CAUTI: Reversing the Trend

Transcription

1 CAUTI: Reversing the Trend

2 Why the focus? CAUTI is the most common kind of HAI Increases length of stay 2-4 days A?ributed to 13,000 deaths annually $836 - $3213 addihonal cost per pahent per CAUTI

3 Why now? CAUTI rates are increasing nahonally Iowa remains a high performer Reimbursement issues r/t HAC

4 Organisms enter the bladder by 3 ways: 1. At the Hme of catheter inserhon 2. Through the catheter lumen (from a colonized drainage bag) 3. Along external surface of the catheter (migrate along the catheter- mucosal interface) Tambyah, Halvorson, Maki. Mayo Clinic Proc 1999

5 Urinary Catheters 15-25% of hospitalized pahents OVen placed for inappropriate indicahons Physicians frequently unaware In a recent survey of U.S. hospitals >50% did not monitor which pahents catheterized 75% did not monitor durahon and/or disconhnuahon

6 Current situahon. Statewide Average NHSN data CAUTI rate Device use rate CAHs CAUTI rate per 1000 cath days Device use PPS CAUTI rate Device use

7 What is the goal? ReducHon of catheter uhlizahon rate by 10% by July 2014 (< )

8 Where do we start? ReducHon of inserhon of indwelling catheters. Empower nurses Educate providers Educate pahents and families PracHce appropriate urinary catheter placement in the ED

9 Catheter InserHon in ED More than half of hospital admissions come through the Emergency Department (ED) Avoiding placement of unnecessary urinary catheters in the ED may significantly reduce catheter use among hospitalized pahents. Promote placement of urinary catheters based on appropriate indicahons and compliance with asephc inserhon technique. Establish clear guidelines for urinary catheter use AdopHon of guidelines by the ED Engage ED physicians and nurses Educate staff on appropriate indicahons and asephc inserhon technique. ED Champions ideally, a nurse and physician

10 Examples of Appropriate Uses of Indwelling Catheters PaHent has acute urinary retenhon or bladder outlet obstruchon Need for accurate measurements of urinary output in crihcally ill pahents PerioperaHve use for selected surgical procedures: PaHents undergoing urologic surgery or other surgery on conhguous structures of the genitourinary tract AnHcipated prolonged durahon of surgery (catheters inserted for this reason should be removed in PACU) PaHents anhcipated to receive large- volume infusions or diurehcs during surgery Need for intraoperahve monitoring of urinary output To assist in healing of open sacral or perineal wounds in inconhnent pahents PaHent requires prolonged immobilizahon (e.g., potenhally unstable thoracic or lumbar spine, mulhple traumahc injuries such as pelvic fractures) To improve comfort for end of life care if needed h9p:// pg 11

11 Examples of Inappropriate Uses of Indwelling Catheters As a subshtute for nursing care of the pahent or resident with inconhnence As a means of obtaining urine for culture or other diagnoshc tests when the pahent can voluntarily void For prolonged postoperahve durahon without appropriate indicahons (e.g., structural repair of urethra or conhguous structures, prolonged effect of epidural anesthesia, etc.) h9p:// pg 11

12 What else can we use? Consider using external catheters as an alternahve to indwelling urethral catheters in cooperahve male pahents without urinary retenhon or bladder outlet obstruchon. (Category II) Consider alternahves to chronic indwelling catheters, such as intermi?ent catheterizahon, in spinal cord injury pahents. (Category II) Intermi?ent catheterizahon is preferable to indwelling urethral or suprapubic catheters in pahents with bladder emptying dysfunchon. (Category II) Consider intermi?ent catheterizahon in children with myelomeningocele and neurogenic bladder to reduce the risk of urinary tract deteriorahon.(category II) Further research is needed on the benefit of using a urethral stent as an alternahve to an indwelling catheter in selected pahents with bladder outlet obstruchon. (No recommendahon/unresolved issue) Further research is needed on the risks and benefits of suprapubic catheters as an alternahve to indwelling urethral catheters in selected pahents requiring short- or long- term catheterizahon, parhcularly with respect to complicahons related to catheter inserhon or the catheter site. (No recommendahon/unresolved issue) h9p:// pg 12

13 QuesHons? Nancy Wilde- IDPH Heather Matherly- IHC Jennifer Brockman- IHC