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Preventing CAUTI: Back to basics or New Approach

Preventing CAUTI: Back to basics or New Approach. Deborah R. Campbell, RN-BC, CCRN, MSN Pediatric Cardiovascular CNS Kentucky Hospital Association Children’s Hospital Association QTN faculty. Financial Disclosures. Clinical Consultant for Carefusion

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Preventing CAUTI: Back to basics or New Approach

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  1. Preventing CAUTI: Back to basics or New Approach Deborah R. Campbell, RN-BC, CCRN, MSN Pediatric Cardiovascular CNS Kentucky Hospital Association Children’s Hospital Association QTN faculty

  2. Financial Disclosures • Clinical Consultant for Carefusion • Work to be presented was completed without commercial support

  3. Objectives • Review evidence based interventions to prevent CAUTI • Discuss bundle concept as relates to CAUTI prevention • Discuss CAUTI prevention as a team sport • Discuss ‘safety culture’ aspects of CAUTI prevention

  4. EBP for CAUTI Prevention • Sterile insertion technique (Consider a kit) • Smallest, softest catheter that will do the job • Ensure adequate hydration • Hand hygiene • Perineal care • BID with soap and water, PRN BM (Products) • Keep bag below the level of bladder • Prevent bag, tubing from touching floor • Avoid dependent loops, kinks • No disruption of closed system

  5. More tools for the toolbox • Obtain specimens using aseptic technique • Only if absolutely necessary • Remove and replace for C&S • Empty the bag when1/2-2/3 full (Q4hrs?) • Each patient should have own graduated cylinder • Daily observation for signs, sx of UTI • Isolation of diagnosed CAUTI pt from anyone with a catheter • Utilize a securement device

  6. And even more….. • Bladder scanning- non-invasive, easy, quick • Intermittent catheterization v. in-dwelling caths- better for patient, more work for staff • Ditch the bath basins • CHG baths- microbe burden • Appropriate nurse staffing • Antibiotic or silver-coated catheters • Hydrogel catheters- discourage biofilm adherence • Catheter valves- store urine in bladder v. bag • More physiologic as well, decreases need to re-train

  7. The Bundled Care Approach • Is there a “magic bullet? • Are there certain, specific items • 1+1=3 Synergy? • Pathogen dose v. immune response • Bundles act as checklists • Bundles act as curriculum • Recipe v. culture

  8. Changing Practice • Policy change is not = to practice change • QI 101- Educate, Implement, Audit, Improve, SUSTAIN • All at once or step-wise? • How do I choose from the menu? • Problems known to exist at your place • Acceptable to your front line staff • Ways to measure already in place (LAST) • RCAs on CAUTIs that occur

  9. Auditing: How often? How long? • Is there a best way? • Direct Observation • Peers • Supervisors, educators, CNSs • Self-audits • Secret Shoppers • Sampling • Include weekends, nights • Attempt randomness by setting specific days, times • Met your goals consistently, decrease frequency-BUT never less than quarterly.

  10. Successful Strategies • Make the right action the default • Opt-outs v. necessity to overtly choose • Nurse driven protocols • Standardization • Redundant processes • From the IHI- Everyone chooses (or is assigned) a focus area for which they provide input • 5 audits per day per person (on HAPU, CLABSI, CAUTI, SSI or VAP)

  11. Maintenance Takes a Village • Care team members other than primary RN • Nurses helping out (regular, floated, agency) • PCAs • X-ray technicians • Respiratory therapists • Transporters • Family members • Patients themselves

  12. Team Members Outside Our Walls • Decrease the number of insertions/transfers with catheters • ED • OR • Success is possible! • Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Presented by RM Gokula, MD, MA Smith, MD, and J Hickner, MD, Lansing, Michigan

  13. Culture of Safety-Context Matters • Can’t define it, but we know it when we see it • Non-heirarchical • Healthy team dynamics • First names • Safe to question, interrupt (Scripting!) • Patient-Centered • No blame-it’s all about the process • Personal accountability (1 patient, 1 action at a time) • Link participation to annual evaluations

  14. Culture of Safety-Context Matters • Build concept that patient well-being is everyone’s responsibility • Individual • Team • No carve-outs • Rules apply to everyone, regardless of discipline • Think pro-actively- “what could harm this patient today?” • Effective for more than one outcome • Infections • Unplanned device removals • Med Errors

  15. Emotional Appeals • Videos, e.g. Josie King • Think of patient in front of you being your mother, grandfather, child • VA campaign • “Have you ever killed someone with your bare hands?”

  16. Questions?

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