Pennsylvania Hospital is the nation’s first hospital. Located in Philadelphia, Pennsylvania, and founded by Benjamin Franklin, our institution is rich in culture and history. As part of the prestigious University of Pennsylvania Health System, our 450-bed facility uses evidence as the foundation to guide all practice.

Staff members in our 8-bed adult neurological intensive care unit (ICU) are well accustomed to using evidence-based “bundles” to guide their practice. Yet, the unit’s rate of catheter-associated urinary tract infections (CAUTIs) from June 2011 to July 2012 was continuously above the national benchmark for a neurological ICU. With such a high incidence of CAUTIs, and an inability to sustain more than 1 month free from CAUTIs in the previous 13 months, the staff in our neurological ICU realized that there was a problem with their current approach to CAUTI prevention.

Since the inception of our project 10 months ago, our team has successfully...

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