1 © 2010 tmit nqf-endorsed ® safe practices for better healthcare safe practice 25...

1© 2010 TMIT

NQF-Endorsed®

Safe Practices for Better Healthcare

Safe Practice 25Catheter-Associated Urinary Tract

Infection Prevention

Chapter 7: Improving Patient Safety Through the

Prevention of Healthcare-Associated Infections

© 2006 HCC, Inc. CD000000-0000XX 2© 2010 TMIT

Slide Deck Overview

Slide Set Includes:

Section 1: NQF-Endorsed® Safe Practices for Better Healthcare Overview

Section 2: Harmonization Partners Section 3: The Problem Section 4: Practice Specifications Section 5: Example Implementation Approaches Section 6: Front-line Resources

3© 2010 TMIT

NQF-Endorsed®

Safe Practices for Better HealthcareOverview





4© 2010 TMIT

34 Safe Practices

• Criteria for Inclusion

• Specificity

• Benefit

• Evidence of Effectiveness

• Generalization

• Readiness

2010 NQF Safe Practices for Better Healthcare: A Consensus Report

5© 2010 TMIT

Culture SP 1

2010 NQF Report

CHAPTER 7: Healthcare-Associated Infections• Hand Hygiene• Influenza Prevention• Central Line-Associated Blood Stream Infection

Prevention • Surgical-Site Infection Prevention• Daily Care of the Ventilated Patient• MDRO Prevention• Catheter-Associated UTI Prevention

Information Management and Continuity of Care

Medication Management

Healthcare-Associated Infections

Condition- and Site-Specific Practices

Consent & Disclosure

Wrong-siteSx Prevention

Press. Ulcer Prevention

VTE Prevention

Anticoag. Therapy

VAP Prevention

Central Line-Assoc.BSI Prevention

Sx-Site Inf.Prevention

Contrast Media Use

Hand HygieneInfluenza

Prevention

Pharmacist Leadership Structures and Systems

Med. Recon.

Culture

CPOE

Read-Back & Abbrev.

Discharge Systems

PatientCare Info.

LabelingDiag. Studies

Culture Meas.,FB., and Interv.

Structuresand Systems

Risk and HazardsTeam Trainingand Skill Bldg.

Nursing Workforce

ICU CareDirect

Caregivers

Workforce CHAPTER 4: Workforce• Nursing Workforce• Direct Caregivers• ICU Care

CHAPTER 2: Creating and Sustaining a Culture of Safety (Separated into Practices]

Culture of Safety Leadership Structures and Systems Culture Measurement, Feedback, and Intervention Teamwork Training and Skill Building Risks and Hazards

CHAPTER 5: Information Management and Continuity of Care

Patient Care Information Order Read-Back and Abbreviations Labeling Diagnostic Studies Discharge Systems Safe Adoption of Computerized Prescriber Order Entry

CHAPTER 6: Medication Management Medication Reconciliation Pharmacist Leadership Structures and Systems

CHAPTER 8: Condition- and Site-Specific Practices• Wrong-Site, Wrong-Procedure, Wrong-Person

Surgery Prevention • Pressure Ulcer Prevention• VTE Prevention• Anticoagulation Therapy• Contrast Media-Induced Renal Failure Prevention• Organ Donation• Glycemic Control• Falls Prevention• Pediatric Imaging

Informed Consent

Life-Sustaining Treatment

Disclosure

CHAPTER 3: Consent and Disclosure• Informed Consent• Life-Sustaining Treatment• Disclosure• Care of the Caregiver

Consent and Disclosure

Care of Caregiver

MDROPrevention

UTIPrevention

FallsPrevention

OrganDonation

GlycemicControl

PediatricImaging

7© 2010 TMIT

Harmonization Partners





8© 2010 TMIT

Harmonization – The Quality Choir

9© 2010 TMIT

The Patient – Our Conductor

© 2006 HCC, Inc. CD000000-0000XX 10© 2010 TMIT

The Objective

Catheter-Associated Urinary Tract Infection Prevention

Prevent healthcare-acquired catheter-associated urinary tract infections (CAUTIs)

11© 2010 TMIT

The Problem





12© 2010 TMIT

[http://online.wsj.com/article/SB10001424052970204488304574428950126681432.html]

13© 2010 TMIT

[http://patientsafetyauthority.org/NewsAndInformation/PressReleases/Pages/pr_2009_October_13.aspx]

© 2006 HCC, Inc. CD000000-0000XX 14© 2010 TMIT

The Problem

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The Problem

Frequency

CAUTIs are the most frequent HAIs in acute care hospitals

80% are attributable to an indwelling urethral catheter

CAUTIs are associated with increased morbidity, mortality, hospital cost, and length of stay

[Saint, Infect Control Hosp Epidemiol 2000 Jun;21(6):375-80; Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32]

© 2006 HCC, Inc. CD000000-0000XX 16© 2010 TMIT

The Problem

Severity

Between 15%-25% of hospitalized patients may receive short-term indwelling urinary catheters

In 2002, the Centers for Disease Control and Prevention estimated that 561,667 CAUTIs occurred in the United States, contributing to 13,088 deaths

[Warren, Int J Antimicrob Agents 2001 Apr;17(4):299-303; Weinstein, Infect Control Hosp Epidemiol 1999 Aug;20(8):543-8; Klevens, Public Health Rep 2007 Mar-Apr;122(2):160-6]

© 2006 HCC, Inc. CD000000-0000XX 17© 2010 TMIT

The Problem

Preventability

Estimated to be 17%-69% with recommended infection control measures

380,000 preventable infections and 9,000 preventable deaths related to CAUTI annually

Limiting catheter use and minimizing the duration the catheter remains in situ are principal strategies for CAUTI prevention

Use of an antimicrobial or silver alloy-coated catheter reduces risk of CAUTIs

[Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8; Ciavarella, Infect Control Hosp Epidemiol 2009 Apr;30(4):404-5; author reply 405-6; Parker, J Wound Ostomy Continence Nurs 2009 Jan-Feb;36(1):23-34]

© 2006 HCC, Inc. CD000000-0000XX 18© 2010 TMIT

The Problem

Cost Impact

The annual direct medical cost of CAUTI is estimated to be $565 million in the United States

[Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009]

19© 2010 TMIT

Practice Specifications





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Additional Specifications

© 2006 HCC, Inc. CD000000-0000XX 21© 2010 TMIT

Safe Practice Statement

CAUTI Prevention

Take actions to prevent catheter-associated urinary tract infection by implementing evidence-based intervention practices

[Lo, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S41-50; Gould, Guideline for prevention of catheter-associated urinary tract infections, 2008; Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]

© 2006 HCC, Inc. CD000000-0000XX 22© 2010 TMIT


Document the education of personnel—involved in catheter insertion, care, management, and removal—on CAUTI prevention

Education should occur upon hire and annually thereafter

Prior to insertion, educate the patient and family members about CAUTI prevention

Identify the patient groups or units on which surveillance should be conducted, considering frequency of catheter use and potential risk

Implement policies and practices to reduce the risk of CAUTI

[Willson, J Wound Ostomy Continence Nurs 2009 Mar-Apr;36(2):137-54; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8;Smith, Am J Infect Control 2008 Sep;36(7):504-35]

© 2006 HCC, Inc. CD000000-0000XX 23© 2010 TMIT


Evidence-based practices include, but are not limited to, the following: Perform hand hygiene immediately before and

after catheter insertion Ensure that the supplies necessary are readily

available Insert catheters following an aseptic technique

and using sterile equipment Leave urinary catheters in place only as long

as indications remain Obtain a urine culture before initiating

antimicrobial therapy[Greene, Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008; Institute for Healthcare Improvement, Catheter-Associated Urinary Tract Infection (CA UTI) Prevention, IHI Improvement Map, 2009; Joint Commission Resources, Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, National Patient Safety Goals, 2010; Barford, BJU Int 2008 Jul;102(1):67-74]

© 2006 HCC, Inc. CD000000-0000XX 24© 2010 TMIT


Measure compliance with best practices, evaluating the effectiveness of prevention efforts

Provide CAUTI surveillance data, including process and outcome measures, to key stakeholders within the organization

25© 2010 TMIT

Example Implementation Approaches





© 2006 HCC, Inc. CD000000-0000XX 27© 2010 TMIT


Implement a system for documenting the following in the patient record: indications for catheter insertion date and time of catheter insertion individual who inserted catheter date and time of catheter removal

Develop and implement facility criteria for acceptable indications for indwelling urinary catheter use

[Gokula, Am J Infect Control 2004 Jun;32(4):196-9; Marklew, Nurs Crit Care 2004 Jan-Feb;9(1):21-7]

© 2006 HCC, Inc. CD000000-0000XX 28© 2010 TMIT


Suggested indications for indwelling urethral catheter use include: Perioperative use for selected surgical procedures Accurate measurement of urine output in critically

ill patients Management of acute urinary retention and

urinary obstruction To assist in pressure ulcer healing for incontinent

residents As an exception, at patient request to improve

comfort Relief of bladder outlet obstruction or congenital

urologic abnormalities

© 2006 HCC, Inc. CD000000-0000XX 29© 2010 TMIT


Following aseptic insertion of the urinary catheter, maintain a closed drainage system

Maintain unobstructed urine flow Implement an organization-wide program to

identify and remove catheters no longer necessary; method examples include: Automatic stop orders Standardized reminders placed into patient

record Implementation of daily ward rounds to review

all patients with urinary catheters

[Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]

© 2006 HCC, Inc. CD000000-0000XX 30© 2010 TMIT


Strategies of Progressive Organizations

High-performing organizations have protocols for the management of post-operative urinary retention

Innovations include direct visualization of the urethra during insertion of catheters

Implement a system for analyzing and reporting data on catheter use, including adverse events

[Chapple, 2004 June;93(9)1195-1202; Fenton, Urology 2005 Jun;65(6):1055-8; Agency for Healthcare Research and Quality, National Healthcare Disparities Report 2008, 2009; Agency for Healthcare Research and Quality, National Healthcare Quality Report 2008, 2009]

32© 2010 TMIT

[http://www.shea-online.org/about/compendium.cfm; http://www.azdhs.gov/infectioncontrol/pdfs/HAI%20Prevention%20Compendium%20PDFs/CA%20UTI.pdf]

36© 2010 TMIT

[http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/ExpeditionPreventingCatheterAssociatedUrinaryTractInfectionsAug10.htm?

utm_source=email&utm_medium=blast&utm_campaign=cautisep10b1]

© 2006 HCC, Inc. CD000000-0000XX 37© 2010 TMIT

TMIT National Webinar Series

Catheter-Associated Urinary Tract Infection:No One Owns It ... We ALL Pay for It! (SP 25)

Carolyn Gould, MD, MSCR – Topic: The CDC Guideline for Prevention of CAUTI

Sanjay Saint, MD, MPH – Topic: CAUTI Prevention: The Bladder Bundle

Marcia Patrick, RN, MSN, CIC – Topic: CAUTI Reduction Using Rapid-Cycle Improvement

Denise Graham – Topic: APIC Support Patti O'Regan, DNP, ARNP, ANP-C, PMHNP-BC –

Topic: The Role of the Patient Advocate Go to: http://safetyleaders.org/webinars/indexWebinar_August2010.jsp

(August 19, 2010)

© 2006 HCC, Inc. CD000000-0000XX 38© 2010 TMIT

TMIT National Webinar Series

Healthcare-Associated Infection and You:Cleaner, Safer Care (SPs 19-25)

Kathy Warye – Topic: Perspective on the Development of the Implementation Examples of the NQF Safe Practices

Peter Angood, MD – Topic: HAI National Attention and Harmonization

David Classen, MD – Topic: HAI Compendium Harmonization with the Safe Practices

Julianne Morath, RN – Topic: Implementation Jennifer Dingman – Topic: Call to Action Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932

(May 14, 2009)

1 © 2010 tmit nqf-endorsed ® safe practices for better healthcare safe practice 25...

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