LINDA HUDDLESTON, RN, MSN, CIC Director of Infection Prevention and Employee Health

 List the best practices to prevent CAUTI  Identify obstacles in decreasing both CAUTI and indwelling catheter utilization  Describe methodology to engage staff  Describe interventions that decrease CAUTI and indwelling catheter utilization

 Located in Northwest GA  304 bed facility  ICU with 16 beds  CCU with 8 beds  Medical residency program  Hospitalists

Nora McCrary

 The urinary tract is the most common site of Hospital Acquired Infections (HAIs)  Accounts for more than 30% of infections reported by acute care hospitals  More than 13,000 deaths each year (35/day)  Complications associated with CAUTI ◦ Discomfort ◦ Prolonged hospital stays ◦ Increased cost and mortality

 Develop and implement a policy with best practices  Ensure that trained personnel insert catheter  Use hand hygiene  Perform routine hygiene  Evaluate necessity of catheter every 24 hours  Use a closed drainage system  Use smallest gauge catheter if possible  Replace system if a break in asepsis occurs  Evaluate alternate methods  Avoid irrigation  Use barrier precautions for insertion  Do not change catheter routinely  Obtain urine samples aseptically SHEA Compendium of Strategies to Prevent HAIs, 2008

 HABIT – always insert Foley in ECC  ICU – Have to have one  Lack of knowledge that an indwelling urinary catheter is harmful  “Alert Fatigue”  Trained staff?  Convenience  Myth-change catheter every 30 days

 Lean Six methodology  Rapid Cycle test failures ◦ Small green sticker placed on doctor’s progress note every night – made no difference ◦ Big Yellow sheet of paper in front of doctor’s progress notes – one doctor found annoying, most paid it no attention and it was found to make no difference ◦ Yellow sheet (smaller) placed on the front of the chart for the nurse to assess – made no difference ◦ “ASSUMED” that Central had ordered all of the sizes and types. Found out that they had only ordered the regular and were only keeping two different sizes in the Omnicell

 Male external catheters – Pop On and Regular in four different sizes  Folks – SIZE MATTERS!!!  Had one box of 30 of each size and type sent to my office and then distributed by ICU management staff  D/C before transferring out of ICU  Alert to doctor in EMR every 48 hours

 Add to team – Frontline staff – Laura Laurich, Glenn Smith, Norah McCrary, Robin Cater, Jeff O’Kelly  Bulletin Boards- Norah McCrary  Rounding  Ensure that supplies are stocked  Knowledge  Get other units involved – ECC ICU  Competency training annually

QUESTIONS?