Catheter Associated Urinary Tract Prevention CAUTI. Sanford USD Medical Center

Transcription

1 Great Plains Quality Innovation Network Healthcare Associated Infection Learning & Action Network Hot Topic Call How One Hospital Reduced Their CAUTIs Significantly October 28, 2015

2 Catheter Associated Urinary Tract Prevention CAUTI Sanford USD Medical Center

3 Objectives Identify and define the barriers to the implementation of a CAUTI Prevention Program Utilize a gap analysis to identify past state to current state Define key fundamental evidence based nursing practices in the reduction of catheter associated urinary tract infections Discuss strategies to overcome barriers and achieve sustainability

4 Mission Statement: Dedicated to the Work of Health & Healing

5 CAUTI Facts Preventable Condition Patient Harm Extended LOS Increased Mortality and Morbidity 13,000 deaths annually Time, Medication and Human Resources

6 Risk Factors Duration Gender Closed System Older Age

7 Fredrick Foley 300 B.C. Palm & Onion leaves Dr. Frederick Foley 1920 s Open system with the urethral tube draining into an open container. 1950s a closed system

8 CAUTI Prevention Timeline -Sue Hohenthaner

9 CAUTI and Utilization

10 Literature Review

11 Recommendations for Prevention that Guide Practice Insertion of the Catheter for appropriate indications Leave the catheter in only as long as needed Ensure that properly trained persons insert and maintain the catheters Insert the catheters using aseptic technique and sterile equipment Consider use of alternatives Maintain a closed drainage system Secure the system Maintain an unobstructed urine flow Keep the collecting bag below the level of the bladder at all times

12 Success Structured Accountability Skills & Knowledge Resources & Systems

13 HEN- Hospital Engagement Network RAN- Rapid Adoption Network

14 Nurse Driven Protocol 2011: Implementation 2014: Reimplementation

15 Physician Order

16 Nursing View

17 BARD Assessment

18 Insertion Assessment

19 Education & Training Ensure that only trained, dedicated personnel insert urinary catheters SHEA Guidelines Ensure that supplies necessary for aseptic technique for catheter insertion are available and conveniently located SHEA Guidelines Education Plan Promote best practice and utilization of the Nurse Driven Protocol Improve patient safety and CAUTI infection rates Review SMC procedure (criterion checklist) and related supplies Demonstrate proper aseptic catheter insertion technique and catheter care

20 Education & Training

21 Bundle

22 Daily Rounds Conduct daily review during rounds of all patients with urinary catheters by nursing and physician staff to ascertain the necessity of continuing catheter use SHEA Guidelines

23 Hand Hygiene Perform hand hygiene immediately before and after insertion or any manipulation of the catheter device or site - HICPAC Guidelines

24 Education

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26 Supplies Standardized Insertion Kits : 14 fr Smallest bore possible : 14 Fr. Silver catheters Seal intact Coude Insertion Kits Coude Intermittent Cathing Kits Add-A- Foley Kit

27 How did this drive our practice? ER Critical Care : Urometer ER Peds : Urometer Surgery- Critical Care : Urometer Critical Care Medical : Intra-abdominal changed Present on arrival or seal broken : Replaced Recommendation males >50 or BPH : Coude Break in sterile technique new kit not device

28 Foley Care / Peri Care Do not clean the peri urethral area with antiseptics to prevent CAUTI while the catheter is in place. Routine hygiene; cleansing during the daily bath HICPAC Guidelines

29 Irrigations should not be considered a routine practice HICPAC Guidelines Irrigation

30 Specimen Collection Aseptic Collection of the specimen if a small volume of fresh urine is needed for a ua/uc aspirate the urine form the needleless sampling port with a sterile syringe /adapter after cleansing the port. If a CAUTI is suspected the best practice is the removal of the old catheter before obtaining the specimen to eliminate the confounding factor of possible catheter biofilm. HICPAC Guidelines

31 Documentation

32 WHY????? Foley Prevalence 1. Catheter Type Silver catheters are lined with silver, gold, and platinum. This combination does not allow the biofilm to stick and provides added protection from CAUTI s for 3-5 days. 2. Size best practice is to use the smallest size catheter as possible preventing micro tears in the urethra. Mico tears and trauma allows a pathway for organisms increasing the risk for infection. 3. Coude Catheters recommended for males > 50 and for those with a history of BPH. When inserting the catheter the tip should be up this follows the natural pathway of the male ureters. There are also COUDE intermittent kits for straight cathing. 4. Seal intact there is a 30% increased risk of infection when the seal in broken. 5. Securement Devices - increased risk of trauma and also allow the catheter to piston in and out of the bladder. This is a pathway for organisms to enter the bladder. 6. Dependent Loops Keep the tubing straight. Loops allow the biofilm to accumulate. This also will increase the pressure in the bladder potentially causing damage due to the force needed to get the urine through the tubing and urine backflow to the bladder. 7. Green Sheeting Clip assists in the placement of the tubing preventing dependent loops. Also used to clamp the tubing to obtain a urine specimen. 8. Insertion date duration is the leading cause of CAUTI s 9. Foley Care daily and prn. There is an increased risk of dislodging biofilm when the catheter is manipulated. ALWAYS wash hands and put on clean gloves when ever manipulating the catheter. Especially between pericare and foley care. Cath Type Silver Intraabd. S/P Male Pts >50 or BPH COUDE Green Sheeting Clip used Bag & Tubing below bladder Cath Dependent Type of Drainage Clean Room Fr. Seal Device Loops Collection Urometer touching container Insertion Date # Size intact Secure observed Leg/Reg floor / labeled Location Inserted Comments *dated, plan to take out 3303 Silver 16 N/A Yes Yes Yes No Yes Urometer No No today private bathroom - not 3301 Silver 14 N/A Yes Yes No Yes Yes Urometer No Yes labeled 3304 Yes Yes 3305 Silver 16 No Yes Yes Yes No Yes Urometer No Yes container not labeled Silver 16 N/A No No Yes No Yes No container for stool & urine but not labeled 3309 Yes 3310 Silver 14 N/A Yes Yes No No Yes Urometer No 3311 Silver 14 No Yes Yes No No Yes Urometer No Yes container not labeled 3313 Silver 14 N/A Yes Yes No No Yes Urometer No Yes container not labeled 0% 86% 86% 56% 44% 14% 100% 100% 0% 0% 100% 67% Bag/ Meter Yes Yes Yes Yes No Yes Yes Urom. Leg Reg No Yes

33 Alternatives to Urinary Catheters Intermittent Cath Bladder Scan

34 CAUTI Defect Tool

35 Set the Environment for Success Understand that safety is a property of the system Understand that the basic principles of safe design include: standardized work, independent checks(checklists)for key processes, and learn from mistakes Recognize that the principles of safe design work apply to teamwork as well as technical work Understand that teams make wise decisions when there is diverse and independent input Not a blame game

36 DO NO HARM How is the next patient going to be harmed in this setting? How can we prevent this harm from occurring? Open to all ideas

37 Lessons learned from investigating the defect, and changes made in response to the defect are shared vertically and horizontally throughout the organization

38 Comparison

39 SIR orgid summaryy H infcount numexp numucathd ays SIR SIR_pval SIR95CI H , H , H , 0.882

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42 NEXT STEPS Condom catheters, female urinals Management of the patient I/O Weighing pads Electronic Physician reminders Standardized time for foley removal ie. midnight Fecal Management Systems Peppermint Oil

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44 Contact Information KANSAS Nadyne Hagmeier 785/ ext. 374 NEBRASKA Peg Gilbert 405/ NORTH DAKOTA Jean Roland 701/ SOUTH DAKOTA Nancy McDonald 605/ This material was prepared the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-GPQIN-SD-C1-104/1015