cauti crushers eliminating the risk for catheter-associated urinary tract infections
TRANSCRIPT
CAUTI CRUSHERS
ELIMINATING THE RISK FOR CATHETER-ASSOCIATED URINARY
TRACT INFECTIONS
· Describe risk factors associated with urinary tract infections
· Identify catheter-associated urinary tract infection (CAUTI) reduction strategies in order to implement into clinical practice.
• Demonstrate setting up a sterile field for urinary catheterization.
• Demonstrate the use of proper aseptic technique when inserting a urinary catheter.
OBJECTIVES
Ignaz SemmelweisFather of Infection Control
Florence NightingaleFounder of Modern Nursing
Evidence-Based, Best Practice
CAUTI CRUSHERS 101
• Why is this important?
• How will this benefit our patients?
• Give me the facts!
What Are CAUTIs?
• A urinary tract infection (UTI):
– Infection involving any part of the urinary system, including the urethra, bladder, ureters and kidneys.
– Most common type of healthcare-associated infection (HAI) reported to the National Healthcare Safety Network (NHSN)
Urinary tract infections account for more than 30% of infections reported by acute care hospitals in the United States. What percentage of those are associated with a urinary catheter?
a. 25%b. 50%c. 75%d. 90%
ANSWER
C. Approximately 75% are associated with a urinary catheter – tube inserted into the bladder through the urethra to drain urine
Clinical Manifestations
• Vary Greatly• Asymptomatic bacteriuria → overwhelming
sepsis• Symptomatic UTI:– Lower abdominal, suprapubic, or flank pain– Systemic symptoms:• Nausea• Vomiting• Fever
Burden of Illness
• Of patients who receive urethral catheters:– Bacteriuria rate is ≈ 5% per day
• Among those with bacteriuria:– ≈ 10% will develop symptoms of UTI– Up to 3% will develop bacteremia
• Direct medical costs:– Symptomatic UTI: $600-$1,000– Catheter-associated bacteremia: ≈ $3,000 per
episode
CAUTI Facts
• CAUTIs can result in increased:– Morbidity– Mortality– Hospital costs – Length of Stay
What percentage of patients who are hospitalized receive a urinary catheter?
a. 5-10%b. 15-25%c. 30-35%d. 40-45%
ANSWER
B. 15-25% of hospitalized patients receive urinary catheters during their hospital stay
What is the most important risk factor for developing a catheter-associated UTI?
A. Insertion technique (sterile field, aseptic technique)
B. Peri-care; daily cleansing of perineal area surrounding the catheter
C. Prolonged use of the urinary catheterD. Patient’s age, gender and mobility
status
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Prolonged use
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Patient’s
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Answer
• C. Prolonged use of the urinary catheter
CAUTI Stats• 3% increase in CAUTIs nationally from 2009-2012• 12% of Texas hospitals have a Standardized
Infection Ratio (SIR) worse than the national SIR of 1.03 (2013)
Ruling by CMS• Hospital-acquired conditions (HACs): conditions that
patients did not have when they were admitted to the hospital, but which developed during their hospital stay.
• Centers for Medicare & Medicaid Services (CMS) now holds U. S. hospitals accountable for not preventing certain HACs.
• CMS required to choose at least 2 conditions that:– Are high cost and/or high volume; and– Could reasonably have been prevented through the application
of evidence-based guidelines.• CMS chose 10 conditions, and CAUTI was one of them.
Essential Hospitals Engaging Network (EHEN)
• Formerly the National Association of Public Hospitals, EHEN initiated a program in 2012 for public hospitals– Goal: Reduce certain infections and conditions by 40% by
the end of 2013 when compared to 2010 data– CAUTIs were selected as one of the target infections
• UMC joined that initiative. Although we met goal for central line-associated bloodstream infections, we did not meet goal for CAUTIs.
• We are committed to closing this Professional Practice Gap!
CAUTI RATES AT UMC
2010 2011 2012 20130
10
20
30
40
50
60
27
54
37
29
CAUTIs in Combined ICUs at UMC2010-2013
2010201120122013
7% increase inCAUTIs from 2010
2010 2011 2012 20130
5
10
15
20
25
30
35
15
1918
8
12
35
1921
Total CAUTIs for Trauma & Med-Surg ICU at UMC 2010-2013
Trauma ICUMedical-Surgical ICU
Challenge for 2014
• Same challenge has been presented to UMC for 2014: reduce CAUTIs by 40% compared to our 2010 data
Mariam Yazdi, RN, BSN
Cindy Hernandez, RN, BSN
CINDY HERNANDEZMARIAM YAZDI
CAUTI REDUCTION GOAL
• Reduce incidence of CAUTIs by 15% in 2014.
• Reduce incidence of CAUTIs by 30% in 2015.
CAUTI ELIMINATION ACTION PLAN
• Cultivate enthusiasm• Increase Awareness• Provide Ongoing Education• Institute PI Tool – Immediate
Removal of foley• In-service Proper Catheter
Maintenance• Ensure Intradepartmental
Collaboration
When is it appropriate to use an indwelling urinary catheter ?
a. Need for strict, accurate output measurement as per MD ordersb. For end of life issues regarding comfort when requestedc. Strict prolonged immobilization (as in pelvic fracture)d. To help promote healing of Stage III and Stage IV sacral or coccyx pressure ulcers
A. all of the above; B. a & b only; C. c & d only
a) all o
f the above
;
b) a &
b only;
c) c
& d only
33%33%33%
When Is a Catheter Appropriate?
A. All of the aboveIn addition, the following conditions may warrant using an indwelling urinary catheter:• Bladder Injury• Acute Urinary Retention• Acute bladder outlet obstruction• Select peri-operative needs
Catheter Insertion Components
• Hand Hygiene prior to and after insertion
• Proper sterile field set up• Aseptic Technique • Remember, inserting a foley is a component of
evidence-based practice, no matter what the discipline. It requires careful attention and is not just a “task” to be completed
UTI Bundle
Approach
AWARENESS!
LABEL THE FOLEY BAGS
In report, what Foley day is this?
KEEP URINE FLOWING FREELY
No kinks in tubing or
Securement Device
URINE FLOW BAG
BLADDER
BAG
Securement Device
MORE HOUSEKEEPING
Empty Foley bag frequently; avoid allowing the spigot to
touch the collection container
KEEP FOLEY UNIT OFFFLOOR.
FOLEY CARE• Foley/Perineal Care frequency –
EVERY 12 HOURS!
Tools
Don’t Forget! • Bathe patients with product containing
Chlorhexidine Gluconate (CHG), avoiding mucosal areas
• Place CUROS cap on sampling port• Maintain a closed system • Collect urine sample from sampling port
closest to insertion site. • DO NOT COLLECT URINE FROM
DRAINAGE BAG.
Early Removal of Indwelling Catheters
• 14 studies have evaluated urinary catheter-reminders and stop-orders – Written, computerized, or nurse-initiated
• Summary of the Evidence:– Significant reduction in catheter use (≈ 2.5 days)– Significant reduction in infection (≈ 50%)– No evidence of harm (i.e., re-insertion if
necessary)
IMMEDIATE CATHETER REMOVAL
Catheter removed
Review hospital policy and practice
Foley removal
CAUTI ELIMINATION ACTION PLAN
• Educate nurses and nursing support staff– Nurse Technicians– CNAs– Unit Council and Staff Meetings– Quarterly Education: for new hires;
maintaining Unit competence
DATA COLLECTION
• PI Monitoring Tool – Covers all areas of foley management, including
the UTI Bundle
• Collaboration with Quality Management–Nurse residents round 2 times per week.– Quality Management rounds 1-2 times per
week.
• Rounding started on 8/18/14.
Alternatives to the Indwelling Catheter
– Bladder Ultrasound
– Intermittent Catheterization
– Condom Catheter for males
– Area for Research: female external catheters
ReferencesEliminating Catheter-Associated Urinary Tract Infections. Health Research &
Educational Trust, Chicago: July 2013. Accessed at www.hpoe.org. Educational Trust, Chicago: July 2013. Accessed at www.hpoe.org
Educational Tools | catheterout.org. (2014, January 1). Retrieved August 15, 2014.
Health and Research Educational Trust; CUSP, Eliminating CAUTI: A National Patient Safety Imperative. (2013). Interim Data Report on the National On the CUSP: Stop CAUTI Project. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/cusp/using-cusp-prevention/cauti-interim/cauti-interim.pdf
Martinez-Resendez, MD, M., et al. (2014). Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients. American Journal of Infection Control, 42, 713-717.
Rebmann, T., & Greene, L. (2014). Preventing Catheter-associated Urinary Tract Infections: An Executive Summary Of The Association For Professionals In Infection Control And Epidemiology, Inc, Elimination Guide. American Journal of Infection Control,644-646
Strategies to Prevent Catheter‐Associated Urinary Tract Infections in Acute Care Hospitals. (2008). Infection Control and Hospital Epidemiology, Vol. 29(S1). Retrieved August 1, 2014, from http://www.jstor.org/stable/10.1086/591066.
PREVENTION TEAM
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