From intervention to performance: Transitioning ownership of an infection control intervention

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) account for up to 40% of all hospital-acquired infections. Evaluation of a 10-bed post intensive care rehabilitation unit (PICRU) in June 2003 revealed a CAUTI rate of 27.0 per 1000 catheter days. Rates during the previous 12 months ranged from 11.6 to 46.5 per 1000 catheter days (mean = 22.7). Silver alloy–impregnated catheters were used for all patients during this period. In July 2003, nursing staff suggested an intervention of increased perineal care. In July 2003, perineal care was increased from once daily to two to three times daily and with incontinence in addition to daily bathing. Staff education was also part of the intervention. An immediate decrease in the CAUTI rate after the first month of intervention energized staff. After 6 months of the intervention (July-December 2003) showed a sustained decrease in the rates, staff chose to make this protocol permanent. METHODS: CAUTI rates continue to be monitored and reported monthly to staff. Educational posters outlining the process are placed in staff areas. The infection control practitioner (ICP) visits frequently to observe practice. Staff showed enthusiasm about the results and began monitoring each other for compliance. RESULTS: The 6-month post intervention mean (July-December 2003) dropped to 7.3 per 1000 catheter days, a 68% decrease (p < 0.001). Staff chose to make this protocol permanent in January 2004. For the first 11 months of 2004, the mean dropped to 5.9 per 1000 catheter days (range 0–13.1), but an increase in the December 2004 rates brought the 18-month post-intervention mean up to 7.3. Staff members continue to monitor each other for compliance, and the process is included in new employee orientation to the unit. Occasional increases in rates result in immediate staff re-education to the process by both the ICP and the nurse educator. When rates are low, staff celebrates. CONCLUSIONS: It is essential for staff members to support and “own” an intervention. Patient care provider education may result in short-term behavior changes, but moving from intervention to permanent change requires staff inclusion at the onset along with ongoing active participation. Positive changes must be reinforced. When staff members realize the benefits quickly, behavior changes follow and become daily practice.