AHRQ Safety Program for Long-term Care: HAIs/CAUTI Infection Prevention: Surveillance Essentials in Preventing Health Care-Associated Infections How to Monitor, Document and Communicate CAUTI Surveillance Data Nimalie D. Stone, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Onboarding #4 for LTC Facility Team Leads and Core Team

Objectives Upon completion of the program, attendees will be able to: review what surveillance measures are collected to monitor urine cultures ordered, catheter utilization and CAUTI; use surveillance tools and checklists to gather and submit data; share reports with front-line staff, clinicians, residents and families; and engage staff to recognize and document signs and symptoms of CAUTIs. 2

Why is CAUTI Surveillance Important? To define trends in catheter use and complications To assess appropriate indications for catheter placement To help identify opportunities to improve catheter use To assess the impact of new prevention strategies to improve safety of these devices –Has our CAUTI rate declined after starting use of catheter insertion and maintenance checklists? –Are we decreasing antibiotic use by recognizing asymptomatic bacteriuria in residents with a catheter? 3

POLL Question #1 An IP has noticed an increase in the number of residents treated for CAUTI in their facility in the last few months and wants to develop a targeted surveillance program. Which of the following might they monitor? a)Total urinary catheter-days/month b)Number of new catheter insertions/month c)Indications for urinary catheters among residents with CAUTI d)All of the above 4

Surveillance Measures Outcome measures ( events we want to prevent ): ―Tracking CAUTIs that happen in your facility Process measures ( ways we can prevent them ): ―Tracking the way catheters are used  Catheter utilization ratio  Documentation of catheter indication ―Tracking the technique for placing catheters safely  Insertion adherence ―Tracking the technique for handling catheters safely  Maintenance adherence ―Tracking the number of urine cultures ordered 5

Data Measures 6

Collecting Resident Denominators CAUTI Rate (Incidence) – The monthly sum of the number of residents with an indwelling urinary catheter each day of that month  None of the following should be included when counting indwelling catheter days: suprapubic catheters; in/out straight catheters; or condom catheters. – Catheter-day counts should be collected daily for all residents in the facility Population CAUTI Rate – The monthly sum of the total number of residents present in the facility each day of that month 7

Calculating CAUTI Rates CAUTI incidence rate per 1,000 catheter-days Population CAUTI rate per 10,000 resident-days 8 CAUTI Rate = X 1,000 # CAUTIs Identified Urinary Catheter-days CAUTI Rate = X 10,000 # CAUTIs Identified Resident-days

Urinary Catheter Use Urinary catheter utilization ratio (calculated monthly) Measures the proportion of total resident-days in which indwelling urinary catheters were used 9 Urinary Catheter Utilization Ratio Urinary Catheter-days Resident-days =

Data Collection Tool 10

Collecting Surveillance Data Performed by individuals who understand the surveillance definitions and process measures ―Use the training materials to teach front-line staff when to suspect and how to document signs/symptoms of CAUTI Develop a data collection tools to fit a given surveillance objective (process vs. outcome) ―Documentation of the number of urine cultures ordered for all residents ―Documentation of sign/symptoms when CAUTI is suspected ―Documentation of urinary catheter utilization and indication ―Documentation of catheter insertion and maintenance 11

CAUTI Surveillance Worksheet 12

CAUTI Case Review Form 13

System of Documentation Importance of documentation What Indications for catheter insertion Date and time of insertion Name of individual who inserted Date and time of catheter change/removal Routine catheter maintenance Signs and symptoms of infection Diagnostic test results Where (e.g., resident’s medical record) When (how often) 14

Finding a CAUTI—4 Easy Questions to Ask Four Questions to Identify a CAUTI Question 1Question 2Question 3Question 4 Does the resident have an indwelling urinary catheter connected to a drainage device? Does the resident have one or more CAUTI symptoms? There is no other explanation for this resident’s symptoms? Does the resident have a urine culture that fits the criteria? YES YES YES YES then the resident has a CAUTI! 15

POLL Chat #1 What are some challenges you have encountered collecting CAUTI surveillance data in your facility, and what solutions did you identify to improve your processes? 16

Reporting and Using Surveillance Data The goal of conducting HAI and process surveillance is to impact staff behavior to improve outcomes Change won’t happen unless you share your data with staff/providers and leadership Have a strategy for providing monthly or quarterly CAUTI surveillance results for your facility staff/providers ―Present it in a way that all staff can easily understand ―Highlight the processes of care that will improve outcomes ―Share data in a timely manner to increase awareness and highlight teaching opportunities for staff/providers ―Use the CAUTI LTC Team Communication Guide to document progress and facilitate discussion of improvement efforts Lee TB, et al. AJIC 2007; 35:

Comprehensive Data System (CDS) 18

Pitfalls & Opportunities 19

POLL Question #3 What are some ways you have been successful in your facility at communicating CAUTI rates or process measures with Front-line staff? Clinicians? Administration? Residents and families? 20

KNOWLEDGE & SKILLS TRANSFER 21

Materials and Training Aids CAUTI Criteria - NHSN Definitions Pocket Cards 22

Your Role in Engaging Staff in CAUTI Prevention The video and learning activity for front-line staff focuses on recognizing and communicating CAUTI Key messages from that training resource include: ―Presence of an indwelling urinary catheter allows bacteria to enter the urinary tract in many ways ―Urinary diagnostic tests like urinalysis and culture cannot differentiate symptomatic CAUTI from asymptomatic bacteriuria ―Assessing residents for the signs/symptoms of CAUTI and documenting/communicating findings is key to appropriate management of residents with indwelling urinary catheters Review the video and the accompanying case scenarios before facilitating discussion with your front-line staff and providers Share information with all staff/teammates Use the CAUTI definition tools to build, encourage and support staff to correctly identify CAUTI signs and symptoms Recognize staff who accurately observe, report, document and monitor signs and symptoms 23

Educate All Staff to Identify CAUTI Signs and Symptoms Use slide set with facilitator’s notes Share recorded session for all staff who interact with residents Use case study to assess knowledge gained and encourage team discussion Provide copies of tools to guide CAUTI identification Provide Evaluation Form and Certificate of Completion 24

Important Dates Recorded Training ModuleReleased Training Module 1 : Hand Hygiene May 28 Training Module 2: Clean Equipment and Environment Leads to Safe Residents June 11 Training Module 3: Personal Protective Equipment and Standard Precautions June 25 Training Module 4: Avoiding the Harms of Antibiotic Overuse July 9 25

Stay Updated with Useful Resources 1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety 2.TeamSTEPPS ® for Long-term CareTeamSTEPPS ® for Long-term Care 26 3.LTC Program Data Collection ToolLTC Program Data Collection Tool 4.Long-term Care: Indwelling Urinary Catheter Insertion Checklist and Instructions for UseLong-term Care: Indwelling Urinary Catheter Insertion ChecklistInstructions for Use 5.Long-term Care: Indwelling Urinary Maintenance Checklist and Instructions for UseLong-term Care: Indwelling Urinary Maintenance ChecklistInstructions for Use 6.NHSN Criteria—CAUTI Definition Pocket CardsNHSN Criteria—CAUTI Definition Pocket Cards 7.CAUTI Surveillance WorksheetCAUTI Surveillance Worksheet

Your Feedback is Important Please take a moment to complete the evaluation for today’s event. Evaluate Event Now Remember to Download the Onboarding 4 Training Materials Designed for All Facility Staff 27