p.p1 Reducing the Rate of Catheter Insertion to

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Abstract Title:  Reducing the Rate of Catheter Insertion to Reduce Catheter Associated Urinary Tract Infection : A Quality Improvement Project

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1) Problem 
The high prevalence of catheter associated urinary tract infection is well established in literature. It accounts for 36% of all health care associated infections in the united states. In a study published in 2001, 91% of urinary catheters placed within 24 hours of admission were inserted in the emergency department with more than half judged later to have been avoidable. 

2) Background/context
King Abdulaziz Medical City in Riyadh, Saudi Arabia is a large academic hospital with a substantial emergency department. Resulting in a high rate of hospital admission through its ED. The rate of ED-placed foley catheter insertion among patients admitted through the ED of our institution has never been established and no recent interventions in regards of CAUTIs has been done. 

3) Methods
This is an ongoing observational study to assess the impact of implementing a set of interventions to reduce CAUTIs by reducing the rate of urinary catheter insertion in the ED. The first phase of this study was completed by retrospectively reviewing charts of patients admitted through the ED on three different time periods (1-7 November 2016, 1-7 December 2016, 1-7 January 2017) to establish the rate of catheter placement in our ED. 
The ongoing intervention phase, compromised of changes in the electronic health care system (currently awaiting approval) for ordering catheter insertion to choose a valid indication of insertion and a reminder to avoid/replace when possible. Screen savers and educational materials are to be distributed in the ER and among ED physicians and nurses. 
The final phase will be similar to the initial review to establish the rate of catheter insertion post intervention and assess the impact of our project. 

4) Results
For phase one, a total of 647 patient admitted through the ED on the specified time periods with 87 catheter insertions during ED visit making the rate of catheter insertion in our ED = 13.4 per 100 admission. 
Following the intervention phase the rate of catheter insertion will be reassessed and the impact of the intervention program will be determined. 

5) Conclusion/Lessons learned
Depending on phase one results, the higher rate of foley catheter insertion found in our ED suggests a higher percentage of avoidable foley catheter insertions. Predicting large room for improvement with the appropriate intervention.