Introduction to CAUTI and CLABSI Initiatives May 2, 2012

Objectives Goals, Objectives, and Measurement Strategy for CAUTI and CLABSI Initiatives Conducting a Point Prevalence Study CAUTI Initiative CLABSI Initiative Assessing Current Practices September 21, 2018

CAUTI Initiative Goals To reduce unnecessary catheter utilization. To eliminate and sustain reductions in catheter- associated urinary tract infections. September 21, 2018

CAUTI Initiative Objectives By June 2012 Within First 6 Months By November 2013 Implement the CAUTI bundle in the: Emergency Department (ED); In at least one high- utilization adult ICU, and; In at least one high- utilization non-ICU unit. Reduce catheter utilization in the ED, high-utilization ICU, and non-ICU by at least 10%. Reduce CAUTIs in the high-utilization ICU and non-ICU by 20% or achieve a standardized infection ratio (SIR) of 0.8 or less. Reduce catheter utilization hospital- wide by 15%. Reduce CAUTIs by 40% or achieve a SIR of 0.6 hospital-wide. September 21, 2018

CAUTI Measurement Point-prevalence survey, hospital-wide, to determine units with high catheter utilization Monthly data collection Indwelling catheter days (NHSN) CAUTI events in the intervention ICU(s) and non-ICU unit(s) Documentation of appropriate indication for urinary catheter (# of patients on unit with urinary catheter for which there is an appropriate indication/# of patients on unit with urinary catheter.  Assessed at least one day per week) Monthly calculations using data collected Device utilization ratio (NHSN) CAUTI rate in the ICU and non-ICU unit (NHSN) SIR for CAUTI Baseline and follow-up assessments to determine diffusion of the bundle September 21, 2018

CLABSI Initiative Goals To eliminate central line–associated bloodstream infections. September 21, 2018

CLABSI Initiative Objectives By June 2012 Within First 6 Months By November 2013 Implement the CLABSI insertion bundle in the adult ICU setting. Implement the CLABSI maintenance bundle in at least one adult ICU and at least one high-utilization adult non-ICU unit. Reduce CLABSIs in the adult ICU setting by 30% or achieve a SIR of 0.7 or less. Establish a baseline in at least one adult non- ICU unit. Spread the CLABSI insertion and maintenance bundles hospital-wide. Reduce CLABSIs by 50% or achieve a SIR of 0.5 or less hospital- wide. September 21, 2018

CLABSI Measurement Point-prevalence survey to determine non-ICU units with high central line utilization Monthly data collection Central line days (NHSN) # of CLABSI events (NHSN) Documentation of review of line necessity (# of patients on unit with central line for which there is documented review of line necessity/# of patients on unit with central line.  Assessed at least one day per week) Monthly calculations using data collected CLABSI rate (NHSN) SIR for CLABSI Baseline and follow-up assessments to determine diffusion of the bundle September 21, 2018

Where do we start? Determine which units at your hospital have the highest utilization of urinary catheters and central lines by conducting a point prevalence study. Include: Intensive Care Units All General Medical Units May also include surgical and rehab units High utilization units identified through the point prevalence study or through other methods should be the focus of the CAUTI and CLABSI initiatives. September 21, 2018

Procedure for Point Prevalence Study Determine a week to conduct the prevalence study. Recommended week for CAUTI & CLABSI initiatives: Week of May 14, 2012 Recommendation: complete the prevalence study within a narrow timeframe, preferably one to two days during that week. Choose an approximate time within the day to conduct the procedure. September 21, 2018

Procedure for Point Prevalence Study cont. Calculate Point Prevalence on each unit, hospital-wide. CAUTI: Urinary Catheters CLABSI: Central lines September 21, 2018

Personnel to Conduct Prevalence Study Assign someone who is reliable and meticulous to count urinary catheters and central lines on each inpatient unit Staff could include any of the following: Infection Preventionist Nurse Manager Other identified personnel who can take the time to conduct the prevalence study during the specified timeframe September 21, 2018

Data Collection: Important Elements Date Units Number of patients at specific point in time on unit (census) Number of patients with urinary catheters or central lines on unit Calculation of prevalence rate(s) September 21, 2018

Data Collection Example: Point Prevalence for Urinary Catheters and Central Lines Hospital Name: St. Mary’s Hospital Month: May 2012 Today’s Date: May 2, 2012 Data Collector: Michelle Smith Time of Day: 9:45 a.m. Unit # of Patients (Census) # of Patients with Urinary Catheters Prevalence Rate 3 North 38 6 15.8% 5 South 24 9 37.5% 5 North 29 3 10.3% # of Patients with Central Lines 2 5.3% 8.3% 4 13.8% Out of these 3 units, 5 South has the highest prevalence of urinary catheters and 5 North has the highest prevalence of central lines. September 21, 2018

Data Collection Tool Example Hospital____________________________ Point Prevalence study for urinary catheters MONTH Data collector today's date Time UNIT # of Patients (Census) # of Patients with Urinary Catheters Prevalence   total Taken from St. Luke’s Roosevelt Hospital Center September 21, 2018

Next Steps Conduct point prevalence study on units hospital- wide during the week of May 14, 2012 (recommendation to pick 1-2 dates). Identify data collector(s). Collect data. Note: If your institution has already established a process to conduct a point prevalence study, please do NOT change your methodology. Please continue to use your established procedures. Contact your NYSPFP Project Manager with questions! September 21, 2018

Assessment of Current Practices Purpose To identify current practices with regard to CAUTI and CLABSI monitoring and reduction To guide targeted educational programming To provide a baseline assessment for post-intervention comparison Content In addition to background information, each assessment addresses practices surrounding insertion, maintenance, and surveillance Instructions Complete one CAUTI and one CLABSI assessment per institution If you have opted out of either CAUTI or CLABSI, it is not necessary to complete that assessment The clinical and data leads for CAUTI and CLABSI should complete the assessments, with input from key team members as needed Next Steps Links to the assessments will be distributed electronically

Upcoming Events for CAUTI/CLABSI CAUTI/CLABSI Kick-off Educational Webinar – May 24; 1:30 p.m. – 3:30 p.m. CAUTI/CLABSI Regional Meetings – Dates TBD September 21, 2018

Questions ? September 21, 2018