A Summative Program Evaluation of an Implemented HOUDINI Protocol

Abstract

Purpose: This program evaluation aimed to assess if there was a reduction in urinary catheter device utilization ratio and the standardized infection ratio of catheter-associated urinary tract infection after implementing the HOUDINI protocol at HonorHealth Shea Medical Center. Background: Catheter-associated urinary tract infections increase morbidity, mortality, the cost to the patient, and length of stay. The risk of urinary tract infection increases each day an indwelling catheter remains in use. Studies demonstrate that by reducing the utilization of urinary catheters, a decrease in catheter-associated urinary tract infections can be achieved. Nurse-driven removal protocols have been shown to decrease catheter utilization and thus infection rates. The HOUDINI protocol is a nurse-driven removal protocol that provides specific indicators for using a urinary catheter. If no indicator is met, the nurse is to remove the patient’s urinary catheter. The purpose of conducting this program evaluation was to assess if there was a reduction in urinary catheter device utilization and in CAUTI SIR post-implementation of the HOUDINI protocol. Methods: Data was provided to the author from the HonorHealth Infection Prevention department on the standardized infection ratio, urinary catheter days, and the total number of inpatient days for the pre-implementation and post-implementation periods. The pre-implementation period was determined to be the quarter before the education was provided to the staff, and the post-implementation period was one year later. The post-implementation data was compared to the pre-implementation data to assess for decreases in the stated measures. Results: The data concluded that the post-implementation data set demonstrated a decrease in urinary catheter device utilization ratio and the standardized infection ratio of catheter-associated urinary tract infections. The device utilization ratio decreased from .131 to .117 post-implementation. The pre-implementation standardized infection ratio was 0.692, and the post-implementation was calculated to be 0.553 for a decrease of 0.139 after HOUDINI implementation. Conclusions: The HOUDINI protocol implementation at HonorHealth Shea Medical center met its aims in decreasing the urinary catheter device utilization ratio and the standardized infection ratio for catheter-associated urinary tract infections. The HOUDINI protocol and other nurse-driven removal protocols should be considered effective and used widely to decrease patient risk and better patient outcomes.