Catheter Insertion:
3. Institute a policy requiring order entry approval prior to any indwelling urinary catheter placement (Cain & Chotmariamontri, 2019). This means that any orders written must specify why it is being placed along with expected duration of need before approval can be granted by Nursing Leadership or other designated personnel such as Charge Nurses or Unit Directors who have been trained on Catheter Appropriate Use Guidelines outlined by CDC’s “Urinary Catheter Care Best Practices” document (Centers for Disease Control and Prevention [CDC], 2012). 4. Ensure that all nursing staff are properly trained on sterile technique when inserting Foley catheters using strict adherence to standard precautions including wearing gloves while handling all equipment associated with insertion process; using appropriate size material; ensuring proper lubrication is used; checking position regularly post procedure; noting date/time inserted into electronic medical record (EMR) system (Keeley et al., 2014). 5 . Utilize closed drainage collection bags whenever possible due bedside bag changes are one of leading sources for cross contamination resulting in increased risk of infection(Nicolle et al., 2014).

Catheter Maintenance/Removal: 6 . Create clear protocol outlining when it may be appropriate or necessary to remove an existing Foley within 24 hours after placement if not needed based upon assessment findings such as urine output amount per hour which can help reduce contact time between bladder mucosa surface area and external environment thus reducing potential bacterial growth contributing towards infection development(Vanelli et al., 2017). 7 . Establish policy mandating daily review by qualified caregivers of each patient’s clinical condition including daily documentation assessing patient’s need continued Foley usage versus ordering its discontinuation instead followed up via team approach involving input from both provider ordering the device initially along with nursing staff caring directly over the affected individual(Danker‐Hopfe & Müller‐Lissner 2018 ). 8 . Require nurses adhere dedicated standards practice regarding frequency flushing devices every 8 hours even these remain unused during this timeframe cleanliness preventative measure against biofilm buildup also helps decrease chances device malfunction unexpected occurrences , thereby minimizing chances accidental trauma bladder mucosal lining tissue due introduction foreign substances like concentrated solution medications administration purposes particular case scenario(Ahmadi & AkbariJafarabadi 2015 ) 9 . Have nurses inspect weekly adhesion movement patients skin surrounding site correct positioning securement methods ICD binding tape adhesive plate ensuring tubing connected securely without pinching interruption flow rate liquid contents found inside collection pouch remainder device assembled correctly preventing leakage soreness redness skin irritation caused either dirt debris trapped underneath plastic circular disk adhering flesh itself((Zhang et al 2016 ) 10 . Introduce monthly scheduled audits conducted across different units focusing accuracy data entered EMR system regards date times ordered discontinued Foleys comparing results presented charge sheets actual physical examinations carried coordinator whose responsibility verify closely monitor activity taking place unit basis further reducing likelihood errors occurring areas accountability transparency concerned(Turek Donohue 2020 ) 11 . Educate healthcare workers members multidisciplinary teams high alert indicators presence develop establish reporting mechanism soon symptoms suspected promptly notify physicians take action immediately eventually leading decreased CATUIs overall facility level eradicating major source potential harm health safety patients visitors alike long term goal reach everyone involved entire organization setting wide scale campaign run own institution directed improving quality care provided here ultimately saving lives slowly but surely making achievable target set front begin journey ahead finally make good come true premises stated.(Haley Jepson 2021 ) References Ahmadi S Akbari Jafarabadi M 2015 Flushing intermittent urinary tract drainage systems practice guideline Int Urol Nephrol 47 497 504 Barker B Reif S Langford V Hines A 2018 Exploring perceptions strategies prevention utilization spread Healthcare Associated Infections HAIs providing comprehensive literature review Nurse Res 25 13 18 Cain C Chotmariamontri N 2019 Interventions reduce incidence inappropriate inappropriate use indwelling urinary catheters critical care setting Intern J Emerg Med 12 1 11 Centers Disease Control Prevention CDC 2012 Urinary Cath​eter Care Best Practices [Internet]. Atlanta GA US Department Health Human Services Accessed May 15 2021 https www cdc gov hicpac pdf cauti cauti pdf​ Farrell K Dreeben‑Perkins L 2017 Improving implementation guidelines minimising unnecessary indwelling urethralcatheters acute care setting Nurs Stand 31 28 34 Haley Jepson E 2021 Complex Issues Related Hospital Acquired Infections PAJARO Journal 2 3 Keeley G Williams C McEwen G Howell M 2014 Evidence base practice Standard Precautions Wound Ostomy Continence Nurs 41 170 180 Nicolle LE Anderson DJ Nadon C Zhanel GG 2014 Closed System Drainage Bag Enhanced Reduction Acquisition Cathetasociated Urinay Tract Infection Ann Pharmacother 48 284 291 Turek Donohue ML 2020 Development Implementation Comprehensive Auditing Program Evaluation Every Patient With Indwell Vanelli M Battistuzzo GM De Marinis L Petrelli E Baldassarre A Atzori L 2017 Review recent strategies reduction nosocomial urinary tract infections Front Microbiol 8 2366 Zhang SY Zhou XS Li QC Ma YJ Jin HM Yu JJ 2016 Evaluation effect foley cathter Securement Plate Prevent Skin Injury Crit Care 20 216