utis at sph adrienne melck, md, mph, frcsc division of general surgery meghan macleod, msc quality...
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UTIs at SPH
Adrienne Melck, MD, MPH, FRCSC
Division of General Surgery
Meghan MacLeod, MSc
Quality Improvement Specialist
NSQIP• Nationally validated, risk adjusted, outcomes based
quality improvement program
• Rigorous prospective collection of preoperative through 30 day postoperative outcome variables
• 1,680 cases across 8 specialties each year
• Intense Surgical Clinical Reviewer training, continuing education, and support
• Highly standardized and validated data definitions
• 135 total variables collected
• Data analyzed by NSQIP and hospital performance is reported back to drive quality improvement work
Geographic Distribution of ACS NSQIP Participating Sites Included in the Semiannual Report (n=289). A total of 440 sites are enrolled in all ACS NSQIP programs.
The Problem(NSQIP Data)
• SPH UTI incidence 2011: 4.4%
• NSQIP avg. UTI incidence 2011: 1.6%
• BC UTI incidence 2011: 2.8%
• OR = 1.84
• 10th Decile!
• UTIs are a problem across the specialties
SPH Overall Multispecialty (All cases)
Overall Multispecialty (All cases)Raw Data
Our Goal
• 0% UTI incidence by December 2012!
• ....or at least no longer “in the pink”
The Facts
• Up to 80% of UTIs are attributable to urinary catheterization
• Patients with indwelling Foleys >2 days postop are 2X more likely to develop a CAUTI
• >50% catheters in hospitalized patients may be unnecessary
• CAUTIs have a significant impact on morbidity, LOS and hospital costs
• Holy Moley, Remove that Foley!
UTI Working Group• Surgery – Stephen Parker
• Ortho – Michele Bech
• Cardiac – Wendy Bowles, Marie McCoy
• O.R. – Jacek Murawski
• MSJ – Connie Degeau
• Clinical Care Analyst – Lisa Toback
• QI Specialists – Meghan MacLeod, Sophie Clyne
• IPAC – Dr. Victor Leung
• Anesthesia – Dr. Chan
• Urology – Dr. Mike Eng
• Gyne – Dr. Cundiff
• Chair – Dr. Melck
UTI WG – 1st meeting
• Data and Literature Review– Nearly all of our UTI cases had a urinary
catheter at some point
– Of those, >50% developed a UTI within 6 days of surgery
– Decision to make catheters our primary focus
– ACS NSQIP Best Practice Guidelines
UTI WG – 2nd meeting
• Information gathering– Observation from OR and wards:
• Poor sterile insertion technique (hand hygiene!!)• Trainees inserting Foleys in OR • Lack of adequate securing of catheters• Drainage bags not being kept below bladder (especially
during transfer)• Routine Foleys for epidural analgesia• Lack of daily meatal care• Lack of hand hygiene prior to catheter manipulation• Indwelling catheters to treat retention rather than in and outs• CATHETERS LEFT IN TOO LONG!
UTI WG – 3rd meeting
• Revision of Nursing Practice Standards– More emphasis on:
• hand hygiene• proper sterile insertion technique • using smallest catheter size possible
• Presentation at MSJ and SPH All Party rounds
Top 10 Ways to Prevent Catheter-Associated UTIs
1. Don’t use a Foley unless absolutely necessary.
2. Trained staff should supervise medical students/junior residents putting in a Foley.
3. WASH HANDS BEFORE DONNING GLOVES TO INSERT FOLEY!
4. Use the smallest size Foley possible: 12F for women, 14F for men.
5. Always secure the catheter to the patient.
6. Always keep the catheter bag below the bladder.
7. Document everything.
8. Keep the integrity of the sealed catheter system; use only the sampling port to collect urine samples.
9. Routinely speak up and question the need for a Foley; listen to and respect others’ opinions.
10. An epidural is not an indication for a Foley.
SPH Multidisciplinary Surgical Program Meeting April 27, 2012
What are you curious about?
Ask me!