Infection control performance improvement 4.16.2015 rev 0

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Visually-guided catheterizations

can reduce trauma and injuries

which can decrease CAUTI rates.

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Difficult Urinary Catheterization Definition

DUC is defined as unexplained resistance with the initial catheter

despite multiple insertion attempts.

Urethral Anatomy

15-25% of all patients admitted into a US hospital are catheterized.

CDC, http://www.cdc.gov/HAI/ca_uti/uti.html

Prostate

Bulbous Urethra

Urethral Sphincter

Bladder

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• 1.4% of catheter placements result in identifiable catheter-related urethral injury2

• 12.72% of patients with injury developed a UTI2

• 32.87% of patients with catheter-related trauma required surgery2

Acute Urethral Injury

Urethral lumen

3-4 cell layers thick!!!

Mucosal tear

Catheter trauma often doubles the likelihood of CAUTI and increases LOS by 1.5-3.5 days1

.

1

National Incidence and Impact of Noninfectious Urethral Catheter Related Complications on the Surgical Care Improvement Project; Journal of Urology, 2011

Urothelium of urethraUrethral Perforation

2

Chavez AH, Coffield KS, Kuykendall SJ, et al. Incidence of Foley catheter-related urethral injury in a tertiary referral center. J Am Coll Surg

2009;209:S129-30. URL: http://www.journalacs.org/article/S1072-7515%2809%2900902-8/abstract

Lumen

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NATIONAL CAUTI INITIATIVESMedicare stopped reimbursing hospitals in

2008 for Hospital-Acquired CAUTI. a

Joint Commission Hospital National Patient Safety Goal 07.06.01: Requires hospitals to use evidence-based practices to prevent CAUTI. b

HHS National 5-year Prevention Target: 25% national decrease from 2007 baseline. Actual reduction was 7%. Measure: # of UTI / 1,000 urinary catheter days as measured in NHSN. c

a http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html

b http://www.cdc.gov/hicpac/cauti/002_cauti_toc.html

c http://www.hhs.gov/ophs/initiatives/hai/prevtargets.html

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NATIONAL CAUTI INITIATIVESUnder the Affordable Care Act, CMS is implementing

the Hospital-Acquired Condition (HAC) Reduction Program. The penalty is 1% of the hospital’s total gross Medicare patient revenue. Performance period ended 12/31/2013. Penalties to be assessed starting 10/1/14. d

Starting in 2014, a hospital’s Medicare Annual Performance Update (APU) of 2% can be reduced if CAUTI data are not submitted. e

d http://www.stratishealth.org/documents/HAC_fact_sheet.pdf

e http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2013-fact-sheets-items/2013-08-02-3.html

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JOINT COMMISSION & CAUTI

NPSG.07.06.01 - “Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract.”

“Catheter-associated urinary tract infection (CAUTI) has been associated with increased morbidity, mortality, hospital costs, and length of stay.”

Sources:

Guidelines for Prevention of Catheter-Associated Urinary Tract Infections 2009. Healthcare Infection Control Practices Advisory Committee (HICPAC)

Klevens RM, Edwards JR, Richards CL,Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002.Public Health Rep. 2007;122(2):160-166.

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JOINT COMMISSION & CAUTI

“NPSG.07.06.01 on CAUTI does not specify whether hospital-wide or targeted surveillance. In fact, it does not specifically require that surveillance for CAUTI be performed at every accredited hospital. Rather, it allows for each organization to decide, based on its risk assessment (IC.01.03.01) whether CAUTI is a priority warranting surveillance.”

Source: Joint Commission, National Patient Safety Goals

http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf

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JOINT COMMISSION & CAUTI

“Survey process note: This new NPSG has a phase-in period during 2012, during which surveyors will be ensuring that hospitals are planning and preparing for full implementation in 2013. Starting in January 2013, a hospital that has decided, based on its risk assessment, that CAUTI surveillance is not indicated should be prepared to discuss this decision with its survey team and provide a clear rationale. Even if surveillance is not performed, the insertion and management requirements of the goals must still be implemented.” (emphasis added).

Source: Joint Commission, National Patient Safety Goals

http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf

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NATIONAL CAUTI METRICS

2 million HAC/year. 32% are CAUTI, of which 80% are attributable to indwelling catheter

National data from acute care hospitals report mean CAUTI rates of 3.1 – 7.5% infections per 1,000 catheter days

15% to 25% of hospitalized patients receive short-term indwelling catheter

Source: Safe Practices for Better Healthcare 2010 Update, National Quality Forum.

http://www.qualityforum.org/Publications/2010/04/Safe_Practices_for_Better_Healthcare_%E2%80%93_2010_Update.aspx

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NATIONAL CAUTI METRICS

CDC estimates that in 2002, 561,667 CAUTI occurred, resulting in 13,088 deaths.

CAUTI contribute to nosocomial bloodstream infection5% of bacteruric cases develop bacteremia, making CAUTI the leading cause of nosocomial bloodstream infections

17% of hospital-acquired bacteremias are from a urinary source, with an associated mortality of approx. 10%.

Source: Safe Practices for Better Healthcare 2010 Update, National Quality Forum. http://www.qualityforum.org/Publications/2010/04/Safe_Practices_for_Better_Healthcare_%E2%80%93_2010_Update.aspx

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CAUTI INCREASE COSTS

The cost per case for nosocomial urinary tract infections (UTIs) ranges from $1,200 to more than $2,700.

UTIs cost the health care system more than $400 million annually.

Catheter-related bacteremia increases the cost of care by at least $2,800 per patient

Source: R3 Report Requirement, Rationale, Reference, The Joint Commission Issue 2, September 28,

2011. http://www.jointcommission.org/assets/1/18/r3_report_issue_2_9_22_11_final.pdf

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CATHETER PLACEMENT IN HOSPITAL

37% - ER

29% - OR

34% - Nursing Units

Source: How-to Guide: Prevent Catheter-Acquired Urinary Tract Infections: Cambridge, MA. Institute for Healthcare Improvement; 2011. www.ihi.org