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CAUTI Reduction

CAUTI Reduction. Legacy Good Samaritan Medical Center Presented by Jim Marangoni RN SCNR Thank You Art Ashby and Cindy Evans. Objectives. Deciding on the issues R oles in an infection reduction project UTI prevention bundle Describe Process and Outcome M onitoring

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CAUTI Reduction

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  1. CAUTI Reduction Legacy Good Samaritan Medical Center Presented by Jim Marangoni RN SCNR Thank You Art Ashby and Cindy Evans

  2. Objectives • Deciding on the issues • Roles in an infection reduction project • UTI prevention bundle • Describe Process and Outcome Monitoring • Integrate NSQIP Data into UTI reduction efforts: Realtime, Risk Adjusted, Regional

  3. Legacy Good Samaritan Medical Center • Legacy Health – 6 hospitals, regional referral laboratory, research programs, clinics, hospice program and IP rehabilitation center • Urban hospital in NW Portland: 230 Staffed beds, Average Census 130-170 patients • NSQIP since Sept 2008 • Multispecialty with OHS

  4. Oregon NSQIP Consortium

  5. CAUTI ReductionProduct Conversion to Silver Hydrogel Coated Urinary Catheters Catheter Associated - Nosocomial Urinary Tract Infections April - June 2005 compared to April - June 2006 Rates per 1000 Patient Days Projected Net Cost Avoidance: $115,700 based on CAUTIs prevented and projected increased cost of products

  6. CAUTI Rates 2006-2008: Kern CCUper 1000 device days

  7. Overall* Urinary Tract Infections Observed Rate: 2.06% Expected Rate: 1.53% O/E Ratio: 1.35 Status: As Expected * Includes General and Vascular Surgery Cases

  8. First Step – Collaborating Chief Nursing Officer and Quality Improvement Specialist Legacy Initiative to Focus on Infection Prevention Led to Development of Infection Prevention Bundles CAUTI Reduction Strategy

  9. Foley CatheterBest Practice Bundle • Sterile technique for insertion • Always keep drainage bag below level of the bladder • Empty bag before transport • Prevent dependent loops in tubing • Secure catheter to decrease movement of foley • Pericare daily using soap and water with daily bath • Do not allow the bag to overfill • Do not allow bag to touch floor

  10. EPIC Documentation Flowsheet

  11. CAUTI Prevention Process • Best Practices Literature Review • CAUTI Prevention Bundle Development • Educating staff who come into contact with patients with catheters, from placement to transporting patients • Monitoring Compliance with CAUTI Bundle • Process Monitoring Rounds by CNO and ICP • Provide Feedback Regarding Compliance and CAUTI data to staff • Interactive Case Reviews with Nursing Staff

  12. Bundle Education

  13. 71% Reduction in UTI Cases CAUTI Reduction April 2008 – March 2010

  14. Symptomatic CAUTI Case CountsJune 2010 – November 2011

  15. Quarterly UTI Realtime NSQIP

  16. Monthly UTI NSQIP

  17. Overall* Urinary Tract Infections Observed Rate: 0.82% Pred. Obs. Rate: 0.93% Expected Rate: 1.04% Odds Ratio: 0.89 Status: Non-Outlier * Includes General and Vascular Surgery Cases

  18. Conclusions The Bundles approach works Leadership involvement is essential Education, Education and Re-education is required Surveillance includes process AND outcomes monitoring and feedback to the staff Involving care staff in case analysis leads to discovery

  19. Questions?

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