LINDA HUDDLESTON, RN, MSN, CIC Director of Infection Prevention and Employee Health

1. LINDA HUDDLESTON, RN, MSN, CIC Director of Infection Prevention and Employee Health LINDA HUDDLESTON, RN, MSN, CIC Director of Infection Prevention and Employee Health

2.  List the best practices  Identify obstacles and indwelling catheter utilization  Describe methodology to engage  Describe interventions and indwelling catheter utilization best practices to prevent CAUTI obstacles in decreasing both CAUTI engage staff interventions that decrease CAUTI

4.  Located in Northwest GA  304 bed facility  ICU with 16 beds  CCU with 8 beds  Medical residency program  Hospitalists

6. Nora McCrary

7.  The urinary tract is the most common site of Hospital Acquired Infections (HAIs)  Accounts for more than 30% of infections reported by acute care hospitals  More than 13,000 deaths each year (35/day)  Complications associated with CAUTI ◦ Discomfort ◦ Prolonged hospital stays ◦ Increased cost and mortality

8.  Develop and implement a policy with best practices  Ensure that trained  Use hand hygiene  Perform routine hygiene  Evaluate necessity of catheter every 24 hours  Use a closed drainage system  Use smallest gauge catheter if possible  Replace system if a break in asepsis occurs  Evaluate alternate methods  Avoid irrigation  Use barrier precautions for insertion  Do not  Obtain urine samples aseptically trained personnel insert catheter not change catheter routinely SHEA Compendium of Strategies to Prevent HAIs, 2008

10.  HABIT – always insert Foley in ECC  ICU – Have to have one  Lack of knowledge that an indwelling urinary catheter is harmful  “Alert Fatigue”  Trained staff?  Convenience  Myth-change catheter every 30 days

11.  Lean Six methodology  Rapid Cycle test failures ◦ Small every night – made no difference ◦ Big notes – one doctor found annoying, most paid it no attention and it was found to make no difference ◦ Yellow for the nurse to assess – made no difference ◦ “ASSUMED” that Central had ordered all of the sizes and types. Found out that they had only ordered the regular and were only keeping two different sizes in the Omnicell Small green green sticker placed on doctor’s progress note Big Yellow Yellow sheet of paper in front of doctor’s progress Yellow sheet (smaller smaller) placed on the front of the chart

12.  Male external catheters – Pop On and Regular in four different sizes  Folks – SIZE MATTERS!!!  Had one box of 30 of each size and type sent to my office and then distributed by ICU management staff  D/C before transferring out of ICU  Alert to doctor in EMR every 48 hours SIZE MATTERS!!!

14.  Add to team – Frontline staff – Laura Laurich, Glenn Smith, Norah McCrary, Robin Cater, Jeff O’Kelly  Bulletin Boards- Norah McCrary  Rounding  Ensure that supplies are stocked  Knowledge  Get other units involved – ECC ICU  Competency training annually

15. CAUTI RATE CAUTI RATE 1.6 1.4 1.2 1 2010 ICU 2011 ICU 0.8 2012 ICU 0.6 2010 CCU 2011 CCU 0.4 2012 CCU 0.2 0 ICU ICU ICU CCU CCU CCU 2010 2011 2012 2010 2011 2012

17. Utilization Ratio Utilization Ratio 0.9 0.8 0.7 0.6 0.5 Utilization Ratio 0.4 0.3 0.2 0.1 0 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4 2013 Q1