Keystone HAI CAUTI Catheter Associated Urinary Tract Infections

1、catheter associated urinary tract infections (bladder bundle) botsford hospital experience february 28, 2008 getting started project preparation select the pilot unit point prevalence survey of all patients in hospital for use of urinary catheter this survey was done at the same time as the annual p

2、ressure ulcer survey critical care, maternal-child health, emergency department were excluded from the catheter survey pilot units selected based on number of foley catheters. 5 south (pulmonary: 34 beds) most are associated with urinary catheterization 15 - 25% of inpatients are catheterized uti: a

3、bout 40% of hospital-associated infections 80% of hospital associated utis caused by a urinary catheter cost of a cauti - $500 1000, $2,800 if bacteremia most cautis asymptomatic bacteriuria, 1-5% lead to secondary bacteremia 5% of all deaths from hospital-associated infections are urinary catheter

4、associated. proper management and use of catheters could prevent infections study in lansing, mi: less than half of urinary catheters in teaching hospital were indicated. catheters uncomfortable, limit mobility training 3 why target cauti? uncle sam wants you to prevent utis centers for medicare & m

5、edicaid (cms) as of oct. 2008 cms will no longer reimburse hospitals for eight “reasonably preventable” conditions. included are cauti and hospital acquired pressure ulcers. reimbursement to the hospital for care of these patients will be decreased. catheter-associated utis are included because they

6、 are felt to be reasonably preventable by following well-established prevention guidelines. other targeted conditions include injuries from falls, vascular-catheter-associated infections, mediastinitis, objects left in the body during surgery, air embolisms,and blood incompatibility. training 4 who

7、let the bugs in! three sites of bacterial invasion. along the walls of the catheter. bacteria ascend up the external surface of catheter at the junction between the catheter and the drainage bag: opening a closed drainage system lets the bugs in. at the drainage outlet. when emptying the foley bag,

8、good technique must be observed. risk of bacteriuria increases with days of catheterization 5% per day that catheter is in place training 5 prevention of cauti make sure the catheter is indicated remove the catheter as soon as possible consider alternatives to indwelling catheters. training 6 preven

9、tion: catheter care insert catheter using aseptic technique & sterile equipment use a sterile, continuously closed, drainage system important: secure catheter to the leg (may use abdomen in men) use catheter port to obtain samples if needed avoid irrigation, aseptic technique if needed keep collecti

10、on bag below bladder level at all times cath secure training 7 make sure catheter is indicated keystone: reasons /indications for urinary catheters urinary tract obstruction neurogenic bladder urologic study/ urologic surgery stage 3 or 4 pressure ulcer hospice, comfort care, palliative care trainin

11、g 8 keystone: non-indications for use nephrology transferred from icu patient requests a foley confused incontinence other training 9 bladder bundle project keystone interventions to prevent catheter associated urinary tract infections. training 10 5 south pilot project why 5 south? baseline point p

12、revalence survey of patients with foley catheters was done in feb, 2007. high use units were 5s and pcu 5s chosen to start what does the project include? eight week pilot project three phases: pre-intervention, intervention & post- intervention all staff on 5 south will be involved training 11 week

13、one: oct 7 - 13 pre-intervention phase lets get started! baseline assessment frequency of positive urine cultures survey of patients with foley catheters 5 days to determine indications for usage. training 12 weeks 2 & 3: oct. 14 - 27 intervention phase bladder bundle team begins! nurses, nas, physi

14、cian, training on prevention to 5 south staff training on alternatives to catheterization physicians given brochure daily rounds “catheter patrol” assess reason for use, indicated vs. non-indicated rn initiates process to discontinue non-indicated catheters. nursing staff crucial to success of progr

15、am. rn & na develop a plan to manage incontinence as needed for patients who have their catheter dcd (not all patients will be incontinent) collect data m f training 13 interventions cond midnight nurse will evaluate all patients with foley catheters nurse will use keystone criteria to determine if

16、catheter appropriate. if catheter is not appropriate (using keystone criteria) the nurse will place an order sheet (salmon or orange colored) with the physicians orders. this sheet explains keystone criteria and reasons why the catheter is not indicated. physician may choose to leave the catheter in

17、 place. if the order sheet is not signed within 24 hours, the midnight shift nurse will notify the day shift nurse to obtain an order from the physician. training 14 weeks 4-7: post-intervention phase oct 28 nov 24 staff will continue to implement nurse initiated discontinuation of urinary catheters

18、. nurse will identify patients who meet the not indicated catheter list nurse will get order from physician to d/c non-indicated foley catheters nurse will develop plan to manage incontinence as needed. training 15 week 8: post-intervention nov 25 dec 1 phase data collection continue to implement project collect data