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

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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

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

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Nora McCrary

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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

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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

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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

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Lean Six methodology Rapid Cycle test failures Small green sticker placed on doctors progress note every night made no difference Big Yellow sheet of paper in front of doctors 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

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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

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

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QUESTIONS?