Deborah R. Campbell, RN-BC, CCRN, MSNPediatric Cardiovascular CNSKentucky Hospital AssociationChildren’s Hospital Association QTN faculty
Clinical Consultant for Carefusion◦ Work to be presented was completed without
commercial support
Review evidence based interventions to prevent CAUTI
Discuss bundle concept as relates to CAUTI prevention
Discuss CAUTI prevention as a team sport Discuss ‘safety culture’ aspects of CAUTI
prevention
Sterile insertion technique (Consider a kit)◦ Smallest, softest catheter that will do the job
Ensure adequate hydration Hand hygiene Perineal care
◦ BID with soap and water, PRN BM (Products) Keep bag below the level of bladder Prevent bag, tubing from touching floor Avoid dependent loops, kinks No disruption of closed system
Obtain specimens using aseptic technique◦ Only if absolutely necessary◦ Remove and replace for C&S
Empty the bag when1/2-2/3 full (Q4hrs?) Each patient should have own graduated
cylinder Daily observation for signs, sx of UTI Isolation of diagnosed CAUTI pt from anyone
with a catheter Utilize a securement device
Bladder scanning- non-invasive, easy, quick Intermittent catheterization v. in-dwelling
caths- better for patient, more work for staff Ditch the bath basins CHG baths- microbe burden Appropriate nurse staffing Antibiotic or silver-coated catheters Hydrogel catheters- discourage biofilm
adherence Catheter valves- store urine in bladder v. bag
◦ More physiologic as well, decreases need to re-train
Is there a “magic bullet? Are there certain, specific items 1+1=3 Synergy? Pathogen dose v. immune response Bundles act as checklists Bundles act as curriculum Recipe v. culture
Policy change is not = to practice change
QI 101- Educate, Implement, Audit, Improve, SUSTAIN
All at once or step-wise? How do I choose from the menu?
◦ Problems known to exist at your place◦ Acceptable to your front line staff◦ Ways to measure already in place (LAST)◦ RCAs on CAUTIs that occur
Is there a best way?◦ Direct Observation
Peers Supervisors, educators, CNSs
◦ Self-audits◦ Secret Shoppers
Sampling◦ Include weekends, nights◦ Attempt randomness by setting specific days, times
Met your goals consistently, decrease frequency-BUT never less than quarterly.
Make the right action the default◦ Opt-outs v. necessity to overtly choose◦ Nurse driven protocols◦ Standardization◦ Redundant processes◦ From the IHI- Everyone chooses (or is assigned) a
focus area for which they provide input 5 audits per day per person (on HAPU, CLABSI,
CAUTI, SSI or VAP)
Care team members other than primary RN◦ Nurses helping out (regular, floated, agency)◦ PCAs◦ X-ray technicians◦ Respiratory therapists◦ Transporters◦ Family members◦ Patients themselves
Decrease the number of insertions/transfers with catheters◦ ED◦ OR
Success is possible!◦ Emergency room staff education and use of a
urinary catheter indication sheet improves appropriate use of foley catheters. Presented by RM Gokula, MD, MA Smith, MD, and J Hickner, MD, Lansing, Michigan
Can’t define it, but we know it when we see it◦ Non-heirarchical◦ Healthy team dynamics
First names Safe to question, interrupt (Scripting!)
◦ Patient-Centered◦ No blame-it’s all about the process◦ Personal accountability (1 patient, 1 action at a
time) Link participation to annual evaluations
Build concept that patient well-being is everyone’s responsibility◦ Individual◦ Team◦ No carve-outs
Rules apply to everyone, regardless of discipline Think pro-actively- “what could harm this
patient today?” Effective for more than one outcome
◦ Infections◦ Unplanned device removals◦ Med Errors
Videos, e.g. Josie King Think of patient in front of you being your
mother, grandfather, child VA campaign
◦ “Have you ever killed someone with your bare hands?”