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Preventing Catheter-Associated Urinary Tract Infections June 12, 2013

Preventing Catheter-Associated Urinary Tract Infections June 12, 2013 Bonnie Norrick, MT(ASCP) cm , EdM, CIC. Objectives. List risks for acquiring a catheter associated urinary tract infection (CAUTI) Identify interventions for prevention of CAUTI

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Preventing Catheter-Associated Urinary Tract Infections June 12, 2013

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  1. Preventing Catheter-Associated Urinary Tract Infections June 12, 2013 Bonnie Norrick, MT(ASCP)cm, EdM, CIC

  2. Objectives • List risks for acquiring a catheter associated urinary tract infection (CAUTI) • Identify interventions for prevention of CAUTI • List at least 3 elements in a nurse driven protocol for removing a urinary catheter

  3. Licensed 276 acute care beds • Patient days 27,257 for FY 2012; Avg census 77 • Observation days 1041 • Average length of stay 3.4 days • LTC, Hospice, Heart Clinic, Women’s Center, Occupational Medicine, Sleep Center, Cancer Clinic

  4. Impact of Healthcare Associated Infections (HAI) • According to the Centers for Disease Control and Infection (CDC), each year • Approximately 1.7 million people develop HAIs • 100,000 people die due to complications of infections • Between 5 and 10 % of individuals who are admitted to an acute care hospital will develop at least one HAI • Costing $4.5-$5.7 billion • 15% of those are CAUTI

  5. Definition of CAUTI • Catheter-associated UTI (CAUTI): A UTI where an indwelling urinary catheter was in place for >2 calendar days when all elements of the UTI infection criterion were first present together, with day of device placement being Day 1, and • an indwelling urinary catheter was in place on the date of event,

  6. Definition of CAUTI 2 • at least 1 of the following signs or symptoms: fever (>38°C); suprapubic tenderness*; costovertebral angle pain or tenderness* • and • a positive urine culture of ≥105 colony-forming units (CFU)/ml with no more than 2 species of microorganisms. Elements of the criterion must occur within a timeframe that does not exceed a gap of 1 calendar day • *With no other recognized cause

  7. Definition of CAUTI 3 • Patient had an indwelling urinary catheter in place for >2 calendar days and had it removed the day of or the day before all elements of this criterion were first present together • and at least 1 of the following signs or symptoms: fever (>38°C); urgency*; frequency*; dysuria*; suprapubic tenderness*; costovertebral angle pain or tenderness* • and a positive urine culture of ≥105 colony-forming units (CFU)/ml with no more than 2 species of microorganisms. Elements of the criterion must occur within a timeframe that does not exceed a gap of 1 calendar day • *With no other recognized cause

  8. Risks for CAUTI • Duration: Prolonged catheterization > 6 days • Sex: Female gender • Location of insertion: Catheter insertion outside the operating room • Urology Service • Overall health • Other active sites of infection • Diabetes • Malnutrition • Elevated creatinine >2.0mg/dl • Invasive interventions: Ureteral stent • Maintenance of Foley

  9. Our Story: In the Beginning • Surveillance for CAUTI • Facility wide-medical, OB and ICU • Use Definitions • Calculate rates? ICU only, share data

  10. Minimizing the Risks • Use of silver coated Foley catheter’s in all areas • Securement device • Placement of tubing and bag in respect of bladder and floor • Maintain a closed system • Bags emptied appropriately – not overfilled

  11. To Change Requires Measurement November 2008 survey April 2009 Survey-post education of nurses 22 Foley’s reviewed Tubing kinked 0 Bag on floor 5 Seal Broken 0 Bags overfilled 0 Tubing not secure 0 13 Foley’s reviewed • Tubing kinked 5 • Bag on floor 4 • Seal Broken 0 • Bags overfilled 0 • Tubing not secure 11

  12. Interventions Jan-March 2009 • Silver coated catheters • Securement devices (one that stuck) • Visualization of proper positioning of tubing and collection bag • Method to obtain devices days

  13. Education • Aggressive education of staff • Computer based learning • On hire and annually • Skills day • Insertion of Foley and peri-care, urine collection • One on one education • Observation of securement, tubing and bag position • Inquire-medical necessity?

  14. Documentation in EMR

  15. Slide 15

  16. Other interventions • An additional SCIP quality measure began in October 2009 requiring Foley catheter be discontinued on Post Operative Day 1 or Post Operative Day 2. If the Foley remains a reason for continuing urinary catheter must be documented by MD/APN/PA. • Applied to all surgeries. • Increase use of condom catheters for men.

  17. Rates = infections/device days x 1000

  18. Nurse driven protocol-Foley Removal Criteria • Patient is awake, alert, no problems voiding before the catheter was placed • Catheter was not placed for urinary retention/obstruction and no recent urological surgery within 3 months • Patient is able to resume their voiding position • Patient able to cooperate with strict I&O monitoring • No evidence of gross hematuria

  19. Nurse driven protocol-Foley Removal Criteria 2 • Epidural catheter is removed • Patient is not intubated • Patient not admitted with chronic indwelling Foley catheter • Post-op patient surgery greater than or equal to 48 hours. • Open wounds/excoriation absent or resolved. • Catheter is not a suprapubic catheter Using the above guidelines, the indwelling (Foley ) catheter will be removed by the RN 48 hours after insertion of the foley unless a specific physician’s order indicates otherwise. Nurse will review reason why foley was initially inserted.

  20. Bladder scan usage If one of the following is present RN will perform bladder scan. • Bladder discomfort • Distended bladder • Has not voided in 6 hours or at discretion of nurse • Post void residual (Not emptying bladder, voiding frequent small volumes) If urine volume is greater than 250 ml the nurse will call the physician for further instruction such as a straight catherization order. Volumes less that 250 document in nurses notes.

  21. Rates 2012 2013 Risk assessment • Decrease catheter associated UTI by 50% (1 catheter associated urinary tract infections) • Devise days will be collected each month for ICU and ICU SD patients. • Other units devise days will be collected on a rotating schedule.

  22. On Going Initiatives • Continue rounding on all nursing units • Re-educate Foley removal policy during rounding • Observe hand off communication between shifts discussing devices • Identify root cause of each CAUTI

  23. In Summary • Risk assessment a must, prioritize strategy • Measure • Involve leadership • Celebrate • It’s a Team Effort!

  24. References • Guideline for Prevention of Catheter-Associated Urinary Tract Infection 2009, Healthcare Infection Control Practices Advisory Committee, Center for Disease Control • Clarke, K.,Tong, D., Norrick, B., Reduction In catheter-associated urinary tract infection by bundling interventions, International Journal for Quality in Health Care Advance Access, 2012.

  25. Thank you Any questions? I have the time. Questions later, email or call. • Bonnie Norrick • Email norrickb@wghealth.org • Phone 706-845-3180 West Georgia Health- So Healthy Together

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