Preventing CAUTI: Back to basics or New Approach
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Transcript of Preventing CAUTI: Back to basics or New Approach
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Deborah R. Campbell, RN-BC, CCRN, MSNPediatric Cardiovascular CNSKentucky Hospital AssociationChildren’s Hospital Association QTN faculty
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Clinical Consultant for Carefusion◦ Work to be presented was completed without
commercial support
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Review evidence based interventions to prevent CAUTI
Discuss bundle concept as relates to CAUTI prevention
Discuss CAUTI prevention as a team sport Discuss ‘safety culture’ aspects of CAUTI
prevention
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Sterile insertion technique (Consider a kit)◦ Smallest, softest catheter that will do the job
Ensure adequate hydration Hand hygiene Perineal care
◦ BID with soap and water, PRN BM (Products) Keep bag below the level of bladder Prevent bag, tubing from touching floor Avoid dependent loops, kinks No disruption of closed system
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Obtain specimens using aseptic technique◦ Only if absolutely necessary◦ Remove and replace for C&S
Empty the bag when1/2-2/3 full (Q4hrs?) Each patient should have own graduated
cylinder Daily observation for signs, sx of UTI Isolation of diagnosed CAUTI pt from anyone
with a catheter Utilize a securement device
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Bladder scanning- non-invasive, easy, quick Intermittent catheterization v. in-dwelling
caths- better for patient, more work for staff Ditch the bath basins CHG baths- microbe burden Appropriate nurse staffing Antibiotic or silver-coated catheters Hydrogel catheters- discourage biofilm
adherence Catheter valves- store urine in bladder v. bag
◦ More physiologic as well, decreases need to re-train
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Is there a “magic bullet? Are there certain, specific items 1+1=3 Synergy? Pathogen dose v. immune response Bundles act as checklists Bundles act as curriculum Recipe v. culture
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Policy change is not = to practice change
QI 101- Educate, Implement, Audit, Improve, SUSTAIN
All at once or step-wise? How do I choose from the menu?
◦ Problems known to exist at your place◦ Acceptable to your front line staff◦ Ways to measure already in place (LAST)◦ RCAs on CAUTIs that occur
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Is there a best way?◦ Direct Observation
Peers Supervisors, educators, CNSs
◦ Self-audits◦ Secret Shoppers
Sampling◦ Include weekends, nights◦ Attempt randomness by setting specific days, times
Met your goals consistently, decrease frequency-BUT never less than quarterly.
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Make the right action the default◦ Opt-outs v. necessity to overtly choose◦ Nurse driven protocols◦ Standardization◦ Redundant processes◦ From the IHI- Everyone chooses (or is assigned) a
focus area for which they provide input 5 audits per day per person (on HAPU, CLABSI,
CAUTI, SSI or VAP)
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Care team members other than primary RN◦ Nurses helping out (regular, floated, agency)◦ PCAs◦ X-ray technicians◦ Respiratory therapists◦ Transporters◦ Family members◦ Patients themselves
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Decrease the number of insertions/transfers with catheters◦ ED◦ OR
Success is possible!◦ Emergency room staff education and use of a
urinary catheter indication sheet improves appropriate use of foley catheters. Presented by RM Gokula, MD, MA Smith, MD, and J Hickner, MD, Lansing, Michigan
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Can’t define it, but we know it when we see it◦ Non-heirarchical◦ Healthy team dynamics
First names Safe to question, interrupt (Scripting!)
◦ Patient-Centered◦ No blame-it’s all about the process◦ Personal accountability (1 patient, 1 action at a
time) Link participation to annual evaluations
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Build concept that patient well-being is everyone’s responsibility◦ Individual◦ Team◦ No carve-outs
Rules apply to everyone, regardless of discipline Think pro-actively- “what could harm this
patient today?” Effective for more than one outcome
◦ Infections◦ Unplanned device removals◦ Med Errors
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Videos, e.g. Josie King Think of patient in front of you being your
mother, grandfather, child VA campaign
◦ “Have you ever killed someone with your bare hands?”
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