1. Infrequent urinary output measurement
Quality Improvement Plan to Decrease CAUTI Occurrence Rates
Michael Borisow, Wayne Lile, Michelle Russell
Purpose
Results
Measures
To reduce the risk of catheter associated urinary tract infections (CAUTI) at Moffitt Cancer Center
Reduce CAUTIs by means of:
Aseptic technique
Maintenance and timely remove of urinary catheters
Assessment of patient need for a catheter
Examining a patient’s risk factors to acquiring infections
Criteria met for urinary catheter placement
Aseptic technique followed for catheter placement
Daily catheter monitoring and maintenance
Yes
Criterion meet for continuation of catheterization No
Obtain removal order
Remove urinary catheter A
Use Moffitt Cancer Center Catheter Observation Survey per policy.
Record and compare infection pre-improvement process and post-improvement process to determine effectiveness of interventions in the prevention of CAUTI.
Process Improvement
Background
When taking on assigned care of a patient, determine the rationale for the urinary catheter and assess if the need still exists to continue catheterization.
During assessment, inspect the catheter to ensure the seal is still intact, there are no signs and symptoms of infection, the collection bag is hanging below the level of the bladder and the bag is empty.
Record all assessment findings in the door chart.
Clean the genitalia per orders utilizing antiseptic technique starting at the urinary meatus and working away from the point of insertion.
CAUTI contributes to 13,000 deaths per year. (Klevens et al., 2007)
600,000 patients develop hospital acquired infections yearly with 80% of those urinary catheter associated (MIC, 2013)
Approximately half of patients with catheters do not have a valid reason for placement (MIC, 2013)
Each day the catheter remains, there is a 5% risk increase in developing a UTI (MIC, 2013)
Figure B illustrates possible contributing factors for CA-UTI. One particular consideration for Moffitt Cancer Center’s special population is their susceptibility. Many patients at this institute are immunocompromised, or have neutropenia, automatically increasing their likelihood of developing CA-UTI’s.
Research has shown CAUTIs are associated with:
Failure to maintain a closed, sterile drainage system (Dailly, 2011)
Urine stasis due to kinked drainage lines, full collection bags or collection bag stored at the level of the bladder (Oman et al., 2012)
Movement of catheter after insertion due to lack of anchorage to leg (Oman et al., 2012)
Ineffective hand, genital and catheter hygiene (Dailly, 2011)
Lack of effective monitoring and regular catheter care increase CAUTI risks. B
Aseptic technique
Patient susceptibility
Guidelines
Breech of sterility (any point in the process)
Noncompliance with Policy
Neutropenia/
Immunocompromised
Breech in sterile field set-up
Incongruence with evidence based practice
Immobility
C-diff, diarrhea, other bowel disorders
Improper iodine cleansing of meatus
CA-UTI
Improper assessment
of necessity to insert
Infrequent urinary assessment
(Color, Odor, Consistency, Amount)
Infrequent urinary output measurement
Prophylactic antibiotics
as needed
Improper cleansing of perineum
Increased length of stay/ time for removal
Limitations / Lessons Learned
Ineffective subjective/ objective assessment of beginning UTI
Selecting suitable educators to conduct monthly refresher courses.
Active staff ownership and participation in the improvement process, including documentation and monthly refresher training.
Management participation and continued support towards process improvement is a limitation.
Provider order
Catheter care/ management C
Team Members
Nurse Educator
Registered Nurses
Nurse Manager
Oncology Technicians
Infection Control
Physicians
Support Staff
References
Agency for Healthcare Research and Quality. (2009). Strategies to prevent
catheter-associated urinary tract infections in acute care hospitals.
Retrieved from
Conway, L.J., & Larson, E.L. (2012). Guidelines to prevent catheter- associated urinary tract infection: 1980 to Heart and Lung, 41, doi: /j.hrtlng
Dailly, S. (2011). Prevention of indwelling catheter-associated urinary tract
infections. Nursing Older People, 23(2),
Elpern, E.H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009)
Reducing use of indwelling catheters and associated urinary tract
infections. American Journal of Critical Care, 18(6),
Klevens, R.M., Edwards, J.R., Richards, C.L., Horan, T.C., Gaynes, R.P.,
Pollock, D.A., & Cardo, D.M. (2007). Estimating health care-
associated infections and deaths in U.S. hospitals, Public
Health Report, 122(2),
Moffitt Infection Control (MIC). (2013). CAU-TI prevention project.
Moffitt Infection Control (MIC). (2012). Moffitt CA-UTI rates.
Oman, K.S., Makic, M.B.F., Fink, R., Schraeder, N., Hulett, T., Keech, T.,
& Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary t ract infections. American Journal of Infection Control, 40,
Improvement Tools/Methods
CAUTI prevention training for all personnel responsible for ordering, placing and caring for indwelling urinary catheters (Conway et al., 2012)
Consistent documentation for every party responsible for catheter care (Elpren et al., 2009)
Cause and effect analysis (fishbone diagram)
Control charts
Urinary Catheter Patient Microsystem