Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services Trinity Medical Center – Quad Cities

2 Urine-8 Committee Members  Michelle Blackmer, MSN, FNP-BC, RN  Stan Buck, RN, RNFA  Pam Elliott, MBA, BFA  Chris Hansen, MS, RN  Diane Laake, RN, CMSRN  Paula Maddox, MSN, RN, CCRN  Kathryn Marhoefer, MBA, RN  Michelle Mathias, BSN, RN  Mary A. Petersen, MSN, RN (Committee Chair)

3 CAUTI Statistics Nationwide  80% of HA UTIs are caused by urinary catheters  5% deaths from HAIs are urinary catheter associated  Cost of a CAUTI is estimated at $ , $2800 if bacteremia Source: Michigan Keystone Project, 2008

4 Trinity CAUTI Rates CAUTIs Year Raw # Rate /1000 pt daysRate / 1000 Foley days

First Step  Determine specific nursing opportunities to decrease foley related UTI’s  Conducted a one-day prevalence study  Primary aims of the study included 1. Quantify the level of use of indwelling urinary catheters 2. Determine the level of adherence to guidelines 5

Methods  2007, 2008 & 2010 all units on each campus surveyed  List obtained identifying all patients with Foley and RN providing direct care  Data collector directly observed the catheterized patients and interviewed RN  Data was collected on a standardized form  2011 & 2012 implemented Adaptive Design methodology 6

Foley Practice Areas Reviewed  Presence of a Foley catheter  Catheter secured to the pt’s abdomen or leg  Tamper Evident Seal intact (TES)  Tubing extended to prevent the development of dependent loops of drainage tubing  Tubing secured to patient bed or chair to prevent pulling on system  Drainage system not touching the floor  Urine bag not over filled with urine 7

Percentage (%) of Compliance with Total Foley Practice Areas Percentage %

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11 SBAR

12 Catheter Associated Urinary Tract Infection (CAUTI) Prevention URINE-8 1 Good hand hygiene 2 Inserted by qualified staff  Sterile technique when inserting catheter 3 Proper peri care:  Daily with bath, fecal incontinence, presence of discharge or drainage and at bedtime  Document peri-care 4 Secure catheter to patient with a Stat Lock  Change Stat Lock every 7 days  Do not use Stat Lock on edematous patient 5 U/A upon catheter insertion when symptoms present ▪ Document symptoms in Care cast 6 Do not break the red seal 7 Unobstructed urine flow  No kinks, bends, or dependent loops  Keep urine bag off the floor 8 Remove as soon as medically able *SCIP – Remove by the end of post-op day 2

13 Trinity CAUTI Rates CAUTIs Year Raw # Rate /1000 pt daysRate / 1000 Foley days

Trinity SCIP Data 2009 & Today 14

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Nurse Driven Urinary Catheter Removal Protocol 16

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Lessons Learned  Nurse to Nurse Collaboration is a practiced skill  Physician collaboration is key  Physician and Nurse communication / education is paramount  Adaptive Design and daily monitoring drives successful implementation 19

Conclusion:  HAI’s represent a direct threat to patient safety, healthcare quality and they are costly.  The Urine-8 project has consistently decreased the infection rate and identified the positive financial impact directly attributed to evidence-based nursing practice.  The next step of adding the nurse driven catheter removal protocol will continue to decrease unnecessary Foley days and serve as a tool to meet SCIP criteria and avoid CAUTI. 20