Date of Graduation

Summer 8-14-2020

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Margaret Levine, DNP, RN, CNL, CNS

Second Advisor

Dr. Cathy Coleman, DNP, RN, CPHQ, CNL

Third Advisor

Prof. Curt Peterson, RN, MSN


PROBLEM: Hospital-acquired infections (HAI) continuous to be a safety challenge in today’s healthcare systems. Applying a lens to the most common HAIs such as Catheter-associated urinary tract infection (CAUTI) in a Spinal Cord Unit calls for evidenced-based solutions and process improvement. CAUTIs are not only costly and prolongs the patient’s hospitalization, it’s a preventable harm that significantly affects the quality of life of spinal cord injury patients.

CONTEXT: Spinal Cord Injury Unit (SCIU) in VA Palo Alto is a 19-bed capacity inpatient unit where CAUTI rates have been increasing in the recent years. There is a high risk for CAUTIs due to the increase catheter utilization of spinal cord injury patients. At the time of assessment, CAUTI rate in SCIU was found to be eight percent above the VA benchmark of 1.25 per 1,000 catheter days.

INTERVENTIONS: In order to reduce CAUTI in SCIU a process improvement project using an evidence-based two-person technique with checklist was implemented through licensed nursing staff comprehensive training and competency validation. This intervention will address caregiver-related and environmental factors of

MEASURES: Measures for improvement are comprised of CAUTI rate and incidence in SCIU and uniform implementation of two-person urinary catheter insertion by auditing documentation.

RESULTS: The recent pandemic has caused for this project to be on hold indefinitely. Based on literature review of seven academic studies, the intervention plan is projected to have a 72% reduction in CAUTI rates among inpatient units. The baseline CAUTI rate of 1.35 in 1,000 catheter days in SCIU will decrease to 0.38 upon implementation of the two-person technique and checklist.

CONCLUSION: The comprehensive training will reinforce nurses’ current knowledge in urinary catheter management, sterile technique and improve communication between nursing staff which will lead to the safest practice in urinary catheter insertion, will therefore decrease incidence and rate of CAUTI.

Keywords: CAUTI, spinal cord injury, inpatient, hospital-acquired infection