Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention

1. NQF-endorsed™ Safe Practices for Better Healthcare Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

2. Slide Deck Overview Slide Set Includes: • Section 1: NQF-endorsed™ Safe Practices for Better Healthcare Overview • Section 2: Harmonization Partners • Section 3: The Problem • Section 4: Practice Specifications • Section 5: Example Implementation Approaches • Section 6: Front-line Success Stories

3. NQF-endorsed™ Safe Practices for Better Healthcare Overview Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

4. 2010 NQF Safe Practices for Better Healthcare: A Consensus Report • 34 Safe Practices • Criteria for Inclusion • Specificity • Benefit • Evidence of Effectiveness • Generalization • Readiness

5. Culture SP 1 2010 NQF Report

6. Culture • CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices] • Leadership Structures and Systems • Culture Measurement, Feedback, and Interventions • Teamwork Training and Team Interventions • Identification and Mitigation of Risks and Hazards Structures and Systems Culture Meas., FB., and Interv. Team Training and Team Interv. ID and Mitigation Risk and Hazards Consent & Disclosure Consent and Disclosure • CHAPTER 3: Informed Consent and Disclosure • Informed Consent • Life-Sustaining Treatment • Disclosure • Care of the Caregiver Informed Consent Life-Sustaining Treatment Disclosure Care of Caregiver Workforce • CHAPTER 4: Workforce • Nursing Workforce • Direct Caregivers • ICU Care Nursing Workforce Direct Caregivers ICU Care • CHAPTER 5: Information Management and Continuity of Care • Patient Care Information • Order Read-Back and Abbreviations • Labeling Studies • Discharge Systems • Safe Adoption of Integrated Clinical Systems including CPOE Information Management and Continuity of Care Patient Care Info. Read-Back & Abbrev. Labeling Studies Discharge System CPOE Medication Management • CHAPTER 6: Medication Management • Medication Reconciliation • Pharmacist Leadership Role Including: High-Alert Med. and Unit-Dose Standardized Medication Labeling and Packaging Med. Recon. Pharmacist Systems Leadership: High-Alert, Std. Labeling/Pkg., and Unit-Dose • CHAPTER 7: Hospital-Associated Infections • Hand Hygiene • Influenza Prevention • Central Venous Catheter-Related Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Care of the Ventilated Patient and VAP • MDRO Prevention • UTI Prevention Healthcare-Associated Infections Hand Hygiene Influenza Prevention Central V. Cath. BSI Prevention Sx-Site Inf. Prevention VAP Prevention MDRO Prevention UTI Prevention • CHAPTER 8: • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention • Pressure Ulcer Prevention • DVT/VTE Prevention • Anticoagulation Therapy • Contrast Media-Induced Renal Failure Prevention • Organ Donation • Glycemic Control • Falls Prevention • Pediatric Imaging Condition-, Site-, and Risk-Specific Practices Wrong-site Sx Prevention Press. Ulcer Prevention DVT/VTE Prevention Anticoag. Therapy Contrast Media Use Organ Donation Glycemic Control Falls Prevention Pediatric Imaging

7. Harmonization Partners Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

8. Harmonization – The Quality Choir

9. The Patient – Our Conductor

10. The Objective Catheter-Associated Urinary Tract Infection Prevention • Prevent healthcare-acquired catheter-associated urinary tract infections.

11. The Problem Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

12. The Problem

13. The Problem Frequency • CAUTIs are the most frequent HAI in acute care hospitals • 80% are attributable to an indwelling urethral catheter • CAUTIs are associated with increased morbidity, mortality, hospital cost, and length of stay [Saint, Infect Control Hosp Epidemiol 2000 Jun;21(6):375-80; Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32]

14. The Problem Severity • Between 15%-25% of hospitalized patients may receive short-term indwelling urinary catheters • In 2002, the Centers for Disease Control and Prevention estimated that 561,667 CAUTIs occurred in the United States, contributing to 13,088 deaths [Weinstein, Infect Control Hosp Epidemiol 1999 Aug;20(8):543-8; Warren, Int J Antimicrob Agents 2001 Apr;17(4):299-303; Klevens, Public Health Rep 2007 Mar-Apr;122(2):160-6]

15. The Problem Preventability • Estimated to be 17%-69% with recommended measures • 380,000 preventable infections and 9,000 preventable deaths related to CAUTI annually • Limiting catheter use and minimizing the duration the catheter are principal strategies • Use of an antimicrobial or silver alloy-coated catheter reduces risk of CAUTIs [Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8; Ciavarella, Infect Control Hosp Epidemiol 2009 Apr;30(4):404-5; author reply 405-6; Parker, J Wound Ostomy Continence Nurs 2009 Jan-Feb;36(1):23-34]

16. The Problem Cost Impact • The annual direct medical cost of CAUTI is estimated to be $565 million in the United States [Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009]

17. Practice Specifications Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

18. Additional Specifications

19. Safe Practice Statement CAUTI Prevention • Take actions to prevent catheter-associated urinary tract infection by implementing evidence-based intervention practices. [Gould, Guideline for prevention of catheter-associated urinary tract infections, 2008; Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009; Lo, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S41-50]

20. Additional Specifications • Document the education of personnel involved in the entire catheter insertion procedure • Education should occur upon hire and annually thereafter • Prior to insertion, educate the patient and family members about CAUTI prevention • Identify the patient groups or units on which surveillance should be conducted, considering frequency of catheter use and potential risk • Implement policies and practices to reduce the risk of CAUTI [Willson, J Wound Ostomy Continence Nurs 2009 Mar-Apr;36(2):137-54; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8; Smith, Am J Infect Control 2008 Sep;36(7):504-35]

21. Additional Specifications • Evidence-based practices include, but are not limited to, the following: • Perform hand hygiene immediately before and after catheter insertion • Ensure that the supplies necessary are readily available • Insert catheters following an aseptic technique and using sterile equipment • Leave urinary catheters in place only as long as indications remain • Obtain a urine culture before initiating antimicrobial therapy [Barford, BJU Int 2008 Jul;102(1):67-74; Greene, Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008; Institute for Healthcare Improvement, Catheter-Associated Urinary Tract Infection (CA UTI) Prevention, IHI Improvement Map,2009; Joint Commission Resources, Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, National Patient Safety Goals, 2010]

22. Additional Specifications • Measure compliance with best practices, evaluating the effectiveness of prevention efforts • Provide CAUTI surveillance data, including process and outcome measures, to key stakeholders within the organization

23. Example Implementation Approaches Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

24. Example Implementation Approaches

25. Example Implementation Approaches • Implement a system for documenting the following in the patient record: • indications for catheter insertion; • date and time of catheter insertion; • individual who inserted catheter; and • date and time of catheter removal • Develop and implement facility criteria for acceptable indications for indwelling urinary catheter use [Gokula, Am J Infect Control 2004 Jun;32(4):196-9; Marklew, Nurs Crit Care 2004 Jan-Feb;9(1):21-7]

26. Example Implementation Approaches • Suggested indications for indwelling urethral catheter use include: • Perioperative use for selected surgical procedures • Accurate measurement of urine output in critically ill patients • Management of acute urinary retention and urinary obstruction • To assist in pressure ulcer healing for incontinent residents • Relief of bladder outlet obstruction or congenital urologic abnormalities

27. Example Implementation Approaches • Following aseptic insertion of the urinary catheter, maintain a closed drainage system • Maintain unobstructed urine flow • Implement an organization-wide program to identify and remove catheters no longer necessary; method examples include: • Automatic stop orders • Standardized reminders placed into patient record • Implementation of daily ward rounds to review all patients with urinary catheters [Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]

28. Example Implementation Approaches Strategies of Progressive Organizations • High-performing organizations have protocols for the management of postoperative urinary retention • Innovations include direct visualization of the urethra during insertion of catheters • Implement a system for analyzing and reporting data on catheter use, including adverse events [Chapple, 2004 June;93(9)1195-1202; Fenton, Urology 2005 Jun;65(6):1055-8; Agency for Healthcare Research and Quality, National Healthcare Disparities Report 2008, 2009; Agency for Healthcare Research and Quality, National Healthcare Quality Report 2008, 2009]

29. Front-line Success Stories Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through Prevention of Healthcare-Associated Infections

30. http://www.shea-online.org/Assets/files/patient%20guides/NNL_CA-UTI.pdfhttp://www.shea-online.org/Assets/files/patient%20guides/NNL_CA-UTI.pdf

32. TMIT High Performer Webinar Healthcare-Associated Infection and You: Cleaner, Safer Care (Safe Practices 19-25) • The National Quality Forum’s (NQF) 2009 Update of the Safe Practices for Better Healthcare and TMIT’s Webinar series provide tools to unite healthcare providers, purchasers, and consumers to more rapidly identify and adopt techniques that will reduce patient harm and improve care. • Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932