Reducing CAUTIs in Long Term Care

Lori SteeleAmerican Sentinel University

August 20, 2013

Increase and maintain positive patient outcomes through the initiation of CAUTI prevention program

Identify actions and eliminate barriers in relation to successful CAUTI project initiation

Establish educational tactics and approaches

Initiate evidence-based practice

Objectives

A Focus On

Patient Safety

Infection Control Initiative

“Bladder Bundle

Project”

Preventing Catheter

Associated Urinary Tract

Infections

Rationale• CAUTIs are the most common type of HAIs

• 30 million foley catheters inserted annually equals nearly 1 million CAUTIs

• Less than 50% of catheters are placed with proper indications and rationale (Association for Professionals in Infection Control and Epidemiology, 2008)

• Proposal of LTC HAI Action Plan targeting and measuring UTIs and mandatory reporting to HHS (Hanchett, 2012)

• Centers for Medicare and Medicaid Services (CMS) is denying payment to hospitals for CAUTIs and other HAI. LTC denials in all probability soon to follow (Newman, 2010)

• UTIs cause nearly 13,000 deaths annually; costing between $340 million and $450 million (Virginia Department of Health, 2013)

• Residents with long-term indwelling foley catheters exceeds the Illinois state average

• High number of CAUTIs-58% of UTIs diagnosed in residents with long-term indwelling foley catheters in last year

Freeport Rehabilitation

UTI PREVENTION IS OUR GOAL

Contemplate the Alternatives

Intermittent Straight CathsCondom Catheters

Remove that Catheter ASAP!

CAUTIs can be deadly

No such thing as a simple UTI

30 days post cath insertion equals bacterial colonization in

bladder

Strategies Supply staff with persuasive evidence-based practice

Convey expectations and expect accountability

Offer straightforward organizational and supervisory support

Utilize several venues to increase knowledge and understanding

Observe staff on rounds and provide immediate feedback

Support and praise involvement and success

Adapt and modify program as necessary for this facility

Present performance data monthly and post in facility

Implementation of the Bladder Bundle

Bundle (ABCDE) Checklist for Prevention of CAUTIs

• Adherence to general infection control principlesHand hygiene – critical factor in preventing nosocomial infections

Aseptic catheter insertion

Proper catheter maintenance, education, and care by nursing staff

Scrutiny of indwelling catheter use and response

• Bladder ultrasound utilization protocol to prevent avoidable catheterizations

• Catheter alternativesPeriodic straight catheterization for urinary retention

External condom catheter for male patients with urinary incontinence

Absorbent products for individuals with urinary incontinence

Incontinence programs initiated with therapy department

• Do not use foley catheter unless medically appropriate; know appropriate indications

• Early removal of the catheter using a reminder or nurse-initiated (i.e., automatic “stop orders”)

(Uro Today, 2013)

Measuring Outcomes

CDC’s National Healthcare Safety Network (NHSN) evidenced-based outcome measurement tool designed for long term care facilities (Centers for Disease Control and Prevention, 2010)

Ensure that the facility will accurately measure the outcomes of the facility related to the number of CAUTIs per 1000 catheter days to assess the success of the interventions initiated (Gould, 2010)

Measuring Outcomes Tool

CAUTI-Maintenance Best Practices – Compliance

Objective: To provide documentation of compliance with implementation of CAUTI best practices.

Instructions: Assess guideline compliance on patients with indwelling urethral catheters.

CAUTI-Maintenance Best Practices Compliance Checklist

Yes No Identified Barriers/ Plans to Overcome Barriers

1. Maintain a sterile, continuously closed drainage system.

2. Keep catheter properly secured to prevent movement and urethral traction.

3. Maintain unobstructed urine flow.

4. Keep collection bag below the level of the bladder at all times.

5. Empty collection bags regularly, using a separate container dedicated to each patient, and avoid allowing the draining spigot to touch the collecting

container.

6. Review of the need for the urinary catheter is documented daily.

(Department of Health and Human Services, 2013)

Measuring Outcomes Con’t An unrealistic goal would be to prevent 100% of CAUTIs (Saint, 2011)

The NHSN and HHS have established a five year prevention target of decreasing the number of CAUTIs by 25% (Gould, 2010)

The main objective of the Freeport Rehabilitation Center’s CAUTI Prevention program is to decrease the number of CAUTIs by 50% each quarter

Another QI Form!?

Good for a laugh, however, we want our QI to portray our growth opportunities accurately.

Questions?

Thank you for taking time out of

your busy schedule to

discuss this very crucial subject

Reference

Association for Professionals in Infection Control and Epidemiology. (2008). Guide to the Elimination of Catheter-Associated Urinary Tract

Infections (CAUTIs). Retrieved from

http://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdf

Centers for Disease Control and Prevention. (2010). NHSN Urinary Tract Infection (UTI) for LTCF. Retrieved from

http://www.cdc.gov/nhsn/PDFs/LTC/forms/57.140_UTI_LTCF_BLANK.pdf

Centers for Medicare and Medicaid Services. (2013). Nursing Home Compare 5-Star Quality Rating System: Year Three Report. Retrieved from

www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/FSQRS-Report.pdf

Department of Health and Human Services. (2013). Implementation Guide for Catheter-Associated Urinary Tract Infection. Retrieved from

http://www.health.mil/Libraries/PSPDocuments/CAUTI_Guide_Final.pdf

Gould, C. (2010). Catheter-Associated Urinary Tract Infection (CAUTI) Toolkit. Retrieved from http

://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

Hanchett, M. (2012). Preventing CAUTI: A Patient-Centered Approach. Retrieved from

http://www.apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdf

Newman, D. (2010). Prevention and Management of Catheter-Associated UTIs. Retrieved from

http://www.idse.net/download/UTI_IDSE10_WM.pdf

Nursetoon.com (2013). Quality Improvement. Retrieved from http://www.nurstoon.com/quality-improvement/

Saint, S. (2011). Implementing Change: The Technical & Socio-Adaptive Aspects of Preventing CAUTI. Retrieved from https://

s3.amazonaws.com/Learning_Sessions/LS+1+Cohort+4/LS1_Implementing+Change_Saint.pdf

Uro Today. (2013). Preventing Catheter Associated Urinary Tract Infections. Retrieved from

http://www.cautichallenge.com/index.php?option=com_content&view=article&id=3&Itemid=11

Virginia Department of Health. (2013). Urinary Tract Infections and Catheter-Associated Urinary Tract Infections. Retrieved from

http://www.vdh.virginia.gov/epidemiology/surveillance/hai/uti.htm