1. “ Change of Urinary Tract Infection Prevalence at a Skilled Nursing Care (SNF) Facility or Long Term Care Facility (LTCF): Lessons Learned Michael Liu MD, Eric Sasovetz MD, Adriana Linares MD BackgroundRationale for the Project Aims Results Methods 1.In January 2014 the residency program took over the management of a SNF in Vancouver, Washington after changes in leadership at the SNF. 2.It was noticed that the rates of UTI’s were too high when compared to benchmark data related to UTI’s. 3.Strategies and changes in the way we dealt with signs and symptoms of UTI’s were implemented. 4.Protocols were followed 100% of the time by staff and medical providers. 5.The amount of time patients used catheters was minimized. 6.Early intervention was implemented. 7.Team work was emphasized. 8.Improved protocols for management of patients with indwelling catheters were designed. 9.All patients became the responsibility of the medical director and he made prompt decisions regarding management of UTI’s. 10.Straight catheterization was implemented as a guideline for those patients who could tolerate it. The urinary tract is one of the most common sites for infection at Long Term Care facilities (LTCF), accounting for 20- 30% of infections reported by LTCF (1). Catheter-associated UTI’s (CAUTI’s) may lead to complications such as cystitis, pyelonephritis, bacteremia and septic shock. All UTI’s from LTCF’s are reported quarterly to CMS and DSHS in Washington state (2). Our residency program is in charge of a SNF in Vancouver, Washington and we have implemented changes in the management of patients in the SNF to prevent new events of UTI’s and/or CAUTI’s. Since January 2014 we have become involved with the management of the SNF and have made changes in the protocols and guidelines for treatment of all their residents. Lessons learned 1.Time-consuming. 2.Resource consuming. 3.Every day work and team effort. 4.Protocol changes are needed to prevent UTI’s and CAUTI’s. 5.Well defined protocols empowered our staff members (RNs, CNAs) to take action and act promptly to prevent infections. 6.Constant surveillance provided data to target bacterial infections with the appropriate antibiotic in a timely manner. 1.Urinary Tact Infection (UTI) Event for Long-Term Care Facilities. 2.Guideline for Prevention of Catheter- associated Urinary Tract Infections. Healthcare Infection Control Practices Advisory Committee (HICPAC) approved guidelines for the Prevention of catheter associated urinary tract infections, 2009. www.cdc.gov/hicpac/pdf/CAUTI/CAUTI guideline2009final.pdf UTI’s are a great entity to target strategies for its reduction among SNF patients since they are the cause of multiple morbidity and mortality among patients at SNF’s. The price of management of patients with UTI’s is high, and cost and resources can be significantly reduced by prevention and early management of the UTIs. Conclusions To showcase the strategies used at a SNF to decrease the UTI prevalence and its outcomes as evidenced by the results of the reports to the state using data from 2012 to 2014. To discuss different methods to prevent UTI’s among patients living at SNF and the challenges associated with the implementation of these methods. CMS and DSHS are the agencies that evaluate the results of UTI rates in SNF’s and give citation points. The higher the point level, the worse the results. In 2012 the facility received 224 points and at the end of 2014 it received 120 points (46% reduction in two years). During 2014, the average rate of UTI’s in the facility was 4.9% compared to 14.1% in 2012. In 2014, the average rate for CAUTI’s was 3.74% compared to 12% in 2012. Our strategies showed an improvement in the rate of prevalence of UTI’s and CAUTI’s at the SNF during the dates of the data collection. Team work and communication were the main strategies for the change. Management of the catheter related problems with changing the catheter improved the prevalence of infection after the changes. The rates obtained in our SNF reached levels consistent with benchmarks at national levels. We prevented multiple cases of morbidities with early intervention and vigilant treatment of our residents. References