2. Realizing a Sustained Decrease in Catheter-Associated Urinary Tract Infection Rates at an Oncology Hospital Pamela McLaughlin, BSN, RN, OCN®

3. Roswell Park Cancer Institute Buffalo, New York America’s first cancer center started in 1898 with revolutionary multidisciplinary oncology care 133 licensed beds, hematological and surgical Member of National Comprehensive Cancer Network (NCCN), comprised of 26 institutions

4. Objectives Identify best practices & opportunities for improvement in current CAUTI prevention program List the steps to successful CAUTI program implementation & utilization

5. Urinary Tract Infection Facts 13,000 people per year die from UTI 75% of them were from use of a catheter Each time a closed system is opened, it increases the chance for CAUTI by 25% Are estimated to cost up to $1188 per occurrence The most important risk factor is prolonged use of a urinary catheter (UC)

6. What is a Bundle A structured way of improving processes of care and patient outcomes A small straight forward set of Evidence Based Practices (usually 3-5) that when performed collectively have been proven to improve patient outcomes

7. What is in a CAUTI bundle? AVOID all unnecessary catheters – Insert only for appropriate indications Strict I&O, sedated – Leave in only as long as needed The longer it is in the greater the risk of CAUTI – Consider alternatives External catheter, bedside commode, bed pans – Insert using aseptic technique – Maintain catheters based on recommended guidelines http://www.guideline.gov (National Guideline Clearinghouse) http://www.guideline.gov – Review necessity daily and remove promptly

8. How did we achieve success? Multidisciplinary Team Physician Champion Infection Prevention team Nursing Quality Nursing Education Biomedical Engineering Staff RN’s & HCA Urology/Cysto nurses Nursing Administration Wound, Ostomy, Continence experts Purchasing and receiving Data managers Vendors

9. How to build your CAUTI program? Imagine EVERY person in the chain of custody from creation of the product to discharge from the hospital. Include them in the process.

10. Physician Champion They write the orders for insertion and d/c They also treat the CAUTI when they occur

11. Infection Prevention Surveillance with data and reporting Audit current practices and reports to staff Bedside Staff VALUABLE input on bedside concerns Source for feedback and proposed changes Champions for new product Product selection

12. Urology/Cystology RN’s Identify the specialty catheters they need Inventory needs for their area Helped to create a physician prompt in the EMR Internal website postings for education Adjusted the RN documentation in the EMR to work with MD prompts –Insertion date –Routine peri care –Urine characteristics –D/C date & time –Post void residual amt, date and time Nursing Informaticist’s

13. Nursing Educators Mass education to staff Express Inservices Nightshift educators Catheter insertion practices as part of annual privileging fair –RN’s do not insert them often enough to maintain aseptic practice Nursing Administration Remove barriers to implementation Full support and approval to use and gather resources

14. Wound, Ostomy, Continence Nurses Skin care needs Continence expertise Product selection Peri Operative Must have input as all surgical catheters are inserted in OR

15. Purchasing and Distribution Inventory change out Financial side of change over Central distribution and terminology, need to help them understand the supplies Cost analysis Biomedical Engineering Contracts for bladder scanners & equipment Service agreements They need to be able to ensure your devices work properly throughout the lifecycle of the tool

16. Product vendors Provide education & In servicing to your staff Have joined forces in skills fair to provide product expertise Provide train the trainer events When selecting a vendor, remember this: Cost vs. service, education to staff, product, & usability

17. Self Assessment of practices Look at the product you are currently using –Is it based in EBP? –Is it safe for the patient? –Is there great variation among all the departments and units using them? –Do you maintain a closed system at all times?

18. Assessment/Audit Tool Closed system (red seal intact) Leg securement attached Bag off the floor Tubing is not kinked or looped Is the bag below the bladder Is the bag labeled with date & time of insertion Is there a dedicated collection device for each patient

19. Standardized Product The product we selected had: –16 French –Silicone –Temp sensing –Urometer attached to the bag –Stat lock leg securement device

20. Bladder Scanners We purchased enough bladder scanners for all units to be able to use as needed Created a removal algorithm –With staff involvement and input –Several versions

21. Catheter Removal Algorithm

22. How did we get it to staff? Massive Education blitz –We created a worksheet that matched on internal online webpage –Allowed for staff to be able to access the information as they needed it.

23. Online Education tool with all links and resources

24. Something different We developed a CAUTI Rout Cause Analysis (CAUTICA) For every CAUTI, we have a meeting with the MD, Nurse mgr., RN, Infection prevention, fellow or resident involved in the case Has helped us to identify gaps in education or the bundle

25. Wrap Up Take Away’s –Multidisciplinary team with MD’s and bedside staff –Implement practices for EMR alerts of catheter necessity –Standardize the product –Have bladder scanners available –SOP’s to help guide practice –Creation of algorithm –Practice to change catheter every 28 days for long term catheters –Change catheters prior to urine cultures if the catheter has been in 14 days or more –Implement focused rounding to decrease prevalence –Insertion competency during skills/privilege fair –Continued utilization of vendor resources

26. Thank you! Pamela McLaughlin, BSN, RN, OCN Assistant Magnet Coordinator Roswell Park Cancer Institute Pamela.mclaughlin@roswellpark.org 716-845-1300, ext. 5270