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A team approach to preventing Healthcare Acquired Catheter Associated
Urinary Tract Infections (CAUTI) in an Urban Acute Care Facility
Dilcia Ortega, RN, MSN/MPH, CIC; Chris Charles, RN, MHA, CIC; Gloria M. Watson, RN , PhD
INTRODUCTION/ABSTRACT
CAUTIs account for 26% of HAIs; 93,300 infections annually.
CMS publicly reports hospitals’ quality-of-care data including
CAUTI rates. Through the Affordable Care Act, Congress
authorized Value Based Purchasing (VBP). CMS links
healthcare quality to payment through VBP by rewarding high
performance and penalizing low performance. Hospitals must
reduce rates of CAUTI and other HAIs to avoid financial
penalties. Harlem Hospital Center, a 282 bed urban acute care
facility, had a CAUTI rate of 5.8 per 1000 urinary catheter days.
A risk assessment was done and goals set to reduce CAUTI rate
in Adult ICU by 25% and achieve a Standardize Infection Ratio
(SIR) of < 1, and CAUTI Prevention Bundle compliance ≥ 95%.
National Health Care Safety Network (NHSN) and New York
State Rate is 2.2 /1,000 and 2.3 /1,000 urinary catheter days
respectively.
A multidisciplinary team addressed the issue by educating
clinicians on the CAUTI Prevention bundle, conducting daily
compliance audits and providing real time feedback, and
reporting the number of patients with urinary catheters in
daily nursing reports. Also, we reviewed cases meeting
CDC/NHSN definition for CAUTI monthly and provided
feedback to Units and leadership.
A rate of 1.9 per 1000 urinary catheter days, SIR of 0.98, and
96% bundle compliance was achieved in six months. This
resulted in a 68% reduction, significantly exceeding our 25%
goal and the NHSN benchmark.
Evidence-based interventions are effective in preventing
healthcare related infections, promoting high quality patient
care, and reducing healthcare costs. CAUTI Prevention
interventions reduced our CAUTI rates from 5.8 to 1.9.
OBJECTIVES
• Discuss CMS Value Based Purchasing and
its impact on CAUTI Prevention.
• List three of the five components of the
CAUTI prevention bundle.
• Define Standardized Infection Ratio (SIR)
and Cumulative Attributable Difference
(CAD)
METHODS
CONCLUSION
We implemented several steps (see below) to achieve our goals of reducing CAUTI rate in Adult ICU by 25% , achieving a SIR
of < 1, and increasing CAUTI Prevention Bundle compliance ≥ 95%. We used two statistical measures in evaluating our
progress the SIR and CAD. SIR is used to compare different patient populations (e.g. ICU vs Non-ICU patients). CAD is a
measure of the number of infections that occurred compared to the number of infections that were predicted.
• Physicians are required to write insertion and maintenance orders
• Urinary catheters are inserted for clinically indicated reasons only
• Hand hygiene must be performed before and after catheter
insertion or manipulation
• Collection bag are emptied regularly using a separate, clean
container for each patient.
• Nonessential catheters are removed promptly
• MDs must renew maintenance orders every 48 hours
• Catheters are inserted using aseptic technique and sterile equipment • There is ongoing education/reeducation of clinicians
regarding CAUTI Prevention bundle
• IC-BARD Foley Kits are used for urinary catheter insertion
• Nursing implemented CAUTI Prevention Bundle compliance
• Catheters are properly secured after insertion to prevent movement
audits
• Following aseptic insertion, a closed drainage system is maintain
• Infection Prevention reviews each case meeting CDC/NHSN
definition of hospital acquired CAUTI with the team
• Staff ensure that an unobstructed urine flow is maintained
• Catheters and collecting tubes are kept free from kinking
• Collection bags are kept below the level of the bladder at all times
• Clinicians are provided timely feedback regarding infection
rates
• Reports are presented monthly to our Critical Care and
Infection Control Committees and Quarterly Hospital Wide
Performance Improvement Committee.
RESULTS
Figure 1: Unit Level CAUTI SIR/CAD (July 2014 – June 2015)
Figure 2: Facility Wide CAUTI SIR (July 2014 – June 2015)
Evidence based interventions are effective in preventing
healthcare related infections, promoting high quality patient
care, reducing hospital costs, and increasing market share.
Hospital acquired infections contribute to extended length of
stays, additional costs, unhappy patients, and lower staff
morale.
A rate of 1.9 per 1000 urinary catheter days, SIR of 0.98, and
96% bundle compliance was achieved within six months.
Further, the CAUTI Prevention interventions in the ICU
contributed to reducing our CAUTI rate 0.0 per 1000 device
days by 2nd quarter 2015.
In summary, best practice and teamwork helped to
significantly reduce the CAUTI rate in our ICUs. Key steps in
this process included the building of consensus from frontline staff, the heightening of awareness to a huge problem,
and the inclusion of interdisciplinary staff from across the
hospital.
REFERENCES
Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline
for prevention of catheter-associated urinary tract infections 2009.
Infect Control Hosp Epidemiol. 2010;31:319-26.
Jarvis WR. (2011) Healthcare Associated Infection Prevention
Bundles: Preventing the Preventable. www.jasonandjarvis.com ;
www.webbertraining.com
Figure 3: Hospital Wide CAUTI Prevention Bundle Compliance Rates (Jan. 2014 – June 2015)
Scott Rd. The Direct Medical Costs of Healthcare-Associated
Infections in U.S. Hospitals and the Benefits of Prevention, 2009.
Division of Healthcare Quality Promotion, National Center for
Preparedness, Detection, and Control of Infectious Diseases,
Coordinating Center for Infectious Diseases, Centers for Disease
Control and Prevention, February 2009.
Atlantic Quality Innovation Network Improving Healthcare for the
Common Good®(IPRO). August 2015
Figure 4: Urinary Catheter Device Utilization Ratio (July 2014 – June 2015
Figure 5: CAUTI SIR for CMS/IPPS (Jan. 2014 – June 2015)
National Healthcare Safety Network (NHSN). September 2015
CONTACT INFO
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