Deborah R. Campbell, RN-BC, CCRN, MSN Pediatric Cardiovascular CNS Kentucky Hospital Association Children’s Hospital Association QTN faculty

 Clinical Consultant for Carefusion ◦ Work to be presented was completed without commercial support

 Review evidence based interventions to prevent CAUTI  Discuss bundle concept as relates to CAUTI prevention  Discuss CAUTI prevention as a team sport  Discuss ‘safety culture’ aspects of CAUTI prevention

 Sterile insertion technique (Consider a kit) ◦ Smallest, softest catheter that will do the job  Ensure adequate hydration  Hand hygiene  Perineal care ◦ BID with soap and water, PRN BM (Products)  Keep bag below the level of bladder  Prevent bag, tubing from touching floor  Avoid dependent loops, kinks  No disruption of closed system

 Obtain specimens using aseptic technique ◦ Only if absolutely necessary ◦ Remove and replace for C&S  Empty the bag when1/2-2/3 full (Q4hrs?)  Each patient should have own graduated cylinder  Daily observation for signs, sx of UTI  Isolation of diagnosed CAUTI pt from anyone with a catheter  Utilize a securement device

 Bladder scanning- non-invasive, easy, quick  Intermittent catheterization v. in-dwelling caths- better for patient, more work for staff  Ditch the bath basins  CHG baths- microbe burden  Appropriate nurse staffing  Antibiotic or silver-coated catheters  Hydrogel catheters- discourage biofilm adherence  Catheter valves- store urine in bladder v. bag ◦ More physiologic as well, decreases need to re-train

 Is there a “magic bullet?  Are there certain, specific items  1+1=3 Synergy?  Pathogen dose v. immune response  Bundles act as checklists  Bundles act as curriculum  Recipe v. culture

 Policy change is not = to practice change  QI 101- Educate, Implement, Audit, Improve, SUSTAIN  All at once or step-wise?  How do I choose from the menu? ◦ Problems known to exist at your place ◦ Acceptable to your front line staff ◦ Ways to measure already in place (LAST) ◦ RCAs on CAUTIs that occur

 Is there a best way? ◦ Direct Observation  Peers  Supervisors, educators, CNSs ◦ Self-audits ◦ Secret Shoppers  Sampling ◦ Include weekends, nights ◦ Attempt randomness by setting specific days, times  Met your goals consistently, decrease frequency-BUT never less than quarterly.

 Make the right action the default ◦ Opt-outs v. necessity to overtly choose ◦ Nurse driven protocols ◦ Standardization ◦ Redundant processes ◦ From the IHI- Everyone chooses (or is assigned) a focus area for which they provide input  5 audits per day per person (on HAPU, CLABSI, CAUTI, SSI or VAP)

 Care team members other than primary RN ◦ Nurses helping out (regular, floated, agency) ◦ PCAs ◦ X-ray technicians ◦ Respiratory therapists ◦ Transporters ◦ Family members ◦ Patients themselves

 Decrease the number of insertions/transfers with catheters ◦ ED ◦ OR  Success is possible! ◦ Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Presented by RM Gokula, MD, MA Smith, MD, and J Hickner, MD, Lansing, Michigan

 Can’t define it, but we know it when we see it ◦ Non-heirarchical ◦ Healthy team dynamics  First names  Safe to question, interrupt (Scripting!) ◦ Patient-Centered ◦ No blame-it’s all about the process ◦ Personal accountability (1 patient, 1 action at a time)  Link participation to annual evaluations

 Build concept that patient well-being is everyone’s responsibility ◦ Individual ◦ Team ◦ No carve-outs  Rules apply to everyone, regardless of discipline  Think pro-actively- “what could harm this patient today?”  Effective for more than one outcome ◦ Infections ◦ Unplanned device removals ◦ Med Errors

 Videos, e.g. Josie King  Think of patient in front of you being your mother, grandfather, child  VA campaign ◦ “Have you ever killed someone with your bare hands?”