1. CAUTI “Back to Basics”
Lindsey Bruchhaus MSN, RN, CPHQ
June 1, 2017

3. “Back to Basics” CAUTI Background: Problem: Objective:
According to the CDC, urinary tract infections (UTI) are the most commonly reported and approximately 75% are catheter related. The prolonged use of an indwelling urinary catheter puts patients at increased risk for infection.
Problem:
Increase in catheter associated urinary tract infections (CAUTI)
Objective:
To implement an evidence-based practice project that would reduce catheter associated urinary tract infections and reduce indwelling urinary catheter (IUC) utilization.

4. First steps Literature review Policy and Procedure Case analysis
Published guidelines
High performing organizations
Best practices
Policy and Procedure
Gap analysis
Case analysis
Opportunities for improvement
Analyzed trends

5. Facility assessment Issues Identified
The risk of CAUTI is directly related to the duration of catheterization
Issues Identified
Urinary catheters in place that are not indicated
Infection during the maintenance phase
Staff knowledge deficit of clinical indications
Indwelling Urinary Catheter Who: ER most frequently inserts IUC What: IUC not removed timely Where: ICU has highest utilization When: Infection in maintenance phase Why: Strict I&O & urinary retention

6. “back to Basics” Inter-professional approach TEAM
Infection Control Practitioner
Staff Nurses
Leadership
Patient Care Assistants
Educators
Physicians

7. No Foley=No CAUTI CAMPAIGN Empower Nursing Stake holder “Buy-in”
The team launched a hospital wide No Foley=No CAUTI campaign. This campaign included awareness, education, and celebration for success.
Stake holder “Buy-in”
Nurse-driven protocol
Visible support of leadership and physicians

8. implementation Awareness Poster board on CAUTI prevention
Video created by staff portrayed potential causes and the negative outcomes of a CAUTI and included CAUTI prevention methods
Indications for use easily available by pocket card, documentation system, and computer wall paper
“Back to Basics” team members went to all department staff meetings, medical staff meetings, and leadership meetings to create awareness
Video
Real stories shared
Pledge- No Foley, No CAUTI
Days since Last CAUTI posted on Units
Story telling sticks to people
You are more likely to remember the lesson from the story over listing facts. We provided learning through story telling.

9. implementation Interventions
Critical care units remove IUC before transfer to MedSurg if in place for strict I&O
ER performs a straight catheterization for urinary retention
Daily surveillance of device utilization and indication for use through an audit tool
Enhanced dialogue between care givers and between the patient and care giver through a pamphlet

10. implementation Interventions
Daily rounds included discussion on urinary catheter plan for discontinuation
Critical care added invasive lines assessment to the tool for interdisciplinary rounds
MedSurg Charge Nurse asked the question during interdisciplinary rounds, “why is the invasive line in place?”
CHG bathing for all patients with IUC

11. Tools
NO FOLEY =
NO CAUTI

12. VIDEO NO FOLEY=NO CAUTI
Tools
VIDEO NO FOLEY=NO CAUTI

13. Each day the Foley catheter remains, the risk of A CAUTI increases 5%.
If they don’t need it, pull it!
Only keep Foley if…
Neurogenic Bladder
Acute urinary retention or bladder outlet obstruction
STRICT I&O every 1-2 hours: Critical Care Only
Traumatic injuries (eg: unstable spine, pelvic fracture)
To promote healing of OPEN sacral or perineal wound
Comfort for end of life care
Urologic, gynecological, or genitourinary surgery
Anticipate patient is going to surgery
Assess Every Shift
Nurses, remove that Foley!

14. tools
QUICK REFERENCE

15. Tools

16. TOOLS

17. results Summary Pre Data 1 year post intervention
>50% increase in CAUTI from prior year
>50 % reduction in CAUTI
Indwelling urinary catheter utilization decrease by 16%
Sustained 50% reduction in CAUTI
Sustained decreased utilization rate
The pre-data results showed 14 catheter associated urinary tract infections in a one year time frame.( .50% increase)
One year after implementation (ending the year with 5 infections)
Urinary catheter utilization fell 12% ( % decrease)
+ 36 beds
+ 36 beds
+ 36 beds

18. results Timeline Pre data Q1 2015 intervention Post data + 34 beds

19. Results ICU best in system : Days without CAUTI
We measure days since last infection. We have competition with sister facilities

20. results Q1 2015 intervention
According to NHSN we are better than national benchmark
Q began using step down unit for IUC beds
MedSurg started doing IMU level care
Action Item: IC alerts managers/Charge nurses of long length Foley catheters

21. KEY TO SUCCESS Staff buy-in & nurse engagement Accountability
Timely feedback
Physician champion
Nursing leader champion
Celebrate success
Message: Everyone makes meaningful contributions to mission
The different methods used to implement change were innovative and created an awareness that has led to sustainable improvement. The project included staff buy in and accountability to create a culture of patient safety.
We have used this model to for CLABSI prevention. We dropped our infection rate and utilization>50%.. and now OR back to basics

22. Keeping Momentum
7 CLABSI for 2 years prior … CLABSI

23. CLABSI “Back to Basics”
Intervention
First steps: best practice, case analysis (lines in place longer than indicated, scrub the hub (multiple access per day), and policy & procedure gap analysis
Awareness: shared real stories, displayed days since competition, different avenues to create a knowledge of indications
Interventions: rounding structure (Critical care and MedSurg), removal of central line before leave critical care, daily surveillance to assess maintenance and indications, dialogue with patients on infection prevention, appropriateness of PICC were closely looked and Midlines were made available.
** CHG bath and Alcohol bathing caps

24. Reference
Falconio-West, M. (2011). CAUTI Prevention: Craking the Case. The OR Connection, 6(2), Retrieved from Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & H. (n.d.). GUIDELINE FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS Retrieved January 30, 2015, from Fakih, M. G., Rey, J. E., Pena, M. E., Szpunar, S., & Saravolatz, L. D. (2013). Sustained reductions in urinary catheter use over 5 years: Bedside nurses view themselves responsible for evaluation of catheter necessity. American Journal of Infection Control, 41(3), doi: /j.ajic How-to Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA: Institute for Healthcare Improvement; (Available at Lo, E., Nicolle, L., Coffin, S. E., et al. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute are Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. 2014; 35(5): doi: / retrieved from Meddings J, Rogers MA, Macy M et al. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clinical Infectious Disease 2010;51:550–60 Meddings, J., Rogers, M.A., Krein, S., Fakih, M., Olmsted, R., Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter associated-urinary tract infection: an integrative review. BMJ Quality & Safety 2013; 0:1-13.doi: bmjqs Scott, R. A., Oman, K. S., Makic, M. F., Fink, R. M., Hulett, T. M., Braaten, J. S., & ... Wald, H. L. (2014). Reducing Indwelling Urinary Catheter Use in the Emergency Department: A Successful Quality-Improvement Initiative. JEN:Journal Of Emergency Nursing, 40(3), doi: /j.jen