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1、Catheter Associated Urinary Tract Infections(Bladder Bundle),Botsford Hospital ExperienceFebruary 28,2008,Getting Started Project Preparation,Select the Pilot UnitPoint prevalence survey of all patients in hospital for use of urinary catheterThis survey was done at the same time as the annual pressu
2、re ulcer surveyCritical Care,Maternal-Child Health,Emergency Department were excluded from the catheter survey Pilot units selected based on number of foley catheters.5 South(pulmonary:34 beds)&PCU(cardiac step down:65 beds)Decision to begin with 5 South,Getting Started,Team Selected for Pilot on 5S
3、Included Nurse Manager,RN representation,Nurse assistant representation,physician champion,project facilitator,infection control nurse and RN from PCU(next unit for pilot)Ground Work Lots of Preparation prior to the PilotAll team members given articles,information about the projectSeveral meetings h
4、eld to work out details of project.Review of Management Strategies for Incontinent PatientsA major concern was how to manage patients who might be incontinent if foley catheter removed.Resulted in a trial of underpads with an improved product chosen prior to the project,Getting Started cond,Develop
5、process to notify physician of non-indicated cathetersPhysicians would give final order to discontinue foleyDeveloped a peach colored order sheet and process to notify physicians Wanted to avoid multiple calls etc.to docs.Notification of StakeholdersPhysicians Project approved by Medical Executive C
6、ommitteePresented to House staff and Internal Medicine GroupDevelopment of ToolsTri-fold Brochure developed to hand out to physicians and other interested parties which described project.Power Point presentation developed for nursing staffPosters on unit reminding staff of project,Physician Order Sh
7、eet,This is a peach colored order form.Note:though a legal part of the chart this form may be modified depending on user input.Explains why Catheter is non-indicatedPhysician then signs order to remove catheter.,Educational Brochure,This is a tri-fold two sided handoutDesigned for physicians,nurses
8、and any other involved staffExplains purpose of trial,indications etc.,Results of the Pilot Project,Success:There was a decrease in non-indicated foley catheters from 40%to 24%at the end of the pilot period.Nurses became involved,in fact desired more autonomyMany physicians are supportive.,Challenge
9、s/Concerns,Getting all physicians on board.Order sheet at times ignored and nurses must then contact physician.Nurses would like to be able to develop a protocol to remove non-indicated foleys.Would alleviate some of the difficulty with obtaining a physician order.Emergency Department.Most patients
10、admitted through the ED get a foley automatically.Plan to address this issue in the future.Difficulty coding data.If two reasons for the foley catheter are present must choose only one.Some disagreement for non-indications.,Next Steps,Pilot begun on PCU Feb 18.(65 bed step down cardiology unit)Proce
11、ss of implementation adapted to needs of unit.Although criteria and tools remain the same,must adapt implementation to particular needs of the nursing units.Most training done at staff meetings.TKs(nurse assistants specially trained for PCU)identify all patients with foley catheters during their ear
12、ly morning rounds along with vital signs and mark status on data collection sheet.Data collection sheet is then posted at the nurses station.RN assigned to patient is to determine need for urinary catheter.RN will notify physician of non-indicated foley catheters by placing orange order sheet on the
13、 chart.Facilitator(RN assigned as charge nurse)will check that sheets are completed at the end of the shift.,Summary:KEYS TO SUCCESS,The investment of time and planning for the initial pilot is well worth it.Involvement of unit staff at all levels is crucial.,Inservice/Training for Unit Staff,The fo
14、llowing 17 slides are those used when training nursing staff member on the pilot unit.These were short inservices done on the unit.They were available in PowerPoint format on the unit computers.Nurses from the pilot planning team reviewed these slides with nursing staff,usually 2 or 3 nurses/nursing
15、 assistants at a time.,CAUTICatheter Associated Urinary Tract Infections,Nursing Interventions to Remove Non-Necessary Urinary CathetersKeystone HAI:Hospital-Associated Infections Training 1,What Is Keystone HAI(Hospital-Associated Infections),Project of the Michigan Health&Hospital Association Keys
16、tone Center for Patient Safety&QualityProject created to improve patient safety and the quality of health care delivery through the application of science and implementation of best-practice evidence to save lives and reduce costsGOAL:Eliminate hospital-associated infections in the hospital setting.
17、Botsford interventions include:Hand Hygiene,Blood Stream Infection,Ventilator Associated Pneumonia,Urinary Tract Infection,Discontinuation of Non-essential Catheters,Comprehensive Unit Safety Program.,Training 2,Why Target CAUTI(Catheter-Associated Urinary Tract Infections),Urinary tract most common
18、 site of nosocomial infections;most are associated with urinary catheterization15-25%of inpatients are catheterizedUTI:about 40%of Hospital-Associated Infections80%of Hospital Associated UTIs caused by a urinary catheterCost of a CAUTI-$500 1000,$2,800 if bacteremiaMost CAUTIs asymptomatic bacteriur
19、ia,1-5%lead to secondary bacteremia5%of all deaths from Hospital-Associated Infections are Urinary catheter associated.Proper management and use of catheters could prevent infectionsStudy in Lansing,MI:Less than half of urinary catheters in teaching hospital were indicated.Catheters uncomfortable,li
20、mit mobilityTraining 3,Why Target CAUTI?,Uncle Sam wants you to prevent UTIsCenters for Medicare&Medicaid(CMS)As of Oct.2008 CMS will no longer reimburse hospitals for eight“reasonably preventable”conditions.Included are CAUTI and Hospital acquired pressure ulcers.Reimbursement to the hospital for c
21、are of these patients will be decreased.Catheter-associated UTIs are included because they are felt to be reasonably preventable by following well-established prevention guidelines.Other targeted conditions include injuries from falls,vascular-catheter-associated infections,mediastinitis,objects lef
22、t in the body during surgery,air embolisms,and blood incompatibility.Training 4,Who Let the Bugs In!,Three sites of bacterial invasion.Along the walls of the catheter.Bacteria ascend up the external surface of catheter At the junction between the catheter and the drainage bag:Opening a closed draina
23、ge system lets the bugs in.At the drainage outlet.When emptying the foley bag,good technique must be observed.Risk of bacteriuria increases with days of catheterization5%per day that catheter is in place,Training 5,Prevention of CAUTI,Make sure the catheter is indicatedRemove the catheter as soon as
24、 possibleConsider alternatives to indwelling catheters.,Training 6,Prevention:Catheter Care,Insert catheter using aseptic technique&sterile equipmentUse a sterile,continuously closed,drainage systemImportant:Secure catheter to the leg(may use abdomen in men)Use catheter port to obtain samples if nee
25、dedAvoid irrigation,aseptic technique if neededKeep collection bag below bladder level at all times,Cath Secure,Training 7,Make Sure Catheter is Indicated Keystone:Reasons/Indications forUrinary Catheters,Urinary Tract ObstructionNeurogenic BladderUrologic Study/Urologic SurgeryStage 3 or 4 Pressure
26、 UlcerHospice,Comfort Care,Palliative Care,Training 8,Keystone:Non-Indications for Use,NephrologyTransferred from ICUPatient requests a foleyConfusedIncontinenceOther,Training 9,Bladder Bundle ProjectKeystone Interventions to Prevent Catheter Associated Urinary Tract Infections.,Training 10,5 South
27、Pilot Project,Why 5 South?Baseline Point Prevalence Survey of patients with foley catheters was done in Feb,2007.High use units were 5S and PCU5S chosen to startWhat does the project include?Eight week pilot projectThree phases:Pre-Intervention,Intervention&Post-InterventionAll staff on 5 South will
28、 be involved,Training 11,Week One:Oct 7-13 Pre-intervention Phase Lets Get Started!,Baseline AssessmentFrequency of positive urine culturesSurvey of patients with foley catheters 5 days to determine indications for usage.,Training 12,Weeks 2&3:Oct.14-27Intervention Phase,Bladder Bundle Team begins!N
29、urses,NAs,Physician,Training on prevention to 5 South staffTraining on alternatives to catheterizationPhysicians given brochureDaily rounds“catheter patrol”Assess reason for use,indicated vs.non-indicatedRN initiates process to discontinue non-indicated catheters.Nursing staff crucial to success of
30、program.RN&NA develop a plan to manage incontinence as needed for patients who have their catheter DCd(not all patients will be incontinent)Collect data M F,Training 13,Interventions cond,Midnight nurse will evaluate all patients with foley cathetersNurse will use Keystone criteria to determine if c
31、atheter appropriate.If catheter is not appropriate(using Keystone criteria)the nurse will place an order sheet(salmon or orange colored)with the physicians orders.This sheet explains Keystone criteria and reasons why the catheter is not indicated.Physician may choose to leave the catheter in place.I
32、f the order sheet is not signed within 24 hours,the midnight shift nurse will notify the day shift nurse to obtain an order from the physician.,Training 14,Weeks 4-7:Post-Intervention Phase Oct 28 Nov 24,Staff will continue to implement nurse initiated discontinuation of urinary catheters.Nurse will
33、 identify patients who meet the not indicated catheter listNurse will get order from physician to D/C non-indicated foley cathetersNurse will develop plan to manage incontinence as needed.,Training 15,Week 8:Post-Intervention Nov 25 Dec 1Phase Data Collection,Continue to implement projectCollect dat
34、a to assess effect of interventionsCompare results over the project phasesRepeat uropathogen distribution,Training 16,Team Members,5 South StaffPat Quinn-Buchta,Manager 5 SouthDr.Amy Opperer,UrologyMehrnoosh Nelson,RN,5SDoris Micallef,RN,5SErica Hester,NA,5SJanet Antonio,RN,PCUDiane Lenk,CNSJane Moody,RN,Infection Control,Training 17,QUESTIONS?,Contact:Diane Lenk,MSN,RN,CS,CWOCNBotsford CAUTI Project Facilitator 248-471-8877 dlenkbotsford.orgJanet Moody,RN,BSN,Infection Control CoordinatorBotsford Keystone HAI Project Co-Director 248-471-8315 jmoodybotsford.org,
