Urine-8 Project: Next Step

Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice

Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services

Trinity Medical Center – Quad Cities

2

Urine-8 Committee MembersMichelle Blackmer, MSN, FNP-BC, RNStan Buck, RN, RNFAPam Elliott, MBA, BFAChris Hansen, MS, RNDiane Laake, RN, CMSRNPaula Maddox, MSN, RN, CCRNKathryn Marhoefer, MBA, RNMichelle Mathias, BSN, RNMary A. Petersen, MSN, RN (Committee Chair)

3

CAUTI Statistics Nationwide

80% of HA UTIs are caused by urinary

catheters5% deaths from HAIs are urinary

catheter associatedCost of a CAUTI is estimated at

$500-1000, $2800 if bacteremiaSource: Michigan Keystone Project, 2008

4

Trinity CAUTI Rates

CAUTIs 2006-2009Year

Raw #

Rate /1000 pt days Rate / 1000 Foley days

2006 103 1.1  

2007 77 0.87  

2008 89 0.86  

2009 69 0.82 4.25

First Step

Determine specific nursing opportunities to decrease foley related UTI’s

Conducted a one-day prevalence study Primary aims of the study included1. Quantify the level of use of indwelling

urinary catheters2. Determine the level of adherence to

guidelines

5

Methods

2007, 2008 & 2010 all units on each campus surveyed

List obtained identifying all patients with Foley and RN providing direct care

Data collector directly observed the catheterized patients and interviewed RN

Data was collected on a standardized form2011 & 2012 implemented Adaptive Design

methodology

6

Foley Practice Areas Reviewed

Presence of a Foley catheter Catheter secured to the pt’s abdomen or leg Tamper Evident Seal intact (TES) Tubing extended to prevent the development of

dependent loops of drainage tubing Tubing secured to patient bed or chair to prevent

pulling on system Drainage system not touching the floor Urine bag not over filled with urine

7

Percentage (%) of Compliance with Total Foley Practice Areas

8

2007

2008

2010

Per

cen

tag

e %

9

10

11

SBAR

12

Catheter Associated Urinary Tract Infection (CAUTI) Prevention URINE-8

1 Good hand hygiene

2 Inserted by qualified staff Sterile technique when inserting catheter

3 Proper peri care: Daily with bath, fecal incontinence, presence of

discharge or drainage and at bedtime Document peri-care

4 Secure catheter to patient with a Stat Lock Change Stat Lock every 7 days Do not use Stat Lock on edematous patient

5 U/A upon catheter insertion when symptoms present▪ Document symptoms in Care cast

6 Do not break the red seal

7 Unobstructed urine flow No kinks, bends, or dependent loops Keep urine bag off the floor

8 Remove as soon as medically able *SCIP – Remove by the end of post-op day 2

13

Trinity CAUTI Rates

CAUTIs 2006-2011Year

Raw #

Rate /1000 pt days Rate / 1000 Foley days

2006 103 1.1  

2007 77 0.87  

2008 89 0.86  

2009 69 0.82 4.25

2010 18 0.18 0.97

2011 18 0.19 0.9

Trinity SCIP Data 2009 & Today

14

15

Nurse Driven Urinary Catheter Removal Protocol

16

17

18

Lessons Learned

Nurse to Nurse Collaboration is a practiced skill

Physician collaboration is keyPhysician and Nurse communication /

education is paramountAdaptive Design and daily monitoring

drives successful implementation

19

Conclusion:HAI’s represent a direct threat to patient

safety, healthcare quality and they are costly.The Urine-8 project has consistently decreased

the infection rate and identified the positive financial impact directly attributed to evidence-based nursing practice.

The next step of adding the nurse driven catheter removal protocol will continue to decrease unnecessary Foley days and serve as a tool to meet SCIP criteria and avoid CAUTI.

20