Transcript File

Preventing CatheterAssociated Urinary Tract
Infections in the Hospital
Setting
Desiree Hartzell
Matthew Pierson
Amber Morin
Spencer Brown
Allison Hitpas
Alyssa Escobar
University of South Florida CON
What is the Problem?
“The urinary tract is the most common site of healthcare–
associated infection (HAI), accounting for more than 30% of the
infections reported by acute care hospitals. Of these infections,
80% are attributable to an indwelling urethral catheter” (Rothfeld
& Stickley, 2010).
Typical Progression:
1. Physician knows the patient has an IUC.
2. Physician deems the IUC unnecessary.
3. Physician writes order to remove IUC.
4. Nurse removes IUC.
(Meddings, Rogers, Macy, & Saint, 2010)
Proposed Change
Utilize a stop-order generating assessment tool to reduce
catheter-associated urinary tract infections (CAUTI) by
promoting prompt removal of indwelling urinary catheters
(IUCs) in instances of inappropriate use.
Plan
❖ Implement:
➢ IUC Assessment Tool:
■ Separate form from basic shift assessment
■ Based on appropriate IUC criteria
■ Nurse completes once per shift
■ Filed in the patient’s EMR documents
➢ Stop-Order System:
■ Generates after tool is completed
■ Generates based on appropriate criteria
Plan: Supporting Evidence
○ “The rate of CAUTI (episodes per 1000 catheter-days) was reduced by
52% (P<0.001) with use of a reminder or stop order. The mean duration
of catheterization decreased by 37%” (Meddings, Rogers, Macy, & Saint,
2010).
○ “Even 1 fewer day of catheter use could be clinically important as the risk
of CAUTI increases daily” (Meddings, Rogers, Macy, & Saint, 2010).
○ Another study found that when UCs were used for appropriate
circumstances and removed promptly when no longer necessary “the
incidence of CAUTIs decreased by 57% (P < .05)” (Rothfeld & Stickley,
2010).
Plan: Supporting Evidence
Appropriate Indications
HOUDINI
● Hematuria
● Obstruction
● Urology Surgery
● Decubitus Ulcer with incontinence
● Input/Output Measurement (needs to be a specific
reason)
● Nursing End of Life Care
● Immobility
(Adams, Bucior, Day, & Rimmer, 2012)
● Neurogenic Bladder (Fakih MG, Watson SR, Greene M,
et al., 2012)
● Urinary Retention (Centers for Disease Control and
Prevention [CDC], 2009)
● Perioperative needs (i.e. prolonged procedure, large
volume infusions, intra-operative monitoring) (CDC, 2009)
● Emergent Pelvic Ultrasound (Fakih, et al., 2010)
● Acute Hip Fracture (Fakih, et al., 2010)
Inappropriate Indications
● Confusion
● Incontinence
● Patient Request
(Fakih MG, Watson SR, Greene M, et al., 2012)
● Prolonged Post-Op period
● Obtaining urine culture
(CDC, 2009)
Do: Evaluate and Educate
❖ Consult Nursing Informatics to create the assessment tool and stoporder system in the EMR.
❖ Educate personnel in a 10-minute brief information session on the
indwelling catheter assessment tool and stop-order generation
system to be completed each shift.
Do: Implementation
❖ Assessment tool and stop-order system will be created.
❖ Staff education will take place.
❖ Staff implementation will take place.
❖ CAUTI rates and inappropriate indwelling urinary catheter use will
decrease.
Study
❖ Catheter reminders and stop orders were beneficial regardless of tools used.
These interventions are low-cost strategies to be implemented in any health
care system (Meddings, Rogers, Macy, & Saint, 2010).
Pros
●
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Simple
Efficient/Less time taken by healthcare team
Economical
Reduce Inappropriate IUC use
Prompt removal of unnecessary IUCs
Reduce facility costs related to CAUTI
Earlier discharge
Forms easily accessible
Improves patient outcomes, safety, and satisfaction
Less work for nurses
Cons
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More charting
○ Burden
Possibility of recatheterization if premature stop-order
Nurses or doctors not adapting to change
Act: Generalizability
❖ Alert may generate in EMR when IUC assessment has not been completed.
❖ Personnel may be weary about this stop-order protocol for fear of need for
IUC reinsertion.
➢ Need for additional education on supporting evidence.
Summary
❖ Implementing a nurse-driven stop-order protocol to
discontinue inappropriate indwelling catheters will:
■ Reduce hospital CAUTI rates
■ Reduce the cost of CAUTI
■ Improve patient safety
■ Improve patient satisfaction
■ Decrease length of stay
■ Improve staff satisfaction
References
❖
Adams, D., Bucior, H., Day, G., & Rimmer, J. (2012). HOUDINI: Make that urinary catheter disappear - nurse-led protocol.
Journal of Infection Prevention, 13(2), 44-46.
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Centers for Disease Control and Prevention. (2009). Guideline for Prevention of Catheter-associated Urinary Tract Infections,
2009. Retrieved February 20, 2016, from http://www.cdc.gov/hicpac/cauti/002_cauti_toc.html
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Fakih MG, Watson SR, Greene M, et al. Reducing Inappropriate Urinary Catheter Use: A Statewide Effort. Arch Intern Med.
2012; 172(3):255-260. doi:10.1001/archinternmed.2011.627.
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Fakih, M. G., Pena, M. E., Shemes, S., Rey, J., Berriel-Cass, D., Szpunar, S. M., Savoy-Moore, R. T. and Saravolatz, L. D.
(2010), Effect of Establishing Guidelines on Appropriate Urinary Catheter Placement. Academic Emergency Medicine, 17 (3),
337–340. doi: 10.1111/j.1553-2712.2009.00677.x
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Meddings, J., Rogers, M. A., Macy, M., & Saint, S. (2010). Systematic Review and Meta‐Analysis: Reminder Systems to
Reduce Catheter‐Associated Urinary Tract Infections and Urinary Catheter Use in Hospitalized Patients. Clinical Infectious
Diseases, 51(5), 550-560.
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Rothfeld, A., & Stickley, A. (2010). A program to limit urinary catheter use at an acute care hospital. American Journal of
Infection Control, 38(7), 568-571.