CAUTI Talk:The Conversation That Never

Ends

Jenny Tuttle, RN, MSNEd, CNRN

VERKLEMPT

Tucson Medical Center - CAUTI Project

• Identified as a quality initiative in 2012• Joined ON the CUSP: STOP CAUTI project

through AzHA – Cohort #5• Unit 450 – 16 bed Adult ICU– Neuro/neurosurgery– Vascular Surgery– General Surgery– Medical

Implementation of CAUTI project in ICUApril 1st, 2013

So What…. it is just a UTI ?!• Not a glamorous problem• 40% of Hospital Acquired infections are a UTI

with 80% being catheter associated• 13,000 deaths are associated with CAUTI annually• Estimated 65-70% preventable• 3 – 10% daily incidence of bacteriuria occurring from catheter use• Treatment no longer reimbursed by CMS

Medscape.com., 2013. ; OntheCUSPStopHAI.org., 2013.

ICU impact• Prolonged catheterization is the major risk factor for CAUTIs• Twenty-five percent of inpatients and up to 90% of patients in an ICU have a urinary catheter during hospitalization, often without an appropriate indication.• Indwelling urinary catheters are placed without sufficient rationale, and/or remain in place after indications expire.

• CAUTIs can be decreased by interventions that facilitate removal of unnecessary catheters.

• Most hospitals have not implemented effective strategies for preventing CAUTIs. American Association of Critical Care Nurses. (2011). Catheter associated urinary

tract infections. Retrieved from http://www.aacn.org

Challenges

• Worst rate in the hospital• Average device utilization rate – 91%• Infection Control based• Building the right team• Identifying realistic goals• How to get staff involved• Changing the culture• How to sustain improvements

EMR Based – Infection Control ToolBefore After

Building the Right Team for Change • Team dynamics• Team Work

- Monthly Team Meetings- Data review

- RCA on each CAUTI• Identifying problem patients/Making

recommendations- Brainstorming- Revised audit tool- Developed• Ventilator guidelines• Patient/family pamphlet

• Auditing

Auditing

• Not just another audit - modifying audit tool to identify barriers – Bundle assessment • Stat lock use• ER catheter kits – breaking the system

• Influence of the auditor

Revised Audit Tool

Staff Involvement

• Wicking pads

• Scales

• Condom catheters• External Male collection

devices

Changing the Culture

• Team evaluation of nursing practice/process• Listening during audits– “but they are vented”– “but they are on Lasix”– “but they will be incontinent and get a pressure

sore”• Challenging/ Engaging the staff – Everyday• Providing the tools to measure output

Ventilator GuidelineConditions that require a foley:

SEPSIS (24 HRS)CRRTARFPressors with titrationTherapeutic HypothermiaIABPSAH with CSW/SIADH/DISAH with triple H therapyLasix- acute and/or continual IV infusion

Conditions that do not require a foley: MIV Tube feeding Pressors with minimal titration Chronic Lasix Mildly sedated or drowsy

patient Respiratory failure pts not

chemically paralyzed and/or sedated

Case dependant situations

Culture Change at Work

42 yr. old, FemalePulmonary FibrosisVentedParalyzed/sedated x 5

days

23 yr. old, male S/P Craniectomy for

Temporal lobectomy due to chronic seizures

Post op - Seizures

How to Sustain Improvements?(The Conversation Continues……)

• One unit improves another gets worse• When convenience becomes a complication• Consistent message with physicians• Added back the audit

Making Realistic Goals

• Reduced our utilization goal of < 70 %– Lowest month utilization was 32 %

• Reduced our rates by 82% on pilot unit– 12 months before Implementation - 24 CAUTI’s– 12 months after implementation - 4 CAUTI’s

• 3 Months with NO CAUTI’s on both

ICU/CCU

Lessons Learned

• We all own this: Infection Control, Nursing..• Physician buy-in• Bringing all the stakeholders• Don’t give up – keep at it

Thank You !!!