Organizations were tasked with commissioning a new

organizations were tasked with commissioning a new catheter insertion procedure that utilizes
adherence to the highest standards of aseptic technique to limit the chances of introducing
bacteria at the time of insertion (Sampathkumar, Barth, Johnson, Worden, & Thompson, 2016),
as well as training of all members who are responsible for urinary catheter insertions. The
initiation of the “bundle concept” has proven to be a powerful addition to the CAUTI prevention
initiative (Al-Tawfiq & Tambyah, 2014). The Institute for Health Improvement (IHI)
established the “bundles” concept, this is a set of structured evidence-based practices, that when
all aspects of the bundle are utilized together have proven to improve patient outcomes (Institute
for Health Improvement, 2018). The CAUTI bundle sets out to limit the use and duration of
Foley catheters with daily reminders in place so that every shift will reevaluate the necessity of
continuing the use of or discontinuing the indwelling catheter based on the protocol standards.
Additionally, the bundle includes reminders to: wash hands before and after handling catheters,
use of a stabilization device, maintenance of closed drainage system, to keep the drainage bag
below the level of the bladder, maintaining a closed drainage system and unobstructed flow,
regular emptying of the collection bag and the performance of daily and as needed “Foley care”.
Foley care is an evidence based methodical cleansing at the catheter, insertion site, and
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Evidence-Based Practice and Applied Nursing Research
surrounding area with approved cleansing agents (Sentara Healthcare, 2016). Finally, required
documentation following urinary catheter insertion, this is how the person who inserted the
catheter assures: patency of the catheter, appearance of the site of insertion, that the collection
bag is below the level of the bladder, how the catheter is secured (anchoring device, where
attached to pt.), the patient’s response during/following the insertion, validating that the system
remains closed (red seal intact, why or why not), and the frequency and type of care to be
provided for the catheter (Underwood, 2015).
At the threat of diminishing reimbursements by U.S. Centers for Medicare and Medicaid
Services an intense impact on healthcare organizations was made to address and find solutions in
order to slash imminent financial burdens in addition to promoting safety of the patients.
Finding solutions to combat the issue became more relevant requiring man hours and research in
order to find the best solutions. Later, healthcare organizations were then held responsible and
required to report on the number of catheter associated urinary tract infections, this data was used
to determine what the “quality of healthcare” provided by an institution amounted to, and
payments for services would be determined by this data through the national pay-for-
performance programs. This data was then made available to the public and can be found on the
website, Hospital Compare (Sampathkumar, Barth, Johnson, Worden, & Thompson, 2016).