process.
Background
In 2007, White Plains Hospital
experienced a transition in its sen-
ior nursing leadership that reor-
ganized the roles and responsibil-
ities of the directors of nursing.
The incoming chief nursing offi-
cer launched the nursing division
on its Magnet® journey and creat-
ed an innovative role for the
organization: the director of nurs-
ing quality. This senior nursing
EXECUTIVE SUMMARY
Due to treatment costs and lack
of reimbursement, community
hospitals are charged with imple-
menting innovative strategies that
will reduce the incidence of hos-
pital-acquired catheter-associated
urinary tract infections (CAUTI).
A nurse-driven system for
decreasing the number of hospi-
tal-acquired CAUTI is effective
and useful for a community hos-
pital.
One nurse with accountability for
implementing a simple evidence-
based protocol can dramatically

4. decrease the total incidence of
hospital-acquired CAUTI.
The basis for the success of this
initiative relied heavily on the
ease of using the eight-point
Question the Foley criteria, the
availability of the electronic med-
ical record, interdisciplinary col-
laboration, and support from
nursing and physician administra-
tion.
With collaboration and support
from nursing leadership, the
goals for patient safety by reduc-
ing hospital-acquired CAUTI can
become a reality in a short period
of time.
Paul Quinn
Chasing Zero: A Nurse-Driven Process
For Catheter-Associated Urinary Tract
Infection Reduction in a Community Hospital
PAUL QUINN, PhD, CNM, RN-BC, NEA-
BC, CEN, CCRN, is Director of Nursing,
White Plains Hospital, White Plains, NY.
321NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6

5. leadership role had direct respon-
sibility for all nursing-sensitive
indicators, performance improve-
ment, nursing research, evidence-
based practice, and dissemination
of quality data within the nursing
division. Specifically, the director
of nursing quality was charged
with identifying trends in health
care that could affect the nursing
division, performing gap analyses,
and reporting the findings to the
chief nursing officer so that action
plans could be created and imple-
mented.
The author, in the role of direc-
tor of nursing quality, utilizing cod-
ing data and a retrospective chart
audit, found White Plains Hospital
had an astonishing 110 incidences
of CAUTI for the period of 2007
and the first two quarters of 2008.
Current estimates for an organiza-
tion to treat each incidence of hos-
pital-ac quired CAUTI range from
$1,200 to $2,400 (Palmer, Lee,
Dutta-Linn, Wroe, & Hartmann,
2013; Rebmann & Greene, 2010).
Since treating a hospital-acquired
CAUTI was costly, with the poten-
tial for those costs to increase over
time, the chief nursing officer
made reducing the incidence of
CAUTI a key initiative in her strate-
gic plan.

6. The Question the Foley pro -
cess (see Figure 1), an evidence-
based criteria that utilized existing
resources within the organization,
was implemented. Adopted from
a best practice described in a long-
term care setting in Illinois, the
criteria provided a framework for
nurses to use daily to assess the
need for continuing a Foley cath -
eter (Robinson et al., 2007). This
successful initiative, however,
relied on the usefulness of eight-
point criteria, physician support,
informatics collaboration, targeted
education, daily monitoring, and
dissemination of results through-
out the organization (see Table 1).
Question the Foley
To minimize the incidence of
hospital-acquired CAUTI, nurses
needed a way to evaluate which
Figure 1.
Question the Foley Criteria
Ask Daily if the Foley Catheter Is Being Used to:
1. Provide bladder irrigation and/or instill medication?
2. Provide relief from urinary tract obstruction not manageable
by other means?
3. Permit urine drainage in a patient with neurogenic bladder
dysfunction,

7. hydronephrosis, or urinary retention not manageable by other
means?
4. Obtain accurate intake and output in critically ill patients?
5. Aid in urologic surgery or other surgery in the contiguous
area (GYN or lower
GI surgery)?
6. Manage urinary issues or special purposes/circumstances
such as a difficult
insertion per the urologist?
7. Manage urinary incontinence in patients with Stage III or
Stage IV pressure
ulcers?
8. Provide comfort care in terminally ill or hospice patients?
If the patient meets NONE of the above criteria, the RN will
contact the physician
and discuss the possibility of catheter removal.
Table 1.
Tactics for CAUTI Reduction
Tactic Comments
Question the
Foley criteria
• Evidence based
• Daily assessment for Foley catheter need; done on the day
shift only
• Nurse pursues an order to discontinue Foley catheter if the

8. patient no longer meets the criteria
Physician
support
• Support from the chief medical officer crucial
• Physician champion helpful (e.g., chief of infectious diseases)
• Physician assisted with review of medical records
• Enforced process with fellow physicians
Informatics
collaboration
• Designed nursing documentation in electronic medical record
to include 8-point criteria
• Designed physician documentation and ordering to reflect the
criteria
• Created customized reports for tracking and monitoring
Targeted
education
• Created diverse education sessions for nurses and physicians
• Varied hours and shifts
• Case presentation, explanation of process and eight-point
criteria
Daily
monitoring
• One RN responsible only
• Track physician orders, insertions, use of criteria
• Report outliers and statistics

9. • Identify CAUTI from microbiology report
• Identify all staff involved in the care of a patient with CAUTI;
letters sent to all involved
urinary catheters should be con-
tinued and which ones were no
longer being used for a specific
purpose and should thus be dis-
continued. A long-term care cen-
ter in Illinois had tackled this
issue and, through its work with
implementing an evidence-based
practice, created criteria based on
the literature that would provide
nurses with situations to assess
whether a Foley catheter should
be continued (Robinson et al.,
2007). These criteria, evaluated for
NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6322
their applicability to the inpatient
setting of a community hospital,
addressed similar patient popula-
tions. White Plains Hospital’s
adaptation of the criteria was
called Question the Foley, and it
provided decision points for nurs-
es to use daily to assess whether
continuation of a Foley catheter
was appropriate (see Figure 1).

10. In addition to establishing the
eight-point criteria, the hospital
put into place an algorithm for
nurses to use for specific patient
circumstances. There is no auto-
matic stop order or discontinua-
tion of a urinary catheter without
a physician’s order. Therefore, the
daily assessment of Foley catheter
continuation was done on the day
shift to eliminate unnecessary
phone calls to physicians during
off-hours. Furthermore, if the
nurse was uncertain about the
need to continue a Foley catheter,
it allowed the nurse a chance to
either speak to the physician
directly during his or her rounds
or have a detailed conversation
with the physician by phone dur-
ing normal office hours. If a nurse
reviewed the criteria and the
patient was assessed as needing to
have the Foley catheter continued,
then the nurse would document
his or her assessment in the elec-
tronic medical record and remind
the physician to renew the order
daily. If a nurse reviewed the crite-
ria and the patient was assessed as
no longer requiring the Foley
catheter, the nurse would speak
directly to the physician and
secure an order to discontinue the
Foley catheter and monitor the

11. patient accordingly.
Physician Support
Physician support and com-
mitment were crucial to the suc-
cess of this initiative. A report was
created by the author for the chief
medical officer (CMO) highlight-
ing the incidence of hospital-
acquired CAUTI and the proposed
Question the Foley criteria. The
CMO approved the plan and
agreed to be a liaison between
nursing and the medical staff for
physicians who were not willing
to comply with the process.
Additionally, the section chief of
infectious diseases became aware
of the proposed initiative and vol-
unteered to be a physician cham-
pion. In this role, he would edu-
cate physicians about the need to
reduce hospital-acquired CAUTI,
and he would advertise the useful-
ness of the Question the Foley ini-
tiative. This physician also assist-
ed with reviewing medical re-
cords as needed.
Informatics Collaboration
White Plains Hospital con-
verted to an electronic medical
record (EMR), MEDITECH, in

12. 2006 and has maximized many of
the capabilities an EMR offers.
The chief nursing officer identi-
fied internal experts with profi-
ciency in the use and functionali-
ty of the MEDITECH system and
created two distinct roles to man-
age the informatics needs: the
clinical informaticist for nursing
and the clinical informaticist for
physician services. Each role is
designed to assist either nursing or
physicians with documentation,
data mining, and the generation of
customizable user reports. The
clinical informaticist for nursing
changed the nursing documenta-
tion and included the eight-point
Question the Foley criteria. A cus-
tomized report was created that
lists all patients with a Foley
catheter (room number, name, and
medical record number) along
with the date and time of the first
documentation by a nurse within
a 24-hour period. This report
would be invaluable for tracking
patients on a daily basis and
assessing compliance with the ini-
tiative.
The clinical informaticist for
physician services created two
orders for physicians for Foley
catheters: one for the initial inser-
tion of a Foley catheter and one for

13. an ongoing Foley catheter. Phy -
sicians were instructed to use the
insertion order for any new Foley
catheter placed. Once completed,
this order remains active for 48
hours before an electronic remind -
er message is generated to the
physician through the Physician
Desktop. If a physician and a
nurse concur the Foley catheter
should remain in place past 48
hours, then an ongoing continua-
tion order is given. An ongoing
order will generate an electronic
reminder message to the physi-
cian every 24 hours. The expecta-
tion, then, is the need for a Foley
catheter will be evaluated daily
past 48 hours of insertion and that
a daily reorder is required for each
day a Foley catheter remains in
place.
Targeted Education
Educating nurses and physi-
cians was required. In the past,
Foley catheters remained in place,
and the need to continue them
was not addressed on a daily
basis. The director of nursing
quality created diverse education
sessions for the nurses. Some ses-
sions were offered in large group
settings, such as the hospital audi-

14. torium, while others were done
with small groups of nurses on the
nursing units at staff meetings or
daily staff briefing sessions (“hud-
dles”). Huddles, for example,
were opportunities for the nurses
to identify patients with a Foley
catheter on the unit and review
one or two key strategies for
CAUTI reduction. In contrast, the
content of the larger education
session focused on the high inci-
dence of hospital-acquired CAUTI
and introduced the Question the
Foley criteria as a process change.
Case presentations were given to
demonstrate the process of assess-
ing a patient daily, and allowed
role playing of the conversation a
nurse might have with a physician
to pursue a maintenance or dis-
continuation order. These larger
education sessions were offered
on day, evening, and night shifts,
and incorporated the assistance of
clinical nurse specialists and staff
development educators. During a
323NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6
2-month period, over 400 nurses
(approximately 75% of the nurs-
ing staff) attended an educational

15. session.
Physician education proved to
be a challenge. White Plains Hos -
pi tal has more than 800 physi-
cians on staff, including a robust
hospitalist program, and reaching
key members was difficult. Phy -
sicians rely heavily on the hospi-
tal’s email system as their pre-
ferred method of communication,
so an email was generated by the
CMO to the physicians outlining
the Question the Foley initiative,
the reasons behind it, and what
was expected from the physicians.
A printed mailing was created and
distributed to all physicians
through a monthly mailing sent to
their homes or offices. Hospitalists
have their offices on-site, so in-ser-
vice education was created for
them and provided during lunch
hours or at their monthly staff
meetings. More than 90% of the
active hospitalist physicians were
educated about the Question the
Foley initiative.
Daily Monitoring
Monitoring the Question the
Foley initiative was left to the
director of nursing quality, who
was primarily accountable for sus-
taining the process. Each morning,

16. the director of nursing quality
generates the customized report
from the previous day of all
catheterized patients in the organ-
ization. Patients from the materni-
ty unit are excluded first, due to
standard orders that allow Foley
catheter discontinuation within
24 hours of delivery. Using a
checklist, the author identifies
and tracks which patients have
had a Foley catheter inserted or
have an ongoing catheter. Cath -
eterized patients on all other units
are reviewed daily, including five
medical-surgical units, an eight-
bed intensive care unit, an eight-
bed coronary care unit, and two
telemetry/critical care step-down
units. Through the EMR, the
director of nursing quality can
quickly scan the patient’s record
for an existing physician’s order
and review nursing documenta-
tion simultaneously. If a physician
order is missing, a log is main-
tained that is shared daily with
the CMO, the hospitalist program
directors, and the individual
nurse manager and assistant nurse
manager. If nursing documenta-
tion needs to be addressed, an
email is sent to the nurse manager
and assistant nurse manager, and
the nurse is counseled according-

17. ly. From this report, monthly
totals are tabulated, including
total patients, total catheter days,
average catheter dwell time per
unit, catheter utilization rates, and
total number of missing orders.
A concurrent report is gener-
ated daily from the microbiology
department that identifies all pos-
itive urine cultures, and it is sent
via email every morning to the
director of nursing quality. This
report is reviewed in collaboration
with the infection control preven-
tionist to confirm any suspected
hospital-acquired CAUTI. A thor-
ough chart audit follows to identi-
fy when and where the infection
was contracted. Each nurse in -
volved in the care of that patient
then receives a letter from the
director of nursing quality identi-
fying that a patient has contracted
a hospital-acquired CAUTI and
inviting the nurse to participate in
a root cause analysis of the events
surrounding the hospital-acquired
CAUTI. During the analysis, each
nurse is encouraged to identify
any barriers in or breaks to the
prevention initiative. Letters sent
to nurses, and the need to perform
analyses, have decreased over the
past 4 years.

18. Additional Measures
Other evidence-based prac-
tices have been identified as valu-
able in combating the incidence of
CAUTI since the introduction of
the Question the Foley initiative.
For example, the use of silver
alloy Foley catheters, implement-
ing the use of securement devices
to limit Foley catheter movement
after insertion, strict adherence to
proper drainage tube placement to
avoid touching contaminated sur-
faces, and incorporating the
removal of Foley catheters by day
1 or 2 for most postoperative
patients were additional strategies
that demonstrated efficacy in the
overall reduction of hospital-
acquired CAUTI (Trautner, 2010).
These measures were implement-
ed progressively between 2008
and 2011. The infection control
department and nursing division
developed a combined, ongoing
education plan for infection pre-
vention incorporating these strate-
gies in conjunction with the
Question the Foley initiative.
Results
Dramatic reduction in the
incidence of hospital-acquired

19. CAUTI occurred within the first
year of the Question the Foley ini-
tiative (see Figure 2). By 2009, the
total number of hospital-acquired
CAUTI decreased. Specifically,
the CAUTI rate decreased dramat-
ically from 4.9/1,000 catheter days
in 2008 to 3.9/1,000 catheter days
in 2009. Further, the rate contin-
ued to decrease from 2009 to the
first quarter of 2013 where the rate
was only 0.2/1,000 catheter days.
The number of catheter days also
decreased over the same time peri-
od, signifying a direct correlation
between catheter utilization and
CAUTI rates.
White Plains Hospital had a
surge in its annual inpatient cen-
sus since 2010; despite the
increased number of patients
catheterized per month, the time
Foley catheters remained in place,
or dwell time, decreased. In 2008,
Foley catheters remained in place
for an average of 5.6 days, and by
the end of 2009, that number
dropped to 3.7 days. No benchmark
was known to compare our dwell
time, but a goal was to mimic the
emerging data for postoperative
patients that catheters should be in
no longer than 48 hours. Since
2009, the average dwell times for all

20. NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6324
2008 2009 2010 2011 2012
Q1 & 2
2013
Total catheterized patients 5,561 4,174 3,995 3,904 3,022 2,256
Total catheter days 22,212 15,513 13,659 13,523 13,249 6,833
Average catheter dwell days 5.6 3.7 3.4 3.2 3.1 2.4
Total acquired CAUTI 110 56 13 11 5 2
CAUTI incidence rate 4.9% 3.7% 3.4% 3.2% 3.1% 0.30%
ability of the EMR, interdiscipli-
nary collaboration, and support
from nursing and physician ad -
ministration.
The Question the Foley crite-
ria satisfied the hospital’s need to
change practice on the basis of the
latest scientific evidence. The pro-
tocol is simple to compile and
implement, and it contains nor-
mal clinical situations not foreign
to nurses practicing in community
hospitals. The practice change
that followed was not difficult for
the nurses, and hardwiring the
change occurred within a short

21. amount of time. New nurses will
require time to become familiar
with the process, but skilled pre-
ceptors can be an asset for role-
modeling the behavior.
The EMR has multiple capa-
bilities, but the role of clinical and
technologic experts within the
organization who are accessible to
the nursing division and who
have time allotted to dedicate to
new projects is essential. The clin-
ical informaticists played a key
role in creating customized re -
ports, working through revisions
of those reports, and evaluating
ways to enhance those reports
during system upgrades. White
Plains Hospital, recently designat-
ed as a Magnet organization, creat-
ed a nursing informatics council,
which works closely with the clin-
ical informaticists to not only gain
expertise and knowledge of the
MEDITECH system, but also con-
tributes its clinical expertise when
new documentation or reports are
created. The clinical experts, as
the end users of the technology,
are in a key role to ensure adher-
ence to documentation. The com-
Figure 2.
Total Acquired CAUTI and Incidence Rate, 2008 to Quarter 2,
2013

22. To
ta
l A
c
q
u
ir
e
d
C
A
U
T
I
120
100
80
60
40
20
0

23. 4.9%
3.7%
3.4% 3.2%
3.1% 0.3%
2008 2009 2010 2011 2012 Q1 & 2,
2013
Table 2.
Cost Savings Over Time for Implementing a Nurse-Driven
Process for CAUTI Reduction
2008 2009 2010 2011 2012 2013
Number of CAUTI cases 110 59 13 11 5 2
Treatment @ $1,200/case $132,000 $70,800 $15,600 $13,200
$6,000 $2,400
Savings compared to previous fiscal year $61,200 $55,200
$2,400 $7,200 $3,600
Cost with inflation adjusted (nurse salary to lead initiative)
$75,000 $77,625 $80,341 $83,152 $86,062
Cost savings $4,200 $62,025 $67,141 $77,152 $83,662
units, excluding the maternity unit,
has been sustained between 3.1 to
2.4 days. Further, the overall total
cost to the organization to treat
CAUTI decreased (see Table 2). For
example, using the current lowest
cost estimate (e.g., $1,200 per hospi-

24. tal-acquired CAUTI), costs to
treat hospital-acquired CAUTI de -
creased from $132,000 in 2008 to
$2,400 in the first quarter of 2013.
Additionally, for making one nurse
accountable for the success of the
quality monitoring process, there
was an overall cost savings and
return on investment to the organ-
ization of $83,662 (see Figure 3).
Results were printed in tables dis-
played on each nursing unit and
discussed during unit council
meetings. The results continue to
be formally presented to both the
hospital’s performance improve-
ment committee and the board of
trustees on a quarterly basis.
Recommendations for Nurse
Leaders
A nurse-driven system for
decreasing the number of hospi-
tal-acquired CAUTI is effective
and useful for a community hospi-
tal. One nurse with accountability
for implementing a simple evi-
dence-based protocol can dramat-
ically decrease the total incidence
of hospital-acquired CAUTI. The
basis for the success of this initia-
tive at White Plains Hospital
therefore relied heavily on the
ease of using the eight-point Ques -

25. tion the Foley criteria, the avail-
325NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6
bination of clinical experts with
technological experts helps expe-
dite projects to completion and
decreases turnaround time for
special requests.
Utilizing experts outside the
nursing division improves collab-
oration and communication across
disciplines. Having a physician
champion such as the section
chief of infectious disease and the
support of the CMO helped gain
support for the initiative among
the multiple physicians within
the organization. The infection
control preventionists were essen-
tial by identifying the presence of
infection, confirming which ones
were present on admission or
acquired during hospitalization,
and suggesting strategies for con-
tainment and treatment. The col-
laboration of nursing, medicine,
and infection control presented a
united force to physicians and
nurses alike and conveyed the
import of the project. Recognition
from the chief executive officer

26. and the chief nursing officer,
along with celebration of sus-
tained results, reinforced the
efforts of the bedside nurses and
physicians and fostered the col-
laboration and communication
between the disciplines.
A nurse leader with the ability
to critically analyze each clinical
scenario, make pertinent recom-
mendations, and demonstrate leader -
ship savvy to correct inconsisten-
cies can pioneer a similar project
and ensure success for a commu-
nity hospital. With collaboration
and support from nursing leader-
ship, the goals for patient safety by
re ducing hospital-ac quired CAUTI
can become a reality in a short
period of time. $
REFERENCES
Bruminhent, J., Keegan, M., Lakhani, A.,
Roberts, I., & Passalacqua, J. (2010).
Effectiveness of a simple intervention
for prevention of catheter-associated
urinary tract infections in a communi-
ty teaching hospital. American Jour -
nal of Infection Control, 38, 689-693.
Gokula, M., Smolen, D., Gaspar, P.M.,
Hensley, S.J., Benninghoff, M.C., &
Smith, M. (2012). Designing a proto-

27. col to reduce catheter-associated uri-
nary tract infections among hospital-
ized patients. American Journal of
Infection Control, 40(10), 1002-1004.
Hanchett, M. (2012). Preventing CAUTI: A
patient-centered approach. Preven -
tion, 43, 42-50.
Milstein, A. (2009). Ending extra payment
for “never events”: Stronger incen-
tives for patient safety. New England
Journal of Medicine, 360, 2388-2390.
Palmer, J.A., Lee, G.M., Dutta-Linn, M.,
Wroe, P., & Hartmann, C.W. (2013). In -
cluding catheter-associated urinary
tract infections in the 2008 CMS pay-
ment policy: A qualitative analysis.
Urologic Nursing, 33(1), 1-9.
Rebmann, T., & Greene, L.R. (2010). Pre -
venting catheter-associated urinary
tract infections: An executive summa-
ry of the Association for Professionals
in Infection Control and Epidemi -
ology, Inc., elimination guide. Ameri -
can Journal of Infection Control, 38,
644-646.
Robinson, S., Allen, L., Barnes, M.R., Berry,
T.A., Foster, T.A., Friedrich L. A., ...
Weitzel, T. (2007). Development of an
evidence-based protocol for reduction
of indwelling urinary catheter usage.

28. MEDSURG Nursing, 16(3), 157-161.
Trautner, B. (2010). Management of cath -
eter-associated urinary tract infection
(CAUTI). NIH Public Access, 23, 76-
82.
Wilson, M., Wilde, M., Webb, M.I, Thompson,
D., Parker, D., & Harwood, J. (2009).
Nursing interventions to reduce the
risk of catheter-associated urinary
tract infections: Part II. Staff educa-
tion, monitoring and care techniques.
Journal of Wound Ostomy & Conti -
nence Nursing, 36, 137-154.
Figure 3.
Return on Investment for Implementing a Nurse-Driven Process
for
CAUTI Reduction
$140,000
$120,000
$100,000
$80,000
$60,000
$40,000
$20,000

29. $
120
100
80
60
40
20
0
N
u
m
b
e
r o
f C
a
s
e
s
2008 2009 2010 2011 2012 2013
Treatment @ $1,200/Case
Cost with Inflation Adjusted (nurse salary

30. to lead initiative)
Number of CAUTI Cases
Savings Compared to Previous Fiscal Year
Cost Savings
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