Use this table to quickly find a mentor for the prevention of Catheter-Associated Urinary Tract Infections with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.
Beth Israel Medical Center – New York, NY
Availability Status: Available to answer requests
Licensed Beds: 1106
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: July 2004
Mentor Contact Name: Brian Koll, MD, FACP
Mentor Contact Email: bkoll@chpnet.org
Mentor Contact Phone: 212-420-2853
Additional Information:
1. Forming an interdisciplinary teams consisting of physicians, nurses, nurses assistants, transporters with identification of "champions" from each discipline.
2. Feedback of Foley catheter UTI surveillance data on a quarterly basis to identify rates of infection at baseline and after interventions. Data presented to interdisciplinary teams as well as Administration and Board of Trustees.
3. Set goals of: avoid unnecessary urinary catheters, care for catheters as per recommended guidelines (keep collection bag below the level of the bladder at all times including patient transport), daily review of catheter necessity with prompt removal when indicated.
4. Daily reminder on rounds: "Does patient still require a Foley catheter? If so, why?"
5. Education and validation of competancy regarding Foley catheter insertion, care and maintenance with a focus on emptying collection bag with nursing assistants.
6. Began on one unit, then spread through hospital.
PROCESS MEASURES
Conduct random audits of selected units and calculate rate of compliance with documentation of catheter insertion and removal dates: 100% compliance with insertion of Foley catheters using aseptic technique.
Conduct random audits of selected units and calculate rate of compliance with documentation of indication for catheter placement. 100% compliance with knowledge that patient has a Foley catheter. 90% compliance with documentation of indication
95% - 100% compliance with hand hygiene and emptying of collection bag using a separate collecting container for each patient and preventing spigot from touching the collecting container.
95% compliance with maintaining collection bag below the level of the bladder during transport.
OUTCOME MEASURES
a) Urinary catheter-associated UTI rate: sustained rate of zero on majority of units with decreases noted on remaining units from 6 per 1,000 Foley catheter days to < 1 - 2 per 1,000 Foley catheter days
b) Urinary catheter utilization: decrease in Foley catheter duration by 4 - 7 days depending on the unit
[5/20/09]
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The Heart Hospital Baylor Plano – Plano, TX
Availability Status: Available to answer requests
Licensed Beds: 68
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2007
Mentor Contact Name: Brenda Helms, RN, BSN, MBA/HCM, Infection Control
Mentor Contact Email: Brenda.helms@baylorhealth.edu
Mentor Contact Phone: 469-814-3531
Additional Information:
The Heart Hospital Baylor Plano utilized a multidisciplinary approach to the implementation of care bundles and providing education related to care of indwelling Foley catheters in order to decrease catheter-related UTIs by at least 10%.
An increase in Catheter-Associated Urinary Tract Infections was identified at The Heart Hospital Baylor Plano. The following changes were implemented to address this issue:
• Identified possible causes of the increase such as variation in practice and lack of knowledge regarding current evidence for catheter care.
• In October 2007, provided education to all staff regarding catheter care procedures and timing.
• In December 2007, implemented Insertion Bundles and Daily Care Bundles (see details below).
• In January 2008, added UA to order sets.
• In March 2008, began hand hygiene campaign.
• In March 2008, attached care bundles to all Foley care kits.
Insertion bundle
• Hand hygiene performed
• Catheter secured
• Catheter not overfilled
• Seal intact
• Tubing extended
• Bag or tubing touching floor
• Catheter care performed w/soap and water every 8 hours
Daily care bundle
• Red tape intact
• Drainage tubing extended
• Tubing secured
• Drainage bag off floor
• Bag not overfilled
• Collection container properly stored
• Foley care Q8hrs
Lessons Learned:
• The importance of ongoing practice evaluation and education.
• We developed a care bundle that hit all the major points of catheter care to ensure that all points were equally emphasized.
• To improve bundle compliance, we attached the form to all Foley insertion kits.
• For both insertion and daily care bundles, we are looking for all-or-none compliance, i.e., all components must be completed to be considered in compliance.
• Adding urinalysis to all order sets identified UTIs that were present on admission.
By removing insert foley from order sets we did decrease the number of foleys inserted. Our statistics do not show this is the number of foley days due to increasing census.
PROCESS MEASURES
We audited 100% of all patients who had foley catheters placed for compliance with insertion technique as well as daily care compliance. All patients who had foley catheters longer than 48 hours were reviewed for clinical justification.
Rates of compliance were tracked by unit monthly and the information was forwarded to the unit managers. Within 3 months the rate of compliance was 100%.
Foley Catheter Bundle Compliance
Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08
67 78 88 100 100 100 100 100 100 100 100 100
If one item of the bundle is not compliant, the entire bundle is considered non-compliant. The number of daily bundles is also compared to the foley days to ensure that a bundle was completed for every day the patient had a foley catheter. Each day a bundle was missing was counted as non-compliant. Non-compliance demonstrates a need to reinforce education.
OUTCOME MEASURES
a) Urinary catheter-associated UTI rate
Aug07 Sep07 Oct07 Nov07 Dec07 Jan08 Feb08 Mar08 Apr08 May08 Jun08 Jul08 Average
Infections
2 4 2 4 1 2 0 1 0 0 0 0 1.7
Rate
7.60 12.86 4.60 11.04 2.62 4.44 0.00 1.57 0.00 0.00 0.00 0.00 3.73
Foley days
263 311 434 362 381 450 534 634 422 607 459 504 446.75
Rate of symptomatic CA-UTI:
We just recently began to separate the symptomatic and asymptomatic CA-UTI, we do not have a comparison at this time.
Rate of bacteremia attributable to CA-UTI:
To date, we do not have a bacteremia attributable to CA-UTI.
[5/20/09]
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Palmetto Health Baptist – Columbia, SC
Availability Status: Available to answer requests
Licensed Beds: 428
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: April 2008
Mentor Contact Name: Heather Mann
Mentor Contact Email: Heather.Mann@palmettohealth.org
Mentor Contact Phone: 803-296-3392
Additional Information:
Since beginning the project (in a medical telemetry unit) in April 2008, the test unit has gone seven months (from June 2008 through December 2008) without a catheter-associated UTI. In addition, the test unit has had only two CA-UTIs since the onset of the project. The total hospital-wide CA-UTIs also demonstrate a downward trend and the work from the initial test unit is in the process of being spread to additional hospital units.
The team has been working to implement both an insertion bundle and care and maintenance measures. Investigation of the data from the initial test unit revealed most of the catheters were inserted in the Emergency Department (ED). Consequently, the ED served as the test unit for the insertion bundle since so few catheters were actually inserted on the test unit. The elements are as follows:
Care & Maintenance Measures
+Daily assessment of catheter necessity
+Catheter secured
+Tamper-evident seal intact
+Drain tubing is properly positioned and secured (no dependent loops)
+Drain bag properly positioned (below bladder and not touching floor)
+Drain bag is not overfilled
+At least daily catheter hygiene
Insertion Bundle
+Assessment of catheter necessity
+Hand hygiene
+Clean the urethral meatus prior to catheter insertion
+Use a single-use packet of lubricant
+Aseptic insertion technique
+Catheter secured
+Sterile closed drainage system
[5/20/09]
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Palmetto Health Richland – Columbia, SC
Availability Status: Available to answer requests
Licensed Beds: 649
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: May 2008
Mentor Contact Name: Heather Mann
Mentor Contact Email: Heather.Mann@palmettohealth.org
Mentor Contact Phone: 803-296-3392
Additional Information:
The initial test unit for this project was a Cardiac Care Unit (Intensive Care Unit) and the second test unit was a Cardiac Telemetry Unit. Initial project activity began in April, 2008, with active data collection on process measures beginning in June and July of 2008. Since the beginning of the team activity, one test unit has been able to demonstrate a five month timespan from July, 2008 through November, 2008 without a catheter-associated UTI. In addition, process meaures measures for both test units have demonstrated 95% reliability or greater for several months. The total number of hospital-wide CA-UTIs has demonstrated a downward trend (with the exception of a couple of months) and the team is confident the total number will decrease as work from the initial test units is currently in the process of being spread to additional hospital units. Please reference the attachment for specific information.
The team has been working to implement both an insertion bundle and care and maintenance measures. Investigation of the data from the initial test unit revealed most of the catheters were inserted in the Emergency Department (ED); therefore, the ED served as the test unit for the insertion bundle since so few catheters were actually inserted on the test unit. Please reference the attachment for specific measure information from the initial test units. The elements are as follows:
Care & Maintenance Measures
+Daily Assessment of Catheter Necessity
+Catheter Secured
+Tamper Evident Seal Intact
+Drain Bag Properly Positioned (below bladder and not touching floor)
+Drain Bag is Not Overfilled
+At Least Daily Catheter Hygiene
Insertion Bundle
+Assessment of Catheter Necessity
+Hand Hygiene
+Clean the Urethral Meatus Prior to Catheter Insertion
+Use a Single-Use Packet of Lubricant
+Aseptic Insertion Technique
+Catheter Secured
+Sterile Closed Drainage System
Keys to success:
1) Representation on the team from all appropriate departments: nursing, nurse technicians, quality, emergency department, education, infection control, surgery, intensive care, pediatrics
2) Standardization of catheter kits to include all items necessary to complete the insertion bundle
3) Revised policies and procedures
4) Staff education regarding CA-UTIs and the care and maintenance and insertion bundles
5) Management (nurse managers, charge nurses, supervisors, etc.) hold staff accountable for meeting the expectations outlined in the bundles.
See graphs of their results.
[5/20/09]
