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Lowering infection risk for spinal cord injury patients 

The challenge:  How to support health teams use best practice catheter management

Partner: Victorian Spinal Cord Service, based at Austin Health

Year: 2017/18

Spinal cord injury (SCI) results in a loss of voluntary control of the urinary bladder. This increases the risk of urinary tract infections (UTIs), the most frequent condition that causes SCI patients to present to hospital emergency departments.

Research has shown that the ongoing use of indwelling catheters, which stay in the bladder for a prolonged period and drain urine into a bag, results in a greater risk of UTI compared to intermittent catheters (IC), which drain urine and remove it immediately.

Despite this evidence, the transition from indwelling to IC after an initial SCI was taking too long – 67 days based on an audit of 143 patients.

What did we do?

To address the issue, the Victorian Spinal Cord Service, based at Austin Health in Melbourne, engaged BehaviourWorks to explore the behavioural aspects of catheter management and trial a new approach.

The research team began by conducting a ‘deep dive’ investigation with spinal consultants, doctors, nurses, patients with SCI and allied health professionals.

This revealed the barriers to optimal SCI bladder management, including beliefs about patient readiness, access to information, inconsistencies in catheterisation techniques and other social influences.

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The researchers used the findings to develop and trial a multi-faceted behaviour change intervention comprising an algorithm summarising best practice, mandatory training for all nursing staff to standardise catheterisation practice, the recruitment of ‘change champions’ to promote best practice and the development of an online patient information resource – mybladdermylife.com.

Results 

The results of the three-month trial showed that the median time of indwelling catheter removal was 19.5 days – around one-third of the pre-implementation rate.