Our facility had the highest urinary catheter standardized utilization ratio (SUR) in our hospital system, which consists of nine acute care hospitals in Nebraska and Iowa. Using the NHSN Tap report and SUR, we were able to focus on the specific unit with the highest SUR's, which was the 29-bed orthopedic medical surgical unit.

We completed a chart review of IUC's in place on this unit, and were able to determine that a majority of the usage was related to orthopedic surgical patients.

After completing a literature review for best practices for utilizing and removing IUC in this patient population, we updated the orthopedic order sets to use alternative urinary collection methods, such as a external female catheter or urinal, prior to inserting a IUC. Orthopedic surgeons allowed removal of the urinary catheter in certain cases in the operating room or post-anesthesia care unit before the patient was transferred to the inpatient units, or did not insert a IUC during the procedure.

During our initial chart audit in October and November 2018, our orthopedic surgeons completed 117 procedures in that time from and 67% of these cases included patients that were admitted to the orthopedic unit was a foley catheter. In September and October 2019, our orthopedic surgeons completed 90 procedures in that time from and 30% of these cases were patients that were admitted to the orthopedic unit was a foley catheter. This was a 37% improvement in IUC utilization in this patient population.

Overall, our interventions had drastically improve our indwelling urinary catheter SUR on our orthopedic medical surgical unit and have helped us to decrease the risk for catheter-associated urinary tract infections for our patients at our facility.