1. Legacy Good Samaritan Medical Center Presented by Jim Marangoni RN SCNR Thank You Art Ashby and Cindy Evans 1

2. Deciding on the issues Roles in an infection reduction project UTI prevention bundle Describe Process and Outcome Monitoring Integrate NSQIP Data into UTI reduction efforts: Realtime, Risk Adjusted, Regional Objectives 2

3. Legacy Health – 6 hospitals, regional referral laboratory, research programs, clinics, hospice program and IP rehabilitation center Urban hospital in NW Portland: 230 Staffed beds, Average Census 130-170 patients NSQIP since Sept 2008 Multispecialty with OHS Legacy Good Samaritan Medical Center 3

4. Oregon NSQIP Consortium 4

5. Catheter Associated - Nosocomial Urinary Tract Infections April - June 2005 compared to April - June 2006 CAUTI Reduction Product Conversion to Silver Hydrogel Coated Urinary Catheters Rates per 1000 Patient Days Projected Net Cost Avoidance: $115,700 based on CAUTIs prevented and projected increased cost of products 5

6. CAUTI Rates 2006-2008: Kern CCU per 1000 device days 6

7. Overall* Urinary Tract Infections * Includes General and Vascular Surgery Cases Observed Rate: 2.06% Expected Rate: 1.53% O/E Ratio: 1.35 Status: As Expected 7

8. First Step – Collaborating Chief Nursing Officer and Quality Improvement Specialist Legacy Initiative to Focus on Infection Prevention Led to Development of Infection Prevention Bundles CAUTI Reduction Strategy 8

9. Sterile technique for insertion Always keep drainage bag below level of the bladder Empty bag before transport Prevent dependent loops in tubing Secure catheter to decrease movement of foley Pericare daily using soap and water with daily bath Do not allow the bag to overfill Do not allow bag to touch floor Foley Catheter Best Practice Bundle 9

10. EPIC Documentation Flowsheet 10

11. Best Practices Literature Review CAUTI Prevention Bundle Development Educating staff who come into contact with patients with catheters, from placement to transporting patients Monitoring Compliance with CAUTI Bundle Process Monitoring Rounds by CNO and ICP Provide Feedback Regarding Compliance and CAUTI data to staff Interactive Case Reviews with Nursing Staff CAUTI Prevention Process 11

12. Bundle Education 12

13. CAUTI Reduction April 2008 – March 2010 71% Reduction in UTI Cases 13

14. Symptomatic CAUTI Case Counts June 2010 – November 2011 14

15. Quarterly UTI Realtime NSQIP 15

16. Monthly UTI NSQIP 16

17. Overall* Urinary Tract Infections * Includes General and Vascular Surgery Cases Observed Rate: 0.82% Pred. Obs. Rate: 0.93% Expected Rate: 1.04% Odds Ratio: 0.89 Status: Non- Outlier 17

18. Conclusions The Bundles approach works Leadership involvement is essential Education, Education and Re-education is required Surveillance includes process AND outcomes monitoring and feedback to the staff Involving care staff in case analysis leads to discovery 18

19. Questions? 19