The tools to make it happen Tuesday 28th September 2010 The tools to make it happen Jacqui Jones 1000 Lives Plus HCAI Programme Manager Insert name of presentation on Master Slide

Starter Guide Management of Invasive Devices: Reducing Catheter Associated Urinary Tract Infections

Four Components of Care Avoid unnecessary urinary catheters Insert urinary catheters using aseptic techniques Maintain urinary catheters based on recommended guidelines Review urinary catheter necessity daily and remove promptly. Four Components of Care

Avoid unnecessary urinary catheters! 21% patients lacked proper indications for insertion 41 to 58% found to be unnecessary 3 fold increase in risk of death......................... p.8 no 5 – studies found 21%....of hsptl pts with indwelling lack proper indications for insertion P.8 n0 6 - .....catheters in place overall found to be unnecessary p.8 no 8 - ....independent of other co-morbidities

Remove promptly! Catheters in place for 14 days put patients at considerable risk 74% respondents did not monitor catheter duration 47% of patient days were not justified 28% of Doctors unaware that catheters were in place 41% Doctors unaware patients were inappropriately catheterised p.15 no 15......of developing bacteria in the bladder that may become resistant to anit –b No 17 – hospital survey, respondents No 18 – continued catheterisation in pts in 47%.... No19 – physicians, residents and med students in a study were unaware of catheters in their pts No 19 -

Care Bundle: Grouping of best practices that individually improve care, but when applied together result in substantially greater improvement. The science supporting each bundle component is sufficiently established to be considered the standard of care3. A care bundle/checklist is a useful tool for staff at the time of insertion and during maintenance of the catheter. It can also serve as a data collection tool to assess compliance.

Care Bundle Approach High Impact Intervention No 6 CAUTI Insertion Bundle High Impact Intervention No 6

Insertion Bundle & Checklist Avoid unnecessary urinary catheters Insert urinary catheters using aseptic techniques Pages 28 & 29 of Starter Guide

Maintenance Bundle 3. Maintain urinary catheters based on recommended guideliens 4. Review urinary catheter necessity daily and remove promptly Page 30 of Starter Guide

Other Initiatives Education and training is fundamental Introduce standard kits or packs (including checklist) Use of anti-infective catheters has been clinically proven to delay the onset and decrease the incidence of CAUTIs by 26% to 47% Include stop orders/reminders to remove Packs that contain all items and only those items will save time for staff who might otherwise need to search for and collect supplies -Silver alloy and hydrogel-coated (p.12 no 12&13) UC for more than 14 days is at considerable risk of developing bacteria in the baldder that may become resistant to antibiotics (p.15 no15) Default stop order 72 hours after catheterisation (reduced average duration by 3 days) A simple written reminder decreased usage by 7.6%

Start by: Forming a team Setting aims Using the model for improvement Get started!