1. CAUTI Talk: The Conversation That Never Ends Jenny Tuttle, RN, MSNEd, CNRN

3. VERKLEMPT

4. Tucson Medical Center - CAUTI Project Identified as a quality initiative in 2012 Joined ON the CUSP: STOP CAUTI project through AzHA – Cohort #5 Unit 450 – 16 bed Adult ICU – Neuro/neurosurgery – Vascular Surgery – General Surgery – Medical Implementation of CAUTI project in ICU April 1 st, 2013

5. So What…. it is just a UTI ?! Not a glamorous problem 40% of Hospital Acquired infections are a UTI with 80% being catheter associated 13,000 deaths are associated with CAUTI annually Estimated 65-70% preventable 3 – 10% daily incidence of bacteriuria occurring from catheter use Treatment no longer reimbursed by CMS Medscape.com., 2013. ; OntheCUSPStopHAI.org., 2013.

6. ICU impact Prolonged catheterization is the major risk factor for CAUTIs Twenty-five percent of inpatients and up to 90% of patients in an ICU have a urinary catheter during hospitalization, often without an appropriate indication. Indwelling urinary catheters are placed without sufficient rationale, and/or remain in place after indications expire. CAUTIs can be decreased by interventions that facilitate removal of unnecessary catheters. Most hospitals have not implemented effective strategies for preventing CAUTIs. American Association of Critical Care Nurses. (2011). Catheter associated urinary tract infections. Retrieved from http://www.aacn.org

7. Challenges Worst rate in the hospital Average device utilization rate – 91% Infection Control based Building the right team Identifying realistic goals How to get staff involved Changing the culture How to sustain improvements

8. EMR Based – Infection Control Tool Before After

9. Building the Right Team for Change Team dynamics Team Work - Monthly Team Meetings - Data review - RCA on each CAUTI Identifying problem patients/Making recommendations - Brainstorming - Revised audit tool - Developed Ventilator guidelines Patient/family pamphlet Auditing

10. Not just another audit - modifying audit tool to identify barriers – Bundle assessment Stat lock use ER catheter kits – breaking the system Influence of the auditor

11. Revised Audit Tool

12. Staff Involvement Wicking pads Scales Condom catheters External Male collection devices

13. Changing the Culture Team evaluation of nursing practice/process Listening during audits – “but they are vented” – “but they are on Lasix” – “but they will be incontinent and get a pressure sore” Challenging/ Engaging the staff – Everyday Providing the tools to measure output

14. Ventilator Guideline Conditions that require a foley: SEPSIS (24 HRS) CRRT ARF Pressors with titration Therapeutic Hypothermia IABP SAH with CSW/SIADH/DI SAH with triple H therapy Lasix- acute and/or continual IV infusion Conditions that do not require a foley: MIV Tube feeding Pressors with minimal titration Chronic Lasix Mildly sedated or drowsy patient Respiratory failure pts not chemically paralyzed and/or sedated Case dependant situations

15. Culture Change at Work 42 yr. old, Female Pulmonary Fibrosis Vented Paralyzed/sedated x 5 days 23 yr. old, male S/P Craniectomy for Temporal lobectomy due to chronic seizures Post op - Seizures

16. How to Sustain Improvements? (The Conversation Continues……) One unit improves another gets worse When convenience becomes a complication Consistent message with physicians Added back the audit

17. Making Realistic Goals Reduced our utilization goal of < 70 % – Lowest month utilization was 32 % Reduced our rates by 82% on pilot unit – 12 months before Implementation - 24 CAUTI’s – 12 months after implementation - 4 CAUTI’s 3 Months with NO CAUTI’s on both ICU/CCU

18. Lessons Learned We all own this: Infection Control, Nursing.. Physician buy-in Bringing all the stakeholders Don’t give up – keep at it

20. Thank You !!!