qi group project - e.c.y.t

7/23/2019 QI Group Project - E.C.Y.T.

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Quality Improvement Proj

C.A.U.T.I. PREVENTIO

NURS362 - FALL2015Elizabeth N., Charleen K., Young-in K., !omi ".



Summary o# the Problm

➢ $o% are C&'!I !au"#(

○ germ) can enter the urinary tract %hen the catheter i) being place* or %hile

remain) in the bla**er.

➢ C&'!I ha) been a))ociate* %ith $%!ra"# morbi*ity, mortality, health care co)t)

)tay.

➢ C&'!I i) one o# ve !ommo% $ealthcare &))ociate* In#ection) $&I)

➢ &AI are in#ection) patient) can get %hile receiving care in a healthcare #acility

➢ '(y patient) get urinary catheter)/○ unable to urinate on their o%n

○ urine output nee*) be mea)ure* )uch a) in inten)ive care unit)

○ *oing an* a#ter )ome type) o# )urgery )uch a) orthope*ic )urgery

○ *oing )ome te)t) o# the 0i*ney) an* bla**er

➢ Ty)" o# catheter)/ in*%elling, intermittent, e1ternal, + )uprapubic

➢ Key player) involve* inclu*e the (al*(!ar *am an* the )a*$%*. !he )ta2 in)catheter an* #ollo%) up %ith catheter care. 3hile the patient i) the one %ith the c



Com)ar$%+ the problemto %a*$o%al a%# "*a* $%#$!a*or"

STATE, $a%aii$a%aii / 456 *ecrea)e reporte* ban* 7894

:3hen a urinary catheter i) not pnot 0ept clean, or le#t in a patientgerm) can travel through the cathin#ect the bla**er an* 0i*ney).:

86 &mong the 94 ho)pital) in $aenough *ata to calculate an ;I<, 8)ignicantly %or)e than the natio9.8=.

:;till nee* to improve even %*ecrea)e.:

NATIONAL,● = percent increa)e in C&'!I bet%een

788> an* 7894● 976 7,?59 '.;. ho)pital) ha* an ;I<

)ignicantly %or)e than the national;I< o# 9.8=.

● 9 o# @ patient) in the ho)pital %illhave a urinary catheter *uring their

)tay. A86 o# %hich are unnece))arilyplace* an* increa)e) length o# )tay i#C&'!I i) pre)ent.



QI *ool" #or Fa$lur o# a%# E!*" a%

1. Sl!* a )ro!"" *o a%aly/, *o )r%* r"$#%*" rom (a$%

2. Sl!* )o)l or *( *am, )(y"$!$a%"4 $%!*$o%-rla*# "*a4 CNA"

3. "!r$b *( )ro!"",

. '(a* !oul# +o 7ro%+ #ur$%+ a!( "*) o *( )ro!""

Indication/ insertion Maintenance Removal/post-

removal

Indication/insertion Maintenance Removal

● Untrained person● Inappropriate indications

(women, elderly, impaired

immunity, incontinence

maintenance, etc)● Violation of aseptic

technique (hand washin,

ectc

)

● !isconnection or

lea"ae

● #on-sterile to o$tain

urine sample

● Urine flow o$struction

(tu$e location lower than

$ladder, "in"ed)

● %laced loner

than necessary




5. P$!8 7($!( )roblm" *o 7or8 o% l$m$%a*$%+ a%

)r$or$*$/$%+9:u"*$o% abou* ou*!om4 "r$*y4 a%# )robabu"$%+ #"!r$)*$ *rm";(ex. catheter use for more than prescribed # of days may have lesssevere outcome than the violation of sterile technique when insertinthe probability may be much higher in the organization - “priority!

6. "$+% a%# $m)lm%* !(a%+" *o r#u! or )r)roblm" "rill down the root cause of the problems utilizing “hy$ technique

hy does our organization have such high incidence of overdue usecatheter$ - %hortage of nursing sta&!




7. Design and implement changes to reduce or prevent prob

8. Measure the success of process changes

&ore Measures● Insert catheter only for appropriate

indications● 'eave catheters in place only as

lon as needed (staff trainin, a

display $oard, educational video at

admission)● terile techniques● Maintain a closed drainae● Maintain uno$structed urine flow

upplemental Measures● lternatives to

indwellin urinary

catheteri*ation● %orta$le ultrasound

devices to reduce

unnecessary

catheteri*ation● ntimicro$ial/antisep

imprenated cathete



PSA, T( *ool *(a* *( )ro<!* la#r" alua* *(

Pla%Boal - zero occurrenceea)ure - D o# C&'!I inci*ence *ivi*e* by total D o# ho)pitalization 988

!ime - one month

o& )mall te)t + *ocumentation - ;ee i# pt) are a%are ho% many *ay) theyFve

S*u#yGearne* that mo)t o# pt) *onFt 0no% the length o# their catheterization)

A!*Implement pt e*ucation an* place a boar* in ptF) room in*icating the D o# *catheterization



R!omm%#a*$o%" to l$m$%a* or r#ur$"8 o the problem

+ R#u! *( ab"olu* %umbr o )a*$%*" %ith urinary catheter)

+ inimize urinary catheter u)e an* *uration o# u)e in all patienparticularly tho)e at higher ri)0 #or C&'!I or mortality #rom cat)uch a) %omen, the el*erly, an* patient) %ith impaire* immun

+ &voi* u)e o# urinary catheter) in patient) an* nur)ing home remanagement o# incontinence.

+ ')e urinary catheter) in operative patient) o%ly a" %!""ary4 rarou*$%ly.

+ Proper (a%# (y+$% imme*iately be#ore an* a#ter in)ertion or %itmanipulation o# the catheter *evice or )ite.+ !he a**ition o# an a%*$m$!rob$al #ru+ in the coat o# catheter) i) a

%ith *elaye* bacterial coloni)ation.

+ (silver-alloy, nitrofural-impregnated, or standard polytetra'uorurinary catheters!

+ aintain a !lo"# "*r$l *rainage )y)tem %ith perio*ical bla##

+ Electronic me*ical recor* )y)tem o# alr*" a%# rm$%#r".+ R$7 o "8$ll"/ re-#re)h )0ill) cour)e + )pecialize* training team



a*a collection to alua* "u!!"" r

+ "epen*ing on acce))ibility/ C&'!I prevention chec0li)

on l!*ro%$! m#$!al r!or# #or a )electe* ho)pital+ Haculty ba)e* r$"8 a""""m%* "!or" an* mo%*(ly

o# nece))ary unit).+ Con)i*er r)or*$%+=#o!um%*$%+ both proce)) an* o

mea)ure) to )enior &*mini)trative, me*ical, an* nur)inlea*er)hip an* clinician) %ho care #or patient) at ri)0 #

+ Ca*(*r u"a+="u))ly u%$* count per year *ecrea)previou) year)

+ Compare %ith nur)e )ubtraction o# I'C #rom omi-ce+ <oom #or error/ %a)te* I'C )et)



rer%!"

&enters for !isease &ontrol (..) 0uideline for %revention of &atheter-cquired Urinary 1ract Infections .. Retrie

http2//wwwcdcov/hicpac/pdf/&U1I/&U1Iuideline..finalpdf

&enter for !isease &ontrol and %revention (.34) Healthcare-associated infections progress report. Retrieved from2

http2//wwwcdcov/5I/pdfs/proress-report/hai-proress-reportpdf

678s a$out &atheter-ssociated Urinary 1ract Infections (.34, 9anuary .) Retrieved from http2//wwwcdcov/hai/pdfs

U1I:taedpdf

0uideline for %revention of &atheter-associated Urinary 1ract Infections, .. (.., !ecem$er ) Retr ieved from

http2//wwwcdcov/hicpac/cauti/..;:evidenceReviewhtml

'eone, M (.3) %revention of &U1I2 simple and $eautiful The Lancet Vol <;., Issue ;4= % 3;3-3; doi23.3

>=<>(3)>3434-<

@man, A, Ma"ic, M, et al (.33) #urse-directed interventions to reduce catheter associated urinary tract infection Ame

Infection Control Vol?., Issue > % 4?;-44< doi23.3.3>/BaBic.33.=.3;

imon, M, Alaus, C !unton, # (..) Usin #!#7I data to manae &U1I Article in Nursing Management Vol ?.

doi23.3.=/.3#UM....<4>>;3;4;=$

Meddins, 9, Reichert, 5, C McMahon, '6 (.3?) &hallenes and proposed improvements for reviewin symptoms and

Infection Control Vol? Issue3. % s<>-s?3 doi2 3.3.3>/BaBic.3?.4.?

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