Patient Education Materials and Catheter Associated Urinary tract Infections or CAUTI Carrie Hayes

How to access patient education materials. 1.Access health online via clinical toolkit 2.When printing discharge materials in CPOE 3.Already printed materials located on 5SE and in the 5SE waiting room

Health Online

Search UWMC authored ready to print only.

“Discharge Readiness” tab, then select “discharge instructions”

Using search tool to find patient education materials to add. Look how it comes out here!

5SE patient education materials

List of 5SE patient ED materials Your guide to cardiac surgeryTwo gram sodium dietCaring for your pacemakerCaring for your defibrillatorResources to quit tobaccoHelping you understand the ICU

Palliative careHeart DiseaseAfter your coronary interventionA stronger pumpVisiting the ICUServices for patients and families

Getting updates and informationPreventing pressure ulcers; what family members can doHealth information resource center

Patient Ed Materials located in the waiting room Information about your healthcarePreventing the spread of infectionDriving directions and parking

Getting updates and information Helping you understand the ICUVisiting the ICU

Catheter Associated Urinary Tract Infections (CAUTIs)

The Magnitude of the problem The most prevalent hospital acquired infection 40% of all hospital acquired infections are CAUTIs (this includes CLABSIs, VAP, surgical infections, C-diff, etc) UTIs are the leasing cause of gram negative sepsis (mortality rate of 30-50%) CAUTIS are the second most common cause of nosocomial blood stream infection

Cost of a CAUTI The average cost of a CAUTI is $600, minimum, that we are not reimbursed for The average cost of a bacteremia caused by a CAUTI is $2800, minimum, which we are not reimbursed for

More CAUTI facts 25% chance of CAUTI after one week of catheter use 50% chance of CAUTI after 2 weeks of catheter use Daily risk of a CAUTI is 3-7% per catheter day For continued use a CAUTI is “inevitable” for any type of catheter and either sex – Dr. Calvin Kunin; Urinary tract infections

Deaths and CAUTI Having a CAUTI increased the mortality rate 3X!!! CAUTIS cause 13,000 deaths in the US each year

CAUTI Prevention Strategies Aseptic technique used to place foleys Sample only from the sample port Keep foley bag lower than the bladder at all times but never on the floor and keep the tubing higher than the bag Keep a closed drainage system at all times

Prevention strategy cont Perineal care each shift and as needed Be careful not to let the empty spout touch anything, treat the empty spout like it is sterile Clean the empty spout off with alcohol after draining foley

The dreaded 3 sites on a foley that can lead to a CAUTI

You can’t get a CAUTI without a catheter…. Take foleys out when no longer needed – Approved use for foleys: Urine retention or bladder outlet obstruction Intensive measurement of urinary output To assist in healing open sacral or perineal wounds in incontinent patients End of life comfort

Order to discontinue foley on CTICU patients. Notice the order is to d/c the foley, you would actually need an order to keep it after POD #2.

SECURE, SECURE, SECURE! Most CAUTIS can be attributed to inadequate securement which causes two things; 1.Irritation of and breakdown of meatal tissue 2.Allowing the dirty outside part of the catheter to slip in and out of the body thus shuttling bacteria inside the urethra Change Securement side every 12 hours and document

Correct foley documentation

Which leg is it secured on? Change every 12 hours.

Perineal care done. Document every 12 hours.

Chart why foley is still in place. Document every 12 hours.

If you are doing a 24 hour urine collection, whatever you do: Don’t put it on ice!

24 hour urine testing If a 24 hour urine test is necessary DO NOT place the foley bag on ice! Instead empty it at least every 4 hours and place the urine in the patient refrigerator. Foley bags should never be submerged in water or ice

CAUTIs and the UW In 2011 the UW had 34 In 2012 the UW had 29 The 2013 goal is 16 So far FY 2013 we have 10 5SE owns 3 of them!!!

Review on 5SE CAUTIs Case #1 Patient had a BLVR and an epidural on 7/10. She kept the foley in while she had the epidural in. Foley was discontinued on 7/12. Her UA came back positive on 7/13. In a review her foley care documentation was not adequate so CAUTI was our fault.

Case # 2 Cardiology heart failure patient admitted 7/26 8/1 was noticed to have low UOP, “no response to 160mg of IV lasix”, bladder scan done showing 43cc of urine, creatine increased from 1.8 to 2.8 Note states foley was “flushed and power flushed” Patient also noted to have diarrhea

8/2 T max /2 positive UA 8/4 Urine culture came back positive for klebsiella pneumoniae Documentation for this CAUTI also not perfect (peri care q12, site changed q12 etc)

Case # 3 Patient had an esophogectomy and epidural placed on 9/4 9/7 while epidural still in foley was discontinued Patient had sustained urinary retention, was BS for significant volumes 5 times and I&O cathed twice, all while epidural still in.

Eventually the next day a new foley was placed Then on 9/9 UA and cultue sent, UA was negative but on 9/11 culutre came back + for enteroccous ABX stopped on 9/15 as it was deterimined that there was no UTI

Here is the Negative UA

What we can do to help prevent CAUTIS Remove foleys as soon as possible, within 48hrs post op. Peri care q shift and document this Change securement q 12 hrs and document Keep foley lower than the bladder but not touching the floor Send UA first and then culture only if UA is positive