1. CAUTI Content Call #6 A Hospital’s Perspective
CAUTI Prevention:
Implementation in a Community Hospital

2. CAUTI Content Call Schedule
CUSP/CAUTI Content Call #1 – CUSP
Moderator – Sam Watson; Speaker – Sean Berenholtz
03/07/11
2 ET/1 CT/12 MT/11 PT
Attendee: (866)
60 Min.
CUSP/CAUTI Content Call #2 - The Science of Safety
Moderator – Sam Watson;  Speaker – Sean Berenholtz
03/22/11
2 ET/1 CT/12 MT/11 PT
Attendee: (866)
60 Min.
CUSP/CAUTI Content Call #3 - Care and Removal Intervention
Moderator – Sam Watson;  Speaker – Mohamad Fakih
04/05/11
2 ET/1 CT/12 MT/11 PT
Attendee: (866)
60 Min.
CUSP/CAUTI Content Call #4 - Data Collection
Moderator – Sam Watson;  Speaker – Sam Watson
04/19/11
2 ET/1 CT/12 MT/11 PT
Attendee: (866)
60 Min.
CUSP/CAUTI Content Call #5 - The View from the Bedside
Moderator – Sam Watson;  Speaker – Russ Olmsted
05/03/11
2 ET/1 CT/12 MT/11 PT
Attendee: (866)
60 Min.
CUSP/CAUTI Content Call #6 - Implementation in a Community Hospital
Moderator – Sam Watson;  Speaker – Mary Jo Skiba
05/17/11
2 ET/1 CT/12 MT/11 PT
Attendee: (866)
60 Min.

3. CAUTI Prevention Implementation in a Community Hospital
Mary Jo Skiba RN BSN
Project Manager QI/Research
January 2011

4. Community Hospital 146 Licensed Beds Med Surg (2 Units) ICU (8 Bed)
Women’s Health
Inpatient Rehab
Inpatient Psych
Non-Profit
Sole Community Provider

5. Objectives
Remove barriers and identify steps towards successful CAUTI project initiation
Demonstrate educational strategies
Maintain success

6. Have a Plan
Plan, Plan, Plan…
then Plan some more…

7. Project Planning CAUTI Team Policies Awareness Campaign
Data Collection Plan
Project Start Date
Education
Plan for Follow-Up

8. Project Planning Establish CAUTI Team Members
Involve frontline staff
Have a physician champion
Include charge nurses
Include staff development
Determine the scope of your initial project
Policy - Urinary Catheterization
Review/Revise
Use policy in toolkit
Don’t re-create the wheel
Consolidate into one policy if possible
Automatic Catheter Stop Policy

9. Project Awareness Hospital Newsletter Flyers Screen Savers
KEYSTONE HAI
(Hospital Associated Infections)
“Bladder Bundle Project”
Preventing Catheter Associated Urinary Tract Infections
Hospital Newsletter
Flyers
Screen Savers

12. Data Collection Data collectors Data forms –
Add qualifiers specific to your
hospital
Assure understanding
of project requirements
5 days week
=Mon thru Fri (not W/E)
Data entry web-based
program

13. Be Flexible Project Start Date
Use calendar or Gantt chart to plot activities
Check vacation schedules of key staff
Watch out for major holidays
Be Flexible

14. Planning Education Nursing Physicians Who will be trained
Who will train
How will we train
When will we train
How will we do make-ups
How much ongoing training
or re-training needed
Physicians
Who will train
How will we train
When will we train

15. Two Fold Approach Didactic 2. Demonstration of Insertion Competency
CAUTI Face to Face Inservice
All Nursing/Aides
Guideline For Prevention of CAUTI
Physician CME
Dept Meetings
2. Demonstration of Insertion Competency

16. Developing CAUTI Education
Don’t Re-create The Wheel
Use Other Hospitals PowerPoint Slides
Update/Revise to Fit
Jerri’s Story
North Carolina Prevent CAUTI Toolkit

17. Trained the trainers

19. Urinary Catheter Insertion Competency
Traveling Mannequin
100% Aides and all nurse frequent inserters
(ED, OR, WHU, IP Rehab, ICU)
Read Policy
Take Quiz
Perform Procedure
Instant Remediation and Repeat Demonstration

20. 167 Competencies
Avg 15 min/staff member
41 Aides, 126 Nurses

21. Outcome Improper Cleaning 26 Improper Gloving 24 Contaminated field 45
Didn’t know needleless
cath port for specimens

22. Urinary Catheter Insertion Competency
Improvement Plan
Require Field Competency all Aides within
2 months - supervised by RN’s
Newly hired Aides trained by RN’s
Yearly Aide hands on demonstration of competency

23. Strategies - Don’t use first urine drained from catheter
Caths flagged with date of insertion
Secured to legs
Specimen collection for culture
- Don’t use first urine drained from catheter
- ED patients – prior to collection, change catheter
unless known change within 7 days
- Inpatients… If catheter in for 7 days must change prior to specimen collection
Perineal hygiene prior to caths
“John Door” educational posters

24. Foley Catheter Prevalence

25. Keystone Center for Patient Safety and Quality
1/1/08 –4/30/08
ARMC
Michigan
1/1/ /30/2008
ARMC
Keystone Center for Patient Safety and Quality
Comparative Data
Units
Data Point
Num
Den
Prevelance Rate
Reporting
Pre 56
233
24.03 29
775
3,912
19.81
Int 1 54
239
22.59 26
697
3,400
20.50
Int 2 27
169
15.98
650
3,709
17.52
Post 1 34
187
18.18
569
3,262
17.44
171
828
20.65
2,691
14,283
18.84

26. ARMC Monthly Urinary Cath Related UTI’s
Outcomes
ARMC Monthly Urinary Cath Related UTI’s
2006
46 CAUTI’s
Avg 3.8 mo
2007
32 CAUTI’s
Avg 2.7 mo
2008
28 CAUTI’s
Avg 2.3 mo
2009
6 CAUTI’s
Avg 0.5 mo

27. ARMC Monthly Urinary Cath Related UTI’s
Outcomes
ARMC Monthly Urinary Cath Related UTI’s
2006
46 CAUTI’s
Avg 3.8 mo
2007
32 CAUTI’s
Avg 2.7 mo
2008
28 CAUTI’s
Avg 2.3 mo
2009
6 CAUTI’s
Avg 0.5 mo

28. Investigation Cath competency plan not followed
Focus was on hospital EMR implementation
Daily cath patrol not consistent
Prevalence rates up

29. New Plan Annual competency aide and ED/OR nurses
Competency imbedded in orientation/annual skills evaluation
Agenda item every leadership/staff mtg
Charge nurses do daily Cath Patrol- Med Surg
Metric reports monthly to staff and physicians
Cath necessity built into EMR documentation
Decrease size standard cath from #16 to #14

30. ARMC Monthly Urinary Cath Related UTI’s
Outcomes
ARMC Monthly Urinary Cath Related UTI’s
ZERO!!

31. Questions
Be vigilant…Plan for and carry out follow-up interventions
Don’t worry alone…
“Courage is being scared to death,
but saddling up anyway”
(John Wayne)
Questions?

32. Your Feedback is Important