A team approach to preventing Healthcare Acquired Catheter

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A team approach to preventing Healthcare Acquired Catheter Associated Urinary Tract Infections (CAUTI) in

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 , Ph. D 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 audits • Catheters are properly secured after insertion to prevent movement • Following aseptic insertion, a closed drainage system is maintain • Staff ensure that an unobstructed urine flow is maintained • Infection Prevention reviews each case meeting CDC/NHSN definition of hospital acquired CAUTI with the team • Clinicians are provided timely feedback regarding infection rates • Catheters and collecting tubes are kept free from kinking • Collection bags are kept below the level of the bladder at all times • 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 2 nd 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 Dilci. [email protected] org Chris. [email protected] org Gloria. [email protected] org