Short Term Urinary Catheter Documentation Care Bundle

1. INFECTION PREVENTION & CONTROL AND CONTINENCE SERVICES JULIE FLOWER Short Term Urinary Catheter Documentation & Care Bundle

2. Incidence of CAUTI The formation of a Working Group Assessment of Current Practice Evaluating Current Evidence Based Care Compiling a Short Term Urinary Catheter Care Bundle Implementation Recommendations for Future Practice

3. Incidence of CAUTI ‘Healthcare Associated Infections (HAI) continue to cause substantial patient morbidity and cost to the health service’ ‘7.4% of adult patients in acute hospital settings have a HAI’ ‘Catheter Associated Urinary Tract Infections (CAUTI) are the second largest group accounting for 16% of all HAI’ (WAG, 2004, Healthcare associated Infections – A strategy for hospitals in Wales) (DOH, 2006, National Prevalence Survey)

4. Incidence of CAUTI 3 - 6% risk / day of developing a UTI 50% of patients catheterised longer than 7-10 days contract bacteriuria 20 -30% of patients with catheter associated bacteriuria will develop symptoms (CAUTI), 1- 4% develop bacteraemia, 13 – 30 of these die Cost & loss of bed days (EPIC 2 Guidelines, 2004)

5. The Formation of a Working Group Consultant Urologist Consultant Microbiologist Infection Prevention & Control Continence Advisor Community Continence Advisor Surgical Nurse Practioner Urology Nurse Specialist Sister, Coronary Care Unit

6. Assessment of Current Practice – Clinical Audit 100% of devices were stored in appropriate areas Evidence that 32% of a patient’s clinical need for continuing catheterisation was reviewed and documented 100% of systems used were closed and sterile 83% of catheters were inserted using a single use anaesthetic lubricant 85% of catheter bags were positioned correctly 68% of circuits were not broken except for good clinical reason 58% of night bags were single use 53% of CSU’s were taken only when clinically indicated (Clinical audit of 55 patients in acute settings – ICNA audit tool)

7. Assessment of Current Practice – Snap Shot Audit 14 /55 (25%) of catheterised patients did not require a catheter. Reasons for catheterisation included: Reduced mobility (43%) Don’t know (14%) Acute retention post 48hours (14%) Urinary Tract Infection (14%) Frequency of micturition (7%) 1 week post surgery (7%)

8. Evidence Based Care

9. Short Term Urinary Catheter Care Bundle User friendly Patient documentation Care pathway Recommend practice Recommend selection of catheter product and size Record of CSU’s sent Record of patient education given

13. Implementation Care Bundle piloted in acute areas, using PDSA cycle adjusted accordingly and introduced Weekly then monthly compliance audits Developed Short Term Urinary Catheter policy to support Care Bundle Liaised with procurement regarding issuing of catheters, developing central storage area for silicone and large gauge catheters at POW site Staff Training & Education Saving 1000 Lives campaign – Gained Clinical Governance support

14. Recommendations for future Practice Continue to roll out Implementation & audit of care bundle until Trust wide Develop the policy & documentation for long term catheters