1. Lori Steele American Sentinel University August 20, 2013

2.  Increase and maintain positive patient outcomes through the initiation of CAUTI prevention program  Identify actions and eliminate barriers in relation to successful CAUTI project initiation  Establish educational tactics and approaches  Initiate evidence-based practice

3. “ “ Bladder Bundle Project” Preventing Catheter Associated Urinary Tract Infections

4. Rationale CAUTIs are the most common type of HAIs 30 million foley catheters inserted annually equals nearly 1 million CAUTIs Less than 50% of catheters are placed with proper indications and rationale (Association for Professionals in Infection Control and Epidemiology, 2008) Proposal of LTC HAI Action Plan targeting and measuring UTIs and mandatory reporting to HHS (Hanchett, 2012) Centers for Medicare and Medicaid Services (CMS) is denying payment to hospitals for CAUTIs and other HAI. LTC denials in all probability soon to follow (Newman, 2010) UTIs cause nearly 13,000 deaths annually; costing between $340 million and $450 million (Virginia Department of Health, 2013)

5. Residents with long-term indwelling foley catheters exceeds the Illinois state average High number of CAUTIs-58% of UTIs diagnosed in residents with long-term indwelling foley catheters in last year

6. UTI PREVENTION IS OUR GOAL Contemplate the Alternatives Intermittent Straight Caths Condom Catheters Remove that Catheter ASAP! CAUTIs can be deadly No such thing as a simple UTI 30 days post cath insertion equals bacterial colonization in bladder

7. Strategies  Supply staff with persuasive evidence-based practice  Convey expectations and expect accountability  Offer straightforward organizational and supervisory support  Utilize several venues to increase knowledge and understanding  Observe staff on rounds and provide immediate feedback  Support and praise involvement and success  Adapt and modify program as necessary for this facility  Present performance data monthly and post in facility  Implementation of the Bladder Bundle

8. Bundle (ABCDE) Checklist for Prevention of CAUTIs A dherence to general infection control principles  Hand hygiene – critical factor in preventing nosocomial infections  Aseptic catheter insertion  Proper catheter maintenance, education, and care by nursing staff  Scrutiny of indwelling catheter use and response B ladder ultrasound utilization protocol to prevent avoidable catheterizations C atheter alternatives  Periodic straight catheterization for urinary retention  External condom catheter for male patients with urinary incontinence  Absorbent products for individuals with urinary incontinence  Incontinence programs initiated with therapy department D o not use foley catheter unless medically appropriate; know appropriate indications E arly removal of the catheter using a reminder or nurse-initiated (i.e., automatic “stop orders”) (Uro Today, 2013)

9. Measuring Outcomes  CDC’s National Healthcare Safety Network (NHSN) evidenced-based outcome measurement tool designed for long term care facilities (Centers for Disease Control and Prevention, 2010)  Ensure that the facility will accurately measure the outcomes of the facility related to the number of CAUTIs per 1000 catheter days to assess the success of the interventions initiated (Gould, 2010)

10. Measuring Outcomes Tool

11. (Department of Health and Human Services, 2013)

12. Measuring Outcomes Con’t  An unrealistic goal would be to prevent 100% of CAUTIs (Saint, 2011)  The NHSN and HHS have established a five year prevention target of decreasing the number of CAUTIs by 25% (Gould, 2010)  The main objective of the Freeport Rehabilitation Center’s CAUTI Prevention program is to decrease the number of CAUTIs by 50% each quarter

13. Another QI Form!? Good for a laugh, however, we want our QI to portray our growth opportunities accurately.

14. Questions?

15. Thank you for taking time out of your busy schedule to discuss this very crucial subject

16. Association for Professionals in Infection Control and Epidemiology. (2008). Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs). Retrieved from http://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdf Centers for Disease Control and Prevention. (2010). NHSN Urinary Tract Infection (UTI) for LTCF. Retrieved from http://www.cdc.gov/nhsn/PDFs/LTC/forms/57.140_UTI_LTCF_BLANK.pdf http://www.cdc.gov/nhsn/PDFs/LTC/forms/57.140_UTI_LTCF_BLANK.pdf Centers for Medicare and Medicaid Services. (2013). Nursing Home Compare 5-Star Quality Rating System: Year Three Report. Retrieved from www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/FSQRS-Report.pdf www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/FSQRS-Report.pdf Department of Health and Human Services. (2013). Implementation Guide for Catheter-Associated Urinary Tract Infection. Retrieved from http://www.health.mil/Libraries/PSPDocuments/CAUTI_Guide_Final.pdf http://www.health.mil/Libraries/PSPDocuments/CAUTI_Guide_Final.pdf Gould, C. (2010). Catheter-Associated Urinary Tract Infection (CAUTI) Toolkit. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

17. Hanchett, M. (2012). Preventing CAUTI: A Patient-Centered Approach. Retrieved from http://www.apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdf http://www.apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdf Newman, D. (2010). Prevention and Management of Catheter-Associated UTIs. Retrieved from http://www.idse.net/download/UTI_IDSE10_WM.pdf http://www.idse.net/download/UTI_IDSE10_WM.pdf Nursetoon.com (2013). Quality Improvement. Retrieved from http://www.nurstoon.com/quality-improvement/http://www.nurstoon.com/quality-improvement/ Saint, S. (2011). Implementing Change: The Technical & Socio-Adaptive Aspects of Preventing CAUTI. Retrieved from https://s3.amazonaws.com/Learning_Sessions/LS+1+Cohort+4/LS1_Implementing+Change_Saint.pdf https://s3.amazonaws.com/Learning_Sessions/LS+1+Cohort+4/LS1_Implementing+Change_Saint.pdf Uro Today. (2013). Preventing Catheter Associated Urinary Tract Infections. Retrieved from http://www.cautichallenge.com/index.php?option=com_content&view=article&id=3&Itemid=11 http://www.cautichallenge.com/index.php?option=com_content&view=article&id=3&Itemid=11 Virginia Department of Health. (2013). Urinary Tract Infections and Catheter-Associated Urinary Tract Infections. Retrieved from http://www.vdh.virginia.gov/epidemiology/surveillance/hai/uti.htm http://www.vdh.virginia.gov/epidemiology/surveillance/hai/uti.htm