Aseptic Catheter Insertion Practices in the ED: A Focus on Engagement

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Aseptic Catheter Insertion Practices in the ED: A Focus on Engagement

Milisa Manojlovich PhD, RN, CCRN
Associate Professor
University of Michigan, School of Nursing

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Learning Objectives

• Discuss barriers to ED staff engagement
• Describe strategies to engage ED staff in aseptic insertion technique

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The Scope of the Problem

• Guidelines for preventing CAUTI have always recommended aseptic insertion techniques.
• Healthcare providers who insert catheters say they use aseptic technique.
• In multiple observation studies, at least half of the time there are significant breaks in aseptic technique.

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Lack of Knowledge

• Healthcare providers may not have the skills to maintain aseptic technique given work environment constraints.
• They may observe peers inserting catheters and notice that aseptic technique is not used.

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Lack of Knowledge: Strategies to Overcome

• First, always make sure that there is an appropriate indication for catheterization.
• Review catheter insertion technique during annual competency testing.
• Require that there be oversight for catheter insertion by a licensed provider.
• Develop a policy on catheter insertion techniques if none is in place.
• Use a variety of checklists.

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Lack of Importance

• Activities strictly within the nursing domain may not perceived as being important or of much value, compared to activities that cross disciplinary boundaries.
• Catheter insertion may be perceived as one of many “tasks” rather than as a component of evidence-based practice.

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Lack of Importance: Strategies to Overcome

• Aseptic insertion of indwelling urinary catheters is a component of evidence-based practice, no matter what the discipline.
• Develop a culture where evidence-based practice is recognized and rewarded.
• Think in terms of nursing practice components rather than a set of tasks to be completed.

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Lack of Feedback & Strategy to Overcome

• Patients move from the ED to other units, and there is no systematic process to let ED staff know of patient outcomes.

Organizational level strategies:

• Post CAUTI rates for all units, so that comparisons can be seen.

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Lack of Resources

• Time, financial, space, equipment constraints can all contribute to situations where aseptic insertion techniques are not used.
• Variation in staffing resources contributes as well:
  • High turnover
  • Understaffing

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Lack of Resources: Strategies to Minimize

• Adequate supplies:
  • Over-the-bed tables
  • Hand sanitizers
  • Sterile gloves
  • Best type of kit to stock for your patient population
• Would individual supplies be better than a kit?
• Adequate facilities for hand hygiene

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Components of Aseptic Insertion

• Set up a sterile field.
• Perform hand hygiene immediately before and after insertion.
• Use sterile gloves, drapes, sponges.
• Use appropriate antiseptic or sterile solution for peri-urethral cleaning, and a single-use packet of lubricant jelly for catheter tip.
• If catheter is accidentally contaminated, it is discarded, and a new sterile catheter is obtained.

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Tips for Success

• A non-punitive culture
• Visible and supportive leadership
• Identify system-wide barriers to aseptic insertion:
  • Lack of adequate supplies
  • Lack of space for sterile field set-ups
  • Lack of manpower
• Allocate resources to overcome as many barriers as possible.

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More Tips for Success!

• Transition to an evidence-based practice approach for patient care delivery:
  • Several evidence-based practice models are available to choose from;
  • They all provide guidelines for enlisting staff support and buy-in.
• Enable collaborative and decentralized decision-making.
• Allow nurses to make decisions that affect their practice.

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Thank you!

Questions?

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Funding

Prepared by the Health Research & Educational Trust of the American Hospital Association with contract funding provided by the Agency for Healthcare Research and Quality through the contract, “National Implementation of Comprehensive Unit-based Safety Program (CUSP) to Reduce Catheter-Associated Urinary Tract Infection (CAUTI), project number HHSA290201000025I/HHSA29032001T, Task Order #1.”

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