Running head: LEADERSHIP STRATEGY

Leadership Strategy: Catheter-Associated Urinary Tract Infections

Jenna Applebach
Ferris State University

LEADERSHIP STRATEGY

Leadership Strategy: Catheter-Associated Urinary Tract Infections

A major role of nurses in the hospital setting involves urinary catheterization.
Unfortunately, it is widely known that catheter-associated urinary tract infections (CAUTIs) are
one of the most common hospital-acquired (nosocomial) types of infection.
In order to combat this issue, it is first important to identify a need for review. Then,
through the establishment of an interdisciplinary team to carry out a new policy to decrease the
CAUTI rate, a leadership strategy will involve data collection of CAUTIs, the establishment of
outcomes reflected by ANA Standards of Practice, the implementation of the new policy through
Kotters Eight-Step Model, and a process of evaluation.
Identify Clinical Need
According to Gokula et al. (2012), hospital-acquired urinary tract infections (HAUTIs) in
the United States comprise 40% of nosocomial infections, and over 80% of these HAUTIs are
associated with urinary catheters. UTIs can also lead to complications and can cost a hospital
$1,200 to greater than $2,700 per reported case (p. 1002). Based on these data and statistics
alone, it is obvious that CAUTIs are a major clinical issue (as they comprise nearly half of
nosocomial infections) and it is therefore within reason to review the methods of catheterization
and catheterization maintenance that may lead to these infections.
Interdisciplinary Team
According to OLeary, Sehgal, Terrell, and Williams (2011), Elements of effective
teamwork have been defined and provide a framework for assessment and improvement efforts
in hospitals (p. 48). Therefore, in order to combat the issue of CAUTIs in a hospital setting, an
interdisciplinary team would be necessary to cover all facets of the issue in an attempt to
improve the issue. The team would consist of nurse managers and educators, registered nurses
and licensed practical nurses, certified nursing assistants, and an infection control team.

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First and foremost, nurse educators and nurse managers would be an extremely important
component in helping to prevent CAUTIs. They will observe catheterization procedures of
registered nurses (RNs) and licensed practical nurses (LPNs) and the cleansing techniques of
certified nursing assistants (CNAs). After their observations, they will educate RNs, LPNs, and
CNAs to correct them in their catheter care measures as needed.
Second, RNs and LPNs would be a crucial component in combating CAUTIs because
they are the primary caregivers; they are in charge of carefully monitoring their patients for any
signs of infection. In this case, RNs and LPNs would have the responsibility of inserting,
maintaining, and removing catheters according to evidence-based practice. They would record an
identification number for each catheter (which will be discussed later) into the charting system.
RNs and LPNs will also be the receivers of education as need be.
The role of certified nursing assistants (CNAs) includes thoroughly cleansing the area
around a catheter with soap and water during patient hygiene procedures. Therefore, in order to
help prevent CAUTIs, they must continue to do this. Also, they will be the receivers of education
as need be.
Finally, an infection control team would monitor and analyze the CAUTI rate at a given
hospital before, during, and after measures were taken to reduce CAUTIs.
Data Collection/Method
There would be several methods for data collection in this plan to reduce the CAUTI rate
at a given hospital. First of all, either the hospital or the company which produces catheters the
hospital purchases would label each catheter kit with an identification number. Nurses and CNAs
alike would be responsible for entering this identification number into their charting so that, if a
UTI were to occur to a patient under their care, they could be tracked down. From there, a nurse

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manager or educator would directly observe a nurses method of catheter insertion or removal
and educate or correct them on proper, evidence-based care. The same would occur for CNAs
regarding cleansing around the catheter site.
Second, throughout each shift, nurses and CNAs would be asked to complete a form with
open-ended questions about correct catheterization procedures, be it insertion, removal, or
maintenance. These forms would be completed anonymously so that staff would not feel
threatened if they answered a question incorrectly. The answers for the forms would be
analyzed by nurse managers for problematic areas and, from there, a meeting would occur for
education over these areas of concern.
Finally, after the two methods above were utilized, an infection control team would be
responsible for analyzing the CAUTI rate before and after these methods were implemented to
determine whether or not they were effective in reducing the CAUTI rate.
These methods of data collection would be supported by a transformational leadership
style as, instead of penalizing staff members and only pointing out what they did incorrectly,
their actions would be corrected through hands-on and demonstrative education. Staff members
would be educated as a group instead of singling out certain staff members. Nurse managers and
educators would also work alongside the nurses and CNAs to encourage proper catheterization
measures (Yoder-Wise, 2015, p. 38).
Establishment of Outcomes
Based on the utilization of catheter identification numbers, forms with open-ended
questions, and necessary education as a new CAUTI improvement policy, the ANAs Standards
of Practice 8 and 10 would reflect this evidence-based practice.

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Standard 8 (Education) would be reflected in this new policy in that nursing staff would
attain knowledge for proper catheter care measures through education they receive from nurse
managers and educators. This new knowledge would reflect best current nursing practice as well
as represent ongoing education to maintain proper clinical skills (ANA, 2010, p. 56).
Standard 10 (Quality of Practice) would be reflected in this new policy in that nursing
staff would participate in quality improvement through their education and through participating
in the data collection used to monitor CAUTI rates of a particular hospital. Also, the
implementation of identification numbers, forms, and subsequent education would be considered
activities to enhance the quality of nursing practice (ANA, 2010, p. 59).
Implementation Strategies
In order for these new CAUTI-reduction strategies to work, an effective model for
implementing change must be used. One such model is called Kotters Eight-Step Model. It
includes the creation of urgency, the formation of a powerful coalition, the creation of a vision
for change, communication of the change vision, the removal of obstacles, the creation of shortterm wins, building on the change, and anchoring the changes in the culture (Yoder-Wise, 2015,
p. 315).
According to Yoder-Wise (2015), the create urgency attribute involves the creation of
open dialogue about external and internal realities impacting the need to change (p. 315). This
might include education on how much longer patients end up being hospitalized and the
complications associated with CAUTIs. This in itself could create a sense of urgency, as a certain
amount of empathy is derived from this information between the nurses and their patients. The
formation of a powerful coalition to promote change would include the nurse managers and
educators. A vision for change might be, for example, making a goal of reducing the rate of

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CAUTIs by up to 60% within six months time. Communication of the change vision would be
done through posters in staff bathrooms, break rooms, and locker rooms and through regular staff
meetings in order to encourage staff members to reinforce the vision. The removal of obstacles
might include, for example, having one-on-one meetings with nurses and CNAs who are
regularly failing to enter the identification numbers of catheters they are responsible for in their
care. The creation of a short-term win might include brunches in the break room as tokens of
appreciation/congratulation for entering identification numbers into the charting system.
Building on the change would involve a positive, can-do atmosphere brought upon by the charge
nurses and nurse managers and educators in order to encourage an ongoing process of change.
Finally, anchoring the changes in the culture would involve holding meetings for reporting
declining CAUTI rates and congratulating staff members on taking part in this success. In this
manner, the change would become more permanent and CAUTI rates might remain low (YoderWise, 2015, p. 315).
Evaluation
Determining whether or not CAUTI rates at a particular hospital were decreased from
implementation of the new policy would best be evaluated by tracking CAUTI rates through the
charting system. Since nurses would ultimately be responsible for charting the presence of UTIs,
the infection control team could collect and analyze this data to determine whether the new
policy was effective or not. Evaluation could also be done through questionnaires asking whether
or not nursing staff felt the corrective education they received was helpful or not. An overall
positive or negative attitude toward this education could then correlate with the CAUTI rate
whether it increased or remained the same (correlated with a negative attitude) or decreased
(correlated with a positive attitude).

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7
Conclusion

Catheter-associated urinary tract infections are an ongoing issue in hospitals throughout

the United States. However, under the direction and cohesion of an interdisciplinary team, new
policies such as having identification numbers for catheter kits and directing nursing staff to
record those numbers, filling out forms with open-ended questions, and hands-on education
about catheterization could be utilized to help reduce CAUTI rates.

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8
References

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver
Spring, MD: American Nurses Association.
Gokula, M., Smolen, D., Gaspar, P.M., Hensley, S.J., Benninghoff, M.C., & Smith, M. (2012).
Designing a protocol to reduce catheter-associated urinary tract infections among
hospitalized patients. American Journal of Infection Control, 40(10), 1002-1004.
doi:10.1016/j.ajic.2011.12.013.
OLeary, K.J., Sehgal, N.L., Terrell, G., & Williams, M.V. (2011). Interdisciplinary teamwork in
hospitals: A review and practical recommendations for improvement. Journal of Hospital
Medicine, 7(1), 48-54. doi: 10.1002/jhm.970.
Yoder-Wise, P.S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Elsevier Inc.