1. Insert name of presentation on Master Slide CAUTI Intervention Cardiff and Vale University Health Board

2. Introduction In Cardiff and Vale UHB we are working on the mini collaborative: Reducing Healthcare Associated Infections focusing on Catheter Urinary Tract Infections. This presentation will inform you of the steps we have taken towards reducing the incidence of Catheter Associated Infections.

3. ObjectivesActionsResponsible LeadTimescaleStatus/Comments 1Select wards/departments for PDSA 1.One Theatre at Llandough 2.Ward West 5 Orthopaedic at UHL 3.Ward C7 at UHW Emma Hayward Angie Williams Helen Bonello (Support from IPCT members) October 2010Oct 2010: Achieved 22.1 Agree on Proforma for use for collating and implementing programme of Urinary Catheter Care Bundle 2.2 Pilot the Proforma 2.1.1 Develop insertion bundle. 2.1.2 Develop Maintenance bundle. 2.1.3 Develop removal and microbiological investigation bundle. 2.2.1 Test the proforma with local staff for acceptability and reliability. Ann Yates / Helen Bonello Helen Bonello IPCNs + Microbiology Dept. Emma Hayward/Helen Bonello / Angie Williams Mid-November 2010 33.1 Prepare ‘Dear Colleague’ letter for informing staff about the bundle and their role. 3.1.1 Letter will include SBAR style details on prevention of CAUTI bundle. Helen BonelloMid-November 2010

4. 44.1 Develop proforma for Urinary Catheter diary 4.1.1 Utilise already existent record from Saving 1000 Lives team – available electronically. EH/HB/AW. 55.1 Use of electronic automated tool - spreadsheet and safety crosses 5.1.1 Distribute tools to target areas. 5.1.2 Implement tools on target areas. LW/JJ EH/HB/AW October 2010October 2010: achieved 66.1 Establish Safety Briefings6.1.1 Implement safety briefings at each hand- over per day on target areas AH/HB/AW with support from IPCNs. 77.1 Education programme7.1.1 Prepare education slides in power-point for use in target areas and for printing and displaying on areas. VS/HB/AW 88.1 Shared drive for CAUTI bundle and implementation 8.1.1 Establish communal site for sharing all information on CAUTI. SCOctober 2010Oct 2010: Achieved

5. 99.1 Establish audit support for collating and analysis of data 9.1 Explore support from Audit Department for supporting this organisational initiative. JW. 1010 10.1 Share findings at Learning sessions. 10.1 Present progress and up-to-date findings for sharing and learning at session on 06 Dec 2010 at Swansea, with support from the group. 10.2 Present findings internally in CAVUHB relevant forums for facilitating spread. HB/VS, with support from group members. All group members December 2010 ? 1 11.1 Re-programme Action Plan from findings and learning sessions. Elaborate in here learning points for consideration.

6. Insertion

7. DAYDAY DATE Is the catheter still needed? Drainage bag positioned below the bladder & off the floor Gloves worn - manipulate catheter preceded & followed by hand hygiene Urethral Meatal hygiene performed Catheter circuit not broken (except for good clinical reason) Overnight link system discarded (Leg bags only) SIGN & Designat ion YESNOYESNOYESNOYESNONO NONO NO 2 3 4 5 6 7 Catheter drainage bag changed? YES / NO 28 IF THE CATHETER IS STILL REQUIRED – CHANGE THE CATHETER, DRAINAGE BAG & COMMENCE NEW DOCUMENTATION Date catheter removed / / Maintenance

8. Catheter Specimen Urine (CSU) CSU ’ s are ONLY to be taken if there is a clinical suspicion of Infection, with the exception of Critical Care patients. For further details please consult the Trusts ’ policy. DateUTI suspected If YES please state symptoms Sample taken aseptically from catheter port Results Lab Specim en nos. Treated YESNOYESNOYESNO CSU – Our clinical nurse specialists in continence plan to revise this to include a procedure style guide for staff to complete. We also plan to include an example of best practice in completing the microbiology sampling form.

9. Dear Colleagues… Catheter Care Bundles Dear Colleague, Your ward is going to be piloting the CATHETER CARE BUNDLE, and your involvement is very important and appreciated. This letter provides you with an overview of the catheter care bundle. Your ward leaders will give you additional information and training as you & your ward progress with rolling out the bundle. Urinary tract infections are one of the most common causes of Health Care Associated Infections in Wales alongside respiratory tract infections and surgical site infections 1. A catheter care bundle has been developed with the aim of reducing the burden of catheter associated urinary tract infections across the NHS Wales. Our aim in Cardiff and Vale UHB is to introduce the bundle to as many clinical areas as possible to reduce the incidence of Catheter Associated Urinary Tract Infections by 20% by June 2011. What is the Catheter Care bundle? The Catheter Care Bundle is based on four components of Care:  Avoid unnecessary urinary catheters.  Insert urinary catheters using aseptic technique  Maintain urinary catheters based on recommended guidelines.  Review urinary catheters necessity daily and remove promptly. Implementation of these four components requires a multidisciplinary approach involving doctors, nurses, leaders and experts in infection prevention and urological care. This requires teamwork; it cannot be achieved by any one discipline alone. What does the Catheter Care bundle involve? Insertion Bundle picture! Maintenance Bundle picture! Daily data collection! Thank-you in anticipation of your support

10. PDSA cycles were used to test the insertion form in clinical practice

11. Data Collection form

12. Where are we now… In the process of devising an education programme to accompany roll out of the bundle (January) Collecting baseline data and completing our safety cross (Now) Running PDSA cycles to ensure our bundles are fit for practice (Now) Re-devising our staff letter ready for pre-roll out (January/February) PLANNED START DATE FEBRUARY!!!

13. If we can improve care for one patient, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a 1000 And if we can do it for a 1000, we can do it for everyone in Wales.