Presentation on theme: "Why are we revising our process?"— Presentation transcript:
1Urinary Catheterization: Insertion, Maintenance, Catheter Care, & Removal September 2012
2Why are we revising our process? Joint Commission requirementsNational Patient Safety Goal – 2013Goal 7Reduce the risk of health care-associated infections.Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI).CDC guidelinesCatheter Associated Urinary Tract Infections (CAUTIs)Are the most common healthcare acquired infectionsUTI causes approximately 36% of all hospital infections per year80% of those are catheter relatedIncreases hospital stayIncreases healthcare costIt is highly preventableYou can make a difference by doing a few simple things!!APIC Guide 2008: Guide to Elimination of Catheter-Associated Urinary Tract Infections.Klevens RM, et al Public Health Rep. 2007; 122:160–167
3“Getting to Zero” Committee developed in 2012 to get to “O” CAUTIs CAUTIs recorded at Aultman2010: 1062011: 922012 YTD: 17Our GoalNO CAUTIs from this point forward in 2012Zero “O” CAUTIs in 2013!Mar 2012 – “O”
4Prevention Strategies Eliminate unnecessary insertion of cathetersReview physician orders to ensure a valid Foley catheter insertion order was enteredEducate your patient about CAUTI (use FAQ sheet) prior to insertionCurrently available on Policy Tech - type “SHEA CAUTI”Insert Foley catheter using sterile techniqueSecure the catheter as to prevent urethral trauma, migration of organisms, and kinking/bending of the catheterKeep catheter below the level of bladderPerform catheter care per policyMaintain a closed systemDiscuss daily with physician potential removal of unnecessary cathetersClinical Care Improvement Strategies: JCR Preventing Catheter Associated Urinary Tract Infections 2011
5NEW catheter kits available to assist us to meet 2013 NPSG! Kits Include:Castile soap wipesBetadine swabsPre-connected, sealed cathetertubingSecurement DeviceInsertion labels for patient chart;apply to front of chart, andcatheter tubing (from BARD ®)* Your unit director will communicate with you when the new kits are available on your unit
6Insertion of Catheter: Policy Revisions Steps removedSteps addedTesting urinary catheter balloonAlready performed by manufacturerUse of cotton balls to cleanse urinary meatusProduct changed to swab sticksUse of castile soapUse of betadine swab sticksUse green sheeting clip to secure catheter drainage tube to the sheetApply insertion labels to the front of the chart and to the catheter drainage tube
7Catheter 101 Proper Techniques for Urinary Catheter Insertion Perform hand hygiene immediately before and after insertionRemember: Wash hands after cleansing patient and before donning sterile glovesInsert urinary catheter using aseptic technique and sterile equipmentUse the smallest Foley catheter possible, consistent with good drainage (18 French or larger not recommended for routine use)Document date and time of catheter insertion, individual who inserted catheter, size of catheter , and date and time of catheter removal along with who removed it in the patient record
8Catheter 101 Proper Techniques for Urinary Catheter Maintenance Secure the Foley catheterMaintain a closed drainage system by utilizing pre-connected, sealed catheter-tubing junctionsMaintain unobstructed urine flow and keep the catheter and collection tube free from kinkingKeep the collection bag below the level of the bladder or hips at all timesEmpty the collection bag a minimum of every shift and prn or per physician’s order using a clean collection containerRinse the collection container after each use
9Catheter Care http://medical-dictionary.thefreedictionary.com/Biofilms Revised process for catheter careCastile soap & water onlyProducts must be thoroughly rinsedNo emollients or residue producing productsBath-in-a bagPerineal cleansersCatheter Care is different than Perineal Care:Skin protectants & emollient products OK for perineum, but not at the insertion site of a catheter (urethral area)Skin protectants & emollient products intensify formation of biofilm* & provide a breeding ground for organisms*Biofilm is a very thin layer of microscopic organisms that covers the surface of an object.
10Catheter Care Product Update Why Castile Soap?Safe, very mild & effective cleanserContains no emollientsWhy not just use the bath-in-a-bag or current perineal cleanser?Both contain emollientsShould not be used on the catheter (urethral) area because it can increase biofilm formation
11Product Update Continued… Why a closed drainage system?Using a pre-connected, sealed catheter tubing junction prevents CAUTIsWhy StatLock ® securement device?Minimizes accidental catheter dislodgementsFirmly holds catheter in place at the “Y”Allows complete freedom of movementLatex freeStatLock ® Application and CareUse skin prep before applicationApply with “click it before you stick it” methodInitial and date securement device upon applicationAssess adherement and skin around device dailyMove device every 7 daysRemove with alcoholPre-connected tubing & securement device
12Catheter Care Procedure Cleanse, thoroughly rinse, and gentlypat dry urethral meatus. (Pericarebottle may be used.)Remove gloves and discard.Perform hand hygiene.Resecure the catheter with securementdevice.Position the patient for comfort.Document activity in the medicalrecord, including education providedto patient/familyPerform at least every 24 hours and prn for soiling.Identify patient using two patient identifiers.Perform hand hygiene.Don clean gloves.Place the patient in supine position and expose the perineal area to easily visualize the meatus.Release the catheter from securement device to prevent urethral trauma.Remove gloves and perform handhygiene.
13Catheter Care Procedure Female:Using castile soap and water, cleanse the urethral area using circular motions moving outward with washcloth, thoroughly rinse with water, and then gently pat dry.Using a separate washcloth, cleanse the catheter beginning at the insertion site moving away from the body, using castile soap and water and then rinse and dry with clean towel.
14Catheter Care Procedure Male:CircumcisedCleanse around the meatus using washcloth, castile soap and water. Rinse and then dry the area with a towel.Using a separate washcloth, cleanse the area between the scrotum and rectal area, rinse and dry.Using a separate washcloth, cleanse the catheter beginning at the insertion site moving away from the body, using castile soap and water and then rinse and dry with clean towel.UncircumcisedRetract the foreskin from the catheter.Cleanse around the meatus using a washcloth, castile soap and water. Rinse and dry with clean towel.Replace the foreskin around the catheter.Using a separate washcloth, cleanse the area between the scrotum and rectal area, rinse dry.Using a separate washcloth, cleanse the catheter beginning at the insertion site moving away from the body, using castile soap and water and then rinse and dry with clean towel.
15Removal of Catheter: Policy Revisions RemindersUse of castile soap to cleanse urinary meatus prior to removalTo prevent migration of organismsCleanse urinary meatus prior to catheter removal - rinse, gently pat dry after cleansingDeflate catheter balloon prior to catheter removalDocument catheter removal in medical recordLiquid Castile Soap
16Documentation – Urinary Catheter Document Patient Education task (fires BID)Select “Education Provided” from navigator barClick box for “Infection Prevention”
17Documentation Continued… Document education providedCAUTI/FAQHand HygieneCatheter secure educationAvoid twisting/kinking catheterCollection bag lower than bladder
18ResourcesSmith, S., Duell, D., Martin, B Clinical Nursing Skills: Basic to Advanced Skills. 7th EditionPrentice Hall.Clinical Care Improvement Strategies: Preventing Catheter-Associated Urinary Tract Infections The Joint Commission Resources.Urinary Catheterization of a Male of Female Patient: Insertion, Care of Patient, and Removal of Catheter Aultman Polices and Procedures.BARD ® Foley and Urethral Catheterization tray insert documents.
19Online EducationYou have completed the Learning Module entitled Urinary Catheterization: Insertion, Maintenance, Catheter Care & RemovalPlease go to the quiz section in QUIA and complete the quiz Urinary Catheterization: Insertion, Maintenance, Catheter Care, & RemovalDeadline for completion: October 15, 2012