Early Removal Prevents Catheter Associated Urinary Tract Infection

Authors: Aileen Rabia, Staff Nurse HDU-A

Anie Mathew, Charge Nurse HDU-B

Prescilla Dizon, Charge Nurse HDU-A

Co-author: Ms. Ma. Leni Garcia, Head of Infection Control

Introduction

What does HOUDINI stand for?

Houdini is an acronym, each letter represents a

different reason a nurse should not remove a

Foley catheter. It’s an easy way to help nurses

remember the protocol, and the clear criteria help

ensure nurses only remove the catheter when

appropriate.

Here’s what the letter stands for:

Hematuria, gross

Obstruction, urinary

Urologic surgery

Decubitus ulcer (pressure sores)

Input / Output fluid monitoring

Nursing care only

Immobility due to physical constrains

Aim

To reduce the incidence of catheter associated

urinary tract infection (CAUTI) to zero in High

Dependency Unit patients at the end of December

2017 by identifying promptly the need for a

catheter to remain in place or the need to remove

it immediately.

Assessment and Analysis

Urinary tract infections (UTI) are the most

common healthcare associated infection in acute

hospitals. The risk of developing a catheter

associated urinary tract infection (CAUTI)

increases the longer a urinary catheter remains in

site. Although indications for insertion and

continuous use are known, there are few tools to

aid with removal decision making. This pilot study

evaluated the effectiveness of a nurse-led

HOUDINI protocol of urinary catheter removal in

reducing the number of days of urinary catheter

usage, thus potentially reducing the associated

risk of a CAUTI.

• Kate Vonderhaar. Frequently asked questions about the

HOUDINI Protocol.

https://www.advisory.com/research/nursing-executive-

center/expert-insights/2013/faqs-houdini-protocol

• Debra Adams, Helen Bucior, Gina Day, Jo-Anne Rimmer.

HOUDINI – make that urinary catheter disappear – nurse-

led protocol. March 15, 2012.

http://journals.sagepub.com/doi/abs/10.1177/17571774124

36818

References:

Strategy for Change

PDSA Methodology

HOUDINI Monitoring Sheet

HOUDINI Team

Project Leader: Ms. Jessy Cherian, Head Nurse

Team Leader: Ms. Prescilla Dizon, Charge Nurse

Sponsor: Mr. Emad Ayoub, Director of Nursing

Coaches: Ms. Ma. Leni B. Garcia, Head of IPC

Dr. Poonam Gupta, Senior Quality

Reviewer

Members: Ms. Aileen Rabia, Staff Nurse

Ms. Anie Mathew, Charge Nurse

Ms. Annal Manuvel, Staff Nurse

Ms. Ann Kartine Cunano, Charge Nurse

Ms. Kristine Icay, Staff Nurse

Dr. Salma Suliman, Fellow Cardiology

Ms. Cherlyn Simbulan, IC Coordinator

Data Collection

Conclusion

Plan – We planned to reduce the prevalence of

Foley catheters to help prevent CAUTIs.

Do – We educated the nurses about when the

patients did and did not require a urinary catheter

with the use of HOUDINI protocol. To help nurses

learn the protocol, we gave them pocket cards

spelling out the HOUDINI criteria.

Study – For 6 months of following the HOUDINI

protocol, we have noticed a reduction in urinary

catheter utilization.

Act – HOUDINI protocol will be continuously

implemented whenever patient requires a catheter

insertion for it has proven to be effective in

reducing CAUTIs and can be escalated in other

units.

There was 25.34% reduction after 6 months of

implementation compared to the initial data.

The implementation of HOUDINI Protocol has

resulted to shortened utilization of urinary

catheters thereby reducing the patient’s risk of

developing CAUTI when urinary catheter

utilization reduction rate increases.

It helps nurses and doctors to meticulously

assess the need for inserting Foley catheter

and it promotes the timely removal of the

urinary catheter once it meets the criteria that

there’s no further indication for its continuing

use.

CAUTI rate has shown favorable result after the

pilot study. Strict adherence and compliance in

the continuous implementation of the HOUDINI

protocol will give the best and effective

outcome in reducing urinary catheter use and

enhancing patient safety.

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Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

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Urinary Catheter Utilization in Telemetry Units, Year 2016

HDU A HDU B HDU C Total UC Days

Pre-intervention (Baseline)

Introduction of HOUDINI Protocol Implementation of HOUDINI Protocol

HDU C Transferred LTC Patients to HDUs

A & B

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CAUTI Rate Versus Urinary Catheter (UC) Utilization Reduction Rate Using HOUDINI Protocol, August 2016-January 2017

Infection Rate UC Utilization Reduction Rate

Introduction of HOUDINI Protocol

Jul-16 Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-17

34.93% reduction

from baseline

25.34% reduction

from baseline

• Prof. William John McKenna, Chief Executive Officer HH

• Mr. Paul Thomas Mavin, Executive Director of Nursing HH

• Mr. Ian Stewart Mcdonald, Assistant Executive Director of

Nursing HH

• Ms. Fadia Hasan Ali, Assistant Executive Director of Patient

Safety Quality HH

Acknowledgements: