1. The CAUTI Prevention and Reduction Journey: Believe in Zero! Renee Juster, RN, BSN, PHN Infection Prevention Manager John Muir Health February 11, 2015

2. John Muir Health – proprietary and confidential 2 Objectives Upon completion of this presentation, APIC members will be able to: 1.Recognize the value of maximizing standardization and minimizing variation to achieve CAUTI reductions through an unwavering commitment to prevention 2.Understand the criticality of collaborative ownership for hospital wide spread of CAUTI prevention and reduction strategies

3. John Muir Health – proprietary and confidential 3 John Muir Health-Walnut Creek and Concord Medical Centers Walnut Creek: Concord: A 572 bed hospitals recognized as one of the nations, state and region’s premier health care providers by U.S. News and World Report for eight consecutive years. Areas of specialty include high- and low- risk obstetrics, pediatrics, orthopedics, rehabilitation, neurosciences, cardiac, emergency, trauma and cancer care. A 245 bed hospital recognized as a preeminent center for cancer care and cardiac care, including open heart surgery and interventional cardiology. Areas of specialty include cardiovascular services, along with surgical care for a wide variety of conditions, cancer care and emergency services

4. John Muir Health – proprietary and confidential 4 What’s the Goal??? 2013 National Prevention Goals Paved the Way  25% reduction in CAUTI in ICU and ward locations or 0.75 SIR(NHSN data source)-NOT MET  Private and public partnerships form at national and state levels (Engagement Networks)….more goals!  40% reduction in CAUTI and meet NHSN SIR of 1.5 What goals did we want to achieve in 2014? 10% improvement on 2014 Q1 results by end of 2014 Our starting point: Walnut Creek: Rate 7.2 Concord: Rate 5.2

5. John Muir Health – proprietary and confidential 5 Gain Perspective-But How? Make the commitment to improve and go all in! –California Hospital Engagement Network (CalHEN) State level –John Muir Device Related Infection Prevention (DRIP) Team Local/Internal level –On the CUSP: Stop CAUTI Cohort #8 United States level; implement Comprehensive Unit-based Safety Programs (CUSP) –Project Protect Fellowship Partnership between On the CUSP: Stop CAUTI and four partner organizations: –Society for Healthcare Epidemiology of America (SHEA) –Association for Professionals in Infection Control and Epidemiology (APIC) –Society of Hospital Medicine (SHM) –Emergency Nurses Association (ENA).

6. John Muir Health – proprietary and confidential 6 Dare to Dream and Seek Miracles

7. John Muir Health – proprietary and confidential 7 Don’t Forget the Basics-Start with Something! Attack Equipment Issues –Take inventory: Who has what where? How many different choices? –Are these things used in the same way by everyone? Do staff pick the same equipment for the task at hand? –Are the staff set up for success? Outcome: Critical Discovery!  Barriers to improvement directly related to equipment  Barriers to improvement directly related to practice Take Action: Maximize Standardization and Minimize Variation in both areas of Critical Discovery!

8. John Muir Health – proprietary and confidential 8 Maximize Standardization and Minimize Variation Kits-Marry the miracle with what already exists Storage-Location, Location, Location! Correct Choice-Maintain Autonomy: Make it a Win Win!

9. John Muir Health – proprietary and confidential 9 Urinary Catheter Care Bundle Maximize Standardization and Minimize Variation

10. John Muir Health – proprietary and confidential 10 Success! Yes, but skepticism remained –Will equipment standardization coupled with minimizing practice variation and use of an innovative product be enough? CAUTI Prevention= Practice + Product

11. John Muir Health – proprietary and confidential 11 Walnut Creek Campus Critical Care Units- CAUTI rate

12. John Muir Health – proprietary and confidential 12 Walnut Creek Campus Critical Care Units- Days between CAUTI 2 pack wipes Foam and Bath wipes-1 out of 3 units All Critical Care Units- Wipes, Foam, Bath

13. John Muir Health – proprietary and confidential 13 Walnut Creek Campus Critical Care Units- CAUTI rate Concord Campus Critical Care Units- CAUTI rate 2 pack wipes

14. John Muir Health – proprietary and confidential 14 Fast Forward-2014 Comes to an End Goal: 10% improvement on 2014 Q1 results by the end of 2014. CAUTI – GOAL MET Q1 2014 Q2-Q4 2014 Concord 5.2 3.4 (35% reduction) Walnut Creek 7.2 5.1 (29% reduction) Combined 6.4.5 (30% reduction) We did hit ZERO on both campuses at one point or another but expecting ZERO to be sustainable over time is not realistic. The rigor becomes more important.

15. John Muir Health – proprietary and confidential 15 Most Valuable Lessons Learned Patience is a virtue Don’t assume they see what you see Tell the Story Data, Data, Data plus what’s happening in the market Crunch the Numbers Collaboration/Partnership –DON’T FORGET THE WOUND CARE NURSES

16. John Muir Health – proprietary and confidential 16 Don’t Give Up- Look Up! “In most cases, the arrival of innovation, like a quality improvement initiative, forces us to contemplate changing the way we live in some way, large or small. Often our reaction is annoyance. We don’t want to be bothered; We are doing nicely without this idea. Find members of the group who are admired, trusted and believe in the idea and set them loose on the group” - Preventing Hospital Infections: Real World Problems, Realistic Solutions Sanjay Saint, Sarah L. Krein with Robert W. Stock Oxford University Press 2015

17. John Muir Health – proprietary and confidential 17 Questions? Thank You!