Presentation on theme: "UTI prevention: Implementing Best Practice"— Presentation transcript:
1 UTI prevention: Implementing Best Practice Theresa Murray RN, MSN, CCRN, CCNS Critical Care Clinical Nurse Specialist President, Critical Concepts, INC.
2 Catheter Related Urinary Tract Infections 700, ,000 UTI’s occur each year and make up 36%-40% of all hospital acquired infections4% of those patients with a UTI will develop a blood infection, which increases risk of deathIncreases length of stay by 1-4 daysAdds approximately $676 to the cost of hospitalization. If blood infection develops the cost increases to $2,836Estimated to cause 1 death per 1000 episodes of catheterization and contribute to over 6,500 deaths per year in the United States
3 How Infections HappenIntroduction of bacteria into the bladder at the time of catheter insertionBacteria can travel from the peri-anal area into the bladder along the outer surface of the catheterBacteria can travel into the bladder from the drainage bag along the inner surface of the catheter
4 Compliance With 2005 JCAHO Hospital National Patient Safety Goal Reduce the risk of health care associated infectionsComply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelinesManage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care associated infection
5 Sentinel Event (JCAHO Criteria) An event that has resulted in an unanticipated death or major permanent loss of function, not related to the natural course of the patient’s illness or underlying condition
6 Sentinel Event Identified by an unnamed facility The sentinel event was investigated using “Root Cause Analysis”Root Cause AnalysisFocuses on the process and system, not individualsLooks for common and special causes by digging deeper by continuing to ask “Why”Identify changes to the process and system that reduce the risk of the event happening in the future.
7 Actual Root Cause Analysis A patient was admitted for a surgical procedure, requiring a catheter for the duration of the surgery and the immediate post op period The patient suffered a stroke post operatively and the catheter remained in place the duration of the hospital stay. The patient was transferred to an ECF after the hospital stay with the catheter still in place and returned to a related hospital with urosepsis in less than 1 hour after discharge. The patient died two days later as a result of septic shock
8 Root Cause Analysis Results Documentation related to foley catheters was often not complete or non existent.Policy for Insertion of Foley Catheters was not being followed.Identified inappropriate use of foley catheters for nursing convenienceAbsence of guidelines for insertion and removal of foley catheters throughout the facility
9 Actions/Policy Changes Developed insertion and removal guidelines for foley catheters.Policy was appropriate but not being followed. The only change is the requirement to document why the catheter is still needed based on the insertion guidelines every 8 hours.Developed a new tab “Urinary Catheter Tab” in CIS to improve foley catheter documentation in computerized areasAreas without computerized documentation will continue to use the appropriate form for that unit
10 Insertion GuidelinesAny patient requiring strict I and O and who is unable to cooperate with bathroom, bed pan, or urinal. (Assess daily for continued need for strict I and O)Any patient with an inability to void when intermittent catheterization is difficultAny patient requiring monitoring of acute renal insufficiency or failure unless anuricAny patient who is chemically paralyzedAny patient who is post prolonged cardiac procedure with femoral arterial sheathAny patient undergoing a urological procedureUnable to avoid contamination of incision and or femoral central lineRemove catheter as soon as possible when the above issues are resolved
11 The Best Way to Prevent Foley Catheter Related Infections Use catheters ONLY when necessary and by removing them when no longer needed.
12 Methods For Reducing and Preventing Catheter Related UTI’s HandwashingSterile technique during insertion and handling of the catheterAdequate training/competency of all staffWhat staff interact with foley cath?? P T, nursing, medicine, the patient. Transporters etcRoutinely use 14 fr to reduce traumaKeep the drainage bag below the level of the bladder at all times (including when moving the patient from the bed to cart).
13 Do not put the bag on the bed or on top of patient’s legs or belly. Antimicrobial cathetersBright sticker on the foley drainage bag that says do not……Work with ED, cath lab, OR if foley placed and the patient is expected to have a stay in the ICU-Urometer… closed system
14 Methods for Reducing and Preventing Catheter Related UTI’s Maintain a closed systemObtain specimens from port asepticallyKeep tubing kink freeSecure catheter to patients legCleanse perineal area dailyAssess daily for continued needRemove as soon as need resolvedMD order? Create protocolUse smallest catheter, if patient has leakage go to smaller cath…. Meatus will close down on it.
15 Documentation Requirements InsertionPerformance of procedureReason for catheterization based on insertion guidelinesSize of catheter and balloonAmount, character, and color of urinePatient’s responseInstruction given to patient and patient response
16 Documentation Requirements Maintenance of CatheterContinued need for catheter based on insertion criteriaAmount, character, and color of urineEvery 8 hours
17 Documentation Requirements DiscontinuationPerformance of procedureAmount, character, color of urinePatient ’s responseInstruction given and patient’s responseIf patient can ambulate take it out…. Don’t train the PT staff to keep it below the waist
18 Documentation Requirements For Those Areas With Computerized Documentation Documentation requirements are the same as those without computerized documentation.Documentation will be required on the “Urinary Tab” on the CIS FlowsheetSee following “snapshots” of the new flowsheet