1. CAUTI Immersion Project
Washington County Memorial Hospital

2. Why Work on CAUTIs?
Washington County was seeing Foleys inserted without proper reason
Foley usage remained high
Bladder scans were obsolete
Infections occurred due to unnecessary and extended use of catheters
Nurses were not consistent in their maintenance or charting of catheters

3. What Barriers Were Identified?
Staff education on multiple fronts
Criteria for insertion
Maintenance
Timely removal
Bladder scans were never done
Poor charting
Physician support of nurse driven protocol

4. Washington County Memorial Hospital Statistics
Washington County Memorial Hospital is a 25 bed Critical Access Hospital that owns & operates 4 rural health clinics
WCMH’s ED treats over 13,000 people each year
WCMH’s Swingbed program provides skilled nursing care and therapy services to approximately 120 people each year

5. Quarterly Tasks Completed
100% of first quarter tasks were completed.
Focus on educating ED staff on insertion criteria and use of bladder scan for urinary retention
100% of second quarter tasks were completed
Physicians still want to be notified before catheter removal
100% of third quarter tasks were completed
Implemented checklist for charge nurse to ensure criteria is met on every catheter daily , maintained appropriately, & removed timely

6. Changes That Made a Difference!
Education, Education, Education!
Added a catheter section to the EHR for charting to ensure all important data is documented at each shift
Daily rounding with charge nurse and primary care nurse

7. What Did We Learn? ED staff inserted catheters too frequently
Educating those nurses drastically reduced the number of catheters that made it the nursing unit
Straight catheters were not being used for urinary retention
WCMH received Foley catheters that did not have a red seal on them.
A new type of Foley is now ordered
Charting was inconsistent
Staff did not follow the same practice for catheter maintenance

8. Catheter Maintenance Compliance Makes a Difference & Prevents HAIs

9. Did All This Work Make a Difference?
YES! It was worth it!
Compared to baseline data the changes in our workflow made a difference
We prevented 3 people from having a CAUTI!
These people did not have an increased length of stay, did not have to undergo additional testing, & did not have to take additional meds
We also saved $3,000!

10. Big Wins! Fewer CAUTIs Fewer catheter days
Improved charting in ED and nursing unit
Nurses are more engaged with their patients
Nurses are more aware of the catheter protocols

11. How Can We Keep This Up?
Checklists are in place for charge nurse to complete daily audits
Does the catheter still meet criteria for use?
Is the appropriate charting done?
Has the catheter been maintained appropriately?
Qualaris is in place and will continue to be our method for audits

12. Now What? Charge nurses will be taking on more audits
Infection Preventionist will continue to do spot checks
We will continue to track catheter days
Physicians still require contact before removing catheters, even if they do not meet criteria for ongoing usage 