AHRQ Safety Program for Long-term Care: HAIs/CAUTI. Training LTC Facility Staff on Catheter Insertion & Maintenance to Prevent CAUTIs

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1 AHRQ Safety Program for Long-term Care: HAIs/CAUTI Training LTC Facility Staff on Catheter Insertion & Maintenance to Prevent CAUTIs National Content Series for Facility Team Leads and Core Team Members June 18, 2015 Bonnie Lansing, LPN Research Nurse / Project Coordinator University of Michigan Learning Objectives Upon completion of this webinar, facility team leads and core team members will be able to: explain the types of catheters and what licensed staff will learn about the insertion of catheters; understand what front-line staff will learn about daily maintenance and catheter care; and explore strategies to engage clinicians, staff, residents and families in caring for the catheter. 2 1

2 Your Role in Engaging Staff in CAUTI Prevention The presentation and learning activity for licensed front-line staff focus on proper catheter insertion and care for residents with indwelling urinary catheters and how to communicate care for catheters with residents and families Key messages from that training resource include: Medical indications for catheter use Aseptic insertion technique with sterile equipment Daily maintenance and care of indwelling catheters Review the video and the accompanying materials before facilitating discussion with your frontline staff and providers Share information with all staff/teammates Recognize and appreciate staff who accurately observe or complete the appropriate steps to insert catheters and care for them properly Your role as leaders and teachers is vital to the prevention of CAUTIs! 3 Indwelling Urinary Catheters Bladder Indwelling Urinary Catheter Urethra (Urinary tract entrance) Photograph from NHSN LTC Urine Collection Bag Figure Source: Dennis G. Maki and Paul A. Tambyah. Engineering Out the Risk of Infection with Urinary Catheters. Emerg Infect Dis, Vol. 7, No. 2, March-April *CMS, State Operations Manual,

3 Catheter Removal Catheters in newly admitted and re-admitted residents should be assessed for necessity Ask the physician for an order to remove if there is no indication Every resident, when clinically possible, deserves a chance to be catheter-free 5 Alternatives to Indwelling Urinary Catheter Types Suprapubic catheters Straight catheters External condom catheters Scheduled toileting programs 6 3

4 Aseptic Insertion Use smallest catheter size effective for resident Only properly trained persons insert catheters Insert using aseptic technique Use gloves and gowns when possible in assisting with intimate activities of daily living Use catheter securement devices 7 Insertion Avoiding Common Mistakes Wash hands BEFORE and AFTER procedure Do not don sterile gloves before opening catheter kit If sterile gloved hand gets contaminated or glove rips, then remove glove, wash hands and don NEW sterile gloves Sterile urinary catheters can get contaminated by touching labia, insertion into vagina or touching any other part of body besides cleansed urethra If this happens, stop procedure and get NEW sterile catheter to use Do not insert catheter with same hand used to swab genitalia 8 4

5 Training for Catheter Care Train staff, residents and families Maintain a closed drainage system Both routine catheter changes and urinalysis are not required Document device and catheter care 9 Maintenance Avoiding Common Mistakes Wash hands BEFORE and AFTER any contact with urinary catheter, tubing or bag Don gloves and gown after washing hands Keep bag below bladder at all times without kinking When emptying bag, do not let outlet port touch ANYTHING Drain into a container used only for ONE resident Sampling port must be DISINFECTED before any use Only STERILE needle/syringe can be used to aspirate urine 10 5

6 Prevent CAUTIs What Not to Do to Do not change catheters or drainage bags at routine, fixed intervals Do not administer routine antimicrobial prophylaxis Do not cleanse periurethral area with antiseptics while a catheter is in place Do not irrigate the bladder with antimicrobials Do not instill antiseptic or antimicrobial solutions into drainage bags Do not routinely screen for asymptomatic bacteriuria (ASB) 11 KNOWLEDGE & SKILLS TRANSFER 12 6

7 Learn from Defects Materials and Training Aids CAUTI Case Review Form Learn from Defects Tool 13 Educate All Staff on Catheter Types, Maintenance and How to Insert Them Share recorded session with All Facility Staff about urinary catheter care and maintenance Presentation can be given live using the accompanying PowerPoint with facilitator s notes instead of playing the recorded video Share the additional recorded session with licensed staff who insert catheters or assist with insertion Use suggested activity to assess knowledge gained, practice identifying opportunities for improvement in a non-punitive manner and encourage team discussion Provide copies of tools to guide discussion Provide Evaluation Form and Certificate of Completion 14 7

8 Checklist and Instructions for Use for the Insertion & Maintenance of Indwelling Urinary Catheters 15 Routine Assessments - Examples Short-term residents (daily) Sticker/label nursing can include in chart to remind physician to justify the urinary catheter: Indwelling Urinary Catheter (IUC) Needs Assessment Indication: 1) Acute urinary retention 2) Open sacral/perineal wound in incontinent resident 3) Improve comfort for end of life care Discontinue IUC (written order is needed) Date: Time: Signature: 16 8

9 Routine Assessments - Examples Long-term residents (monthly) Physician order contains the reason for catheter, size of catheter and to change catheter prn blockage or leakage. The reasons for indwelling catheter and its continued use is documented in the care plan. The care plan includes documentation of: Measures to prevent UTI/other complications Catheter care Positioning of catheter Maintenance of adequate hydration Measures being taken to restore normal urinary function Nursing documentation addresses the resident s tolerance of indwelling catheter. If UTI is present, infection signs and symptoms and resident s response to treatment is documented. Presence of indwelling catheter and precautions taken during care are included on the CNA assignment sheet. Res/Rm Res/Rm 17 Teaching Residents and Families about Catheters Source: CDC. FAQs about CAUTI Resources for educating residents and families can be found at:

10 What will you do to engage staff, residents and families in the maintenance of indwelling urinary catheters? CHAT: ACTION STEPS 19 Catheter Rounds as a Way to Engage Staff in CAUTI Prevention What to look for while rounding: Does the order match what s inserted? Reason for the catheter? Is there a securement device in place? Is the tubing kinked? Is the urine collection bag off the floor? How is the leg bag cared for? What does the resident s bathroom look like? Is the dignity cover being used on the collection bag? Is there a dedicated urine collection device? Resident identifier? Dated? Source: Schweon, S. March A Farewell to Harms: Turbocharged Walking Rounds. AHRQ Safety Program for Long-term Care: HAIs/CAUTI National Content Series

11 Stay Updated with Useful Resources 1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety 2. TeamSTEPPS for Long-term Care Insertion Checklist Indwelling Urinary Catheter 5. Maintenance Checklist Indwelling Urinary Catheter 21 Acknowledgements & References Acknowledgements Slides prepared by Bonnie Lansing, LPN, Jennifer Meddings MD, MSc Milisa Manojlovich PhD, RN, CCRN and Mohamad Fakih MD, MPH for provided figures and reference material to develop these educational slides References Catheterout.org CDC. FAQs about CAUTI. Accessed on 06/09/15: Schweon, S. March A Farewell to Harms: Turbocharged Walking Rounds. AHRQ Safety Program for Long-term Care: HAIs/CAUTI National Content Series