Goodbye UTI

Team Members: Ava J. Dobin, Epidemiologist/ Safety Officer Dr. Mel Kohan, Chairman, ICC Pam Kardys, ANM, Medical Donna Bradford-Wilson, ANM, Critical Care Kendall Pritchard, ANM, Progressive Care Nicole Puleo, ANM, Orthopedics Zeelena Calendar, ANM, Surgical Mary Oulette, ANM, Pediatrics/PICU Saray Diaz, CS, Medical Surgical

Catheter-Associated Urinary Tract Infections About 80% of all HAI urinary tract infections are associated with indwelling catheters 10-15% of hospitalized patients are catheterized Of catheterized patients, evidence for catheter-associated urinary tract infection (CA-NUTI) develops in 20% - 25%

About UTIs Have Become an Expected Outcome in Catheterized Patients Most Frequent Cause of Sepsis 2%-4% of UTIs Progress to Bacteremia Mortality of Patients with Bacteriuria is Nearly 3x Higher Than for Non-bacteriuric Patients 2%-3% of Acute Care Admissions will be Impacted by a UTI Weinstein RA. Nosocomial Infection Update. Emerging Infectious Diseases. 1998; 4(3): 416-420.

NUTI (nosocomial urinary tract infection) Rates 2% - 3% of acute care admissions will be impacted by an NUTI Based on national averages*, a 15,000 admission hospital would experience 10.03 NUTI per month 120.38 NUTI per year Information based on Churchill Economic Model

Consequences of NUTI’s Pain / Discomfort Acute Renal Failure Surgical Site Infection Death (<1%) Prolonged Hospitalization Pyelonephritis Bacteremia Additional Exposure to Antibiotics Additional Hospital Expenditures

RISK OF INFECTION Duration of catheterization is the most important risk factor for development of infection Over first 10 days, 2-16% of will acquire infection each day By 30 days, almost 100% will acquire infection Garibaldi RA et al NEJM 1974;291:215-9 Burke et al. Infect Control 1986; 7(supp):96-99

Cost of UTIs Average Cost of Each Uncomplicated UTI in 1992 was Reported at $680 Based on Total of 84 Patients Average Cost Impact of Each UTI Reported in 1996 was $3,803 Based on 675 Cases, 5,337 Controls Saint S and Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin N Am. 2003; 17:411-432 Public health focus: surveillance, prevention and control of nosocomial infections. MMWR Morb Mortal Wkly Rep. 1992; 41:783-787.

How Fast do Organisms Travel? Pseudomonas aeruginosa 2hrs on a 100% Silicone Foley Catheter Pseudomonas aeruginosa 18hrs on a 100% Silicone Foley Catheter

UTIs and Antibiotics Urinary tract infections are the largest breeding ground of antibiotic resistant organisms* Bacteria exhibit remarkable adaptability in responding to the assault of antibiotics on their survival APIC 2000 *Maki, DL

FOLEY RELATED URINARY TRACT INFECTIONS Cause and Effect Diagram PATIENT RELATED FACTORS CAREGIVER RELATED FACTORS Primary Risks Secondary Risks No handwashing prior to catheter manipulation Poor insertion techniques Female Dehydration Diabetes Sickle-cell anemia Inappropriate use of catheters Breaks in closed system Immobility Urethral obstruction Drainage bag spigot/tube contaminated Other methods to control incontinence not used Other sites of infection Debilitated health Previous UTI Catheter not secured to body Incomplete emptying of bladder Colonization with resistant organisms Foley bag raised above level of bladder Catheter left in place longer than necessary Fecal incontinence Poor personal hygiene Foley Catheter Related UTI Inappropriate antibiotic use Indications for appropriate catheter use not followed Open drainage systems Unsterile insertions Standing columns of urine Improper placement of drainage bag during transport Lack of supplies to manage incontinence No policy and procedures Bacterial adherence to catheter surface Clustering of catheterized patients Routine catheter changes Lack of a closed system Lack of preconnected urine meters Multi-patient use of measuring devices No antiseptic coatings bonded to catheter Breaks in closed system No catheter securing devices No sample port Limited variety of trays/Foley sizes available SYSTEMS / HOSPITAL SYSTEMS / EQUIPMENT SYSTEMS / ENVIRONMENT 1

Solutions

Your patient has had a foley catheter in place for 72 hours (3 days). Dear Doctor, Your patient has had a foley catheter in place for 72 hours (3 days). Please discontinue this device or document why it needs to be continued. Thank you, Coral Springs Medical Center Infection Control Committee BROWARD HEALTH Coral Springs Medical Center 3000 Coral Hills Drive, Coral Springs, FL 33065 (954) 344 -3000

Prevention of Catheter-Associated Urinary Tract Infections (CAUTI) Data Collection Tool Patient Name______________________________ MR #________________ Date urinary catheter inserted _________________Date D/C_____________ Where inserted ___________________________ Evidence Based Practice Guidelines Yes No Date Daily assessment for removal of urinary catheter Sustained closed system Securement device in place Urine drainage bag below bladder Documentation of catheter care (peri-care) with soap and water each shift. Yellow sticker placed in chart for MD to D/C catheter Documentation by MD to keep catheter in 1. 2. 3. 4. 5. 6. 7.

POLICY: Indwelling catheter is assessed initially and daily by the registered nurse Urinary catheter care is carried out at least every shift and more often if necessary. The patient will be assessed daily to determine the need for removal of the urinary catheter.

Prevention Reducing Infection Means: Reducing Potential for Antibiotic-resistant Infection and Need for Isolation Avoiding Diagnosis and Treatment Costs Reducing Morbidity and Mortality Projected savings are related to reducing an average of 4 UTI’s a month at CSMC x (times) 12 months = $192,000 a year!

Questions?