1 © 2010 TMIT NQF-Endorsed ® Safe Practices for Better Healthcare Safe Practice 25 Catheter-Associated Urinary Tract Infection Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections
Dec 22, 2015
1© 2010 TMIT
NQF-Endorsed®
Safe Practices for Better Healthcare
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 2© 2010 TMIT
Slide Deck Overview
Slide Set Includes:
Section 1: NQF-Endorsed® Safe Practices for Better Healthcare Overview
Section 2: Harmonization Partners Section 3: The Problem Section 4: Practice Specifications Section 5: Example Implementation Approaches Section 6: Front-line Resources
3© 2010 TMIT
NQF-Endorsed®
Safe Practices for Better HealthcareOverview
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
4© 2010 TMIT
34 Safe Practices
• Criteria for Inclusion
• Specificity
• Benefit
• Evidence of Effectiveness
• Generalization
• Readiness
2010 NQF Safe Practices for Better Healthcare: A Consensus Report
CHAPTER 7: Healthcare-Associated Infections• Hand Hygiene• Influenza Prevention• Central Line-Associated Blood Stream Infection
Prevention • Surgical-Site Infection Prevention• Daily Care of the Ventilated Patient• MDRO Prevention• Catheter-Associated UTI Prevention
Information Management and Continuity of Care
Medication Management
Healthcare-Associated Infections
Condition- and Site-Specific Practices
Consent & Disclosure
Wrong-siteSx Prevention
Press. Ulcer Prevention
VTE Prevention
Anticoag. Therapy
VAP Prevention
Central Line-Assoc.BSI Prevention
Sx-Site Inf.Prevention
Contrast Media Use
Hand HygieneInfluenza
Prevention
Pharmacist Leadership Structures and Systems
Med. Recon.
Culture
CPOE
Read-Back & Abbrev.
Discharge Systems
PatientCare Info.
LabelingDiag. Studies
Culture Meas.,FB., and Interv.
Structuresand Systems
Risk and HazardsTeam Trainingand Skill Bldg.
Nursing Workforce
ICU CareDirect
Caregivers
Workforce CHAPTER 4: Workforce• Nursing Workforce• Direct Caregivers• ICU Care
CHAPTER 2: Creating and Sustaining a Culture of Safety (Separated into Practices]
Culture of Safety Leadership Structures and Systems Culture Measurement, Feedback, and Intervention Teamwork Training and Skill Building Risks and Hazards
CHAPTER 5: Information Management and Continuity of Care
Patient Care Information Order Read-Back and Abbreviations Labeling Diagnostic Studies Discharge Systems Safe Adoption of Computerized Prescriber Order Entry
CHAPTER 6: Medication Management Medication Reconciliation Pharmacist Leadership Structures and Systems
CHAPTER 8: Condition- and Site-Specific Practices• Wrong-Site, Wrong-Procedure, Wrong-Person
Surgery Prevention • Pressure Ulcer Prevention• VTE Prevention• Anticoagulation Therapy• Contrast Media-Induced Renal Failure Prevention• Organ Donation• Glycemic Control• Falls Prevention• Pediatric Imaging
Informed Consent
Life-Sustaining Treatment
Disclosure
CHAPTER 3: Consent and Disclosure• Informed Consent• Life-Sustaining Treatment• Disclosure• Care of the Caregiver
Consent and Disclosure
Care of Caregiver
MDROPrevention
UTIPrevention
FallsPrevention
OrganDonation
GlycemicControl
PediatricImaging
7© 2010 TMIT
Harmonization Partners
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 10© 2010 TMIT
The Objective
Catheter-Associated Urinary Tract Infection Prevention
Prevent healthcare-acquired catheter-associated urinary tract infections (CAUTIs)
11© 2010 TMIT
The Problem
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
13© 2010 TMIT
[http://patientsafetyauthority.org/NewsAndInformation/PressReleases/Pages/pr_2009_October_13.aspx]
© 2006 HCC, Inc. CD000000-0000XX 15© 2010 TMIT
The Problem
Frequency
CAUTIs are the most frequent HAIs in acute care hospitals
80% are attributable to an indwelling urethral catheter
CAUTIs are associated with increased morbidity, mortality, hospital cost, and length of stay
[Saint, Infect Control Hosp Epidemiol 2000 Jun;21(6):375-80; Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32]
© 2006 HCC, Inc. CD000000-0000XX 16© 2010 TMIT
The Problem
Severity
Between 15%-25% of hospitalized patients may receive short-term indwelling urinary catheters
In 2002, the Centers for Disease Control and Prevention estimated that 561,667 CAUTIs occurred in the United States, contributing to 13,088 deaths
[Warren, Int J Antimicrob Agents 2001 Apr;17(4):299-303; Weinstein, Infect Control Hosp Epidemiol 1999 Aug;20(8):543-8; Klevens, Public Health Rep 2007 Mar-Apr;122(2):160-6]
© 2006 HCC, Inc. CD000000-0000XX 17© 2010 TMIT
The Problem
Preventability
Estimated to be 17%-69% with recommended infection control measures
380,000 preventable infections and 9,000 preventable deaths related to CAUTI annually
Limiting catheter use and minimizing the duration the catheter remains in situ are principal strategies for CAUTI prevention
Use of an antimicrobial or silver alloy-coated catheter reduces risk of CAUTIs
[Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8; Ciavarella, Infect Control Hosp Epidemiol 2009 Apr;30(4):404-5; author reply 405-6; Parker, J Wound Ostomy Continence Nurs 2009 Jan-Feb;36(1):23-34]
© 2006 HCC, Inc. CD000000-0000XX 18© 2010 TMIT
The Problem
Cost Impact
The annual direct medical cost of CAUTI is estimated to be $565 million in the United States
[Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009]
19© 2010 TMIT
Practice Specifications
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 21© 2010 TMIT
Safe Practice Statement
CAUTI Prevention
Take actions to prevent catheter-associated urinary tract infection by implementing evidence-based intervention practices
[Lo, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S41-50; Gould, Guideline for prevention of catheter-associated urinary tract infections, 2008; Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]
© 2006 HCC, Inc. CD000000-0000XX 22© 2010 TMIT
Additional Specifications
Document the education of personnel—involved in catheter insertion, care, management, and removal—on CAUTI prevention
Education should occur upon hire and annually thereafter
Prior to insertion, educate the patient and family members about CAUTI prevention
Identify the patient groups or units on which surveillance should be conducted, considering frequency of catheter use and potential risk
Implement policies and practices to reduce the risk of CAUTI
[Willson, J Wound Ostomy Continence Nurs 2009 Mar-Apr;36(2):137-54; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8;Smith, Am J Infect Control 2008 Sep;36(7):504-35]
© 2006 HCC, Inc. CD000000-0000XX 23© 2010 TMIT
Additional Specifications
Evidence-based practices include, but are not limited to, the following: Perform hand hygiene immediately before and
after catheter insertion Ensure that the supplies necessary are readily
available Insert catheters following an aseptic technique
and using sterile equipment Leave urinary catheters in place only as long
as indications remain Obtain a urine culture before initiating
antimicrobial therapy[Greene, Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008; Institute for Healthcare Improvement, Catheter-Associated Urinary Tract Infection (CA UTI) Prevention, IHI Improvement Map, 2009; Joint Commission Resources, Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, National Patient Safety Goals, 2010; Barford, BJU Int 2008 Jul;102(1):67-74]
© 2006 HCC, Inc. CD000000-0000XX 24© 2010 TMIT
Additional Specifications
Measure compliance with best practices, evaluating the effectiveness of prevention efforts
Provide CAUTI surveillance data, including process and outcome measures, to key stakeholders within the organization
25© 2010 TMIT
Example Implementation Approaches
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2006 HCC, Inc. CD000000-0000XX 27© 2010 TMIT
Example Implementation Approaches
Implement a system for documenting the following in the patient record: indications for catheter insertion date and time of catheter insertion individual who inserted catheter date and time of catheter removal
Develop and implement facility criteria for acceptable indications for indwelling urinary catheter use
[Gokula, Am J Infect Control 2004 Jun;32(4):196-9; Marklew, Nurs Crit Care 2004 Jan-Feb;9(1):21-7]
© 2006 HCC, Inc. CD000000-0000XX 28© 2010 TMIT
Example Implementation Approaches
Suggested indications for indwelling urethral catheter use include: Perioperative use for selected surgical procedures Accurate measurement of urine output in critically
ill patients Management of acute urinary retention and
urinary obstruction To assist in pressure ulcer healing for incontinent
residents As an exception, at patient request to improve
comfort Relief of bladder outlet obstruction or congenital
urologic abnormalities
© 2006 HCC, Inc. CD000000-0000XX 29© 2010 TMIT
Example Implementation Approaches
Following aseptic insertion of the urinary catheter, maintain a closed drainage system
Maintain unobstructed urine flow Implement an organization-wide program to
identify and remove catheters no longer necessary; method examples include: Automatic stop orders Standardized reminders placed into patient
record Implementation of daily ward rounds to review
all patients with urinary catheters
[Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]
© 2006 HCC, Inc. CD000000-0000XX 30© 2010 TMIT
Example Implementation Approaches
Strategies of Progressive Organizations
High-performing organizations have protocols for the management of post-operative urinary retention
Innovations include direct visualization of the urethra during insertion of catheters
Implement a system for analyzing and reporting data on catheter use, including adverse events
[Chapple, 2004 June;93(9)1195-1202; Fenton, Urology 2005 Jun;65(6):1055-8; Agency for Healthcare Research and Quality, National Healthcare Disparities Report 2008, 2009; Agency for Healthcare Research and Quality, National Healthcare Quality Report 2008, 2009]
31© 2010 TMIT
Front-line Resources
Safe Practice 25Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7: Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
32© 2010 TMIT
[http://www.shea-online.org/about/compendium.cfm; http://www.azdhs.gov/infectioncontrol/pdfs/HAI%20Prevention%20Compendium%20PDFs/CA%20UTI.pdf]
36© 2010 TMIT
[http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/ExpeditionPreventingCatheterAssociatedUrinaryTractInfectionsAug10.htm?
utm_source=email&utm_medium=blast&utm_campaign=cautisep10b1]
© 2006 HCC, Inc. CD000000-0000XX 37© 2010 TMIT
TMIT National Webinar Series
Catheter-Associated Urinary Tract Infection:No One Owns It ... We ALL Pay for It! (SP 25)
Carolyn Gould, MD, MSCR – Topic: The CDC Guideline for Prevention of CAUTI
Sanjay Saint, MD, MPH – Topic: CAUTI Prevention: The Bladder Bundle
Marcia Patrick, RN, MSN, CIC – Topic: CAUTI Reduction Using Rapid-Cycle Improvement
Denise Graham – Topic: APIC Support Patti O'Regan, DNP, ARNP, ANP-C, PMHNP-BC –
Topic: The Role of the Patient Advocate Go to: http://safetyleaders.org/webinars/indexWebinar_August2010.jsp
(August 19, 2010)
© 2006 HCC, Inc. CD000000-0000XX 38© 2010 TMIT
TMIT National Webinar Series
Healthcare-Associated Infection and You:Cleaner, Safer Care (SPs 19-25)
Kathy Warye – Topic: Perspective on the Development of the Implementation Examples of the NQF Safe Practices
Peter Angood, MD – Topic: HAI National Attention and Harmonization
David Classen, MD – Topic: HAI Compendium Harmonization with the Safe Practices
Julianne Morath, RN – Topic: Implementation Jennifer Dingman – Topic: Call to Action Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932
(May 14, 2009)