CAUTI (Catheter Associated Urinary

Tract Infection)

Ariana Colina, RN, BSN, CPNClinical Systems Analyst

CAUTI (Catheter Associated Urinary Tract Infection)

CAUTI - Background

According to the CDC (2017), urinary tract infections (UTIs) are the fourth most common type of healthcare associated infection. The vast majority of the healthcare-associated UTIs are caused by instruments of the urinary tract which include indwelling catheters1.

15-25% of hospitalized patients receive a urinary catheter during their hospital stay1.

1Centers for Disease Control. (2009). Catheter-associated Urinary Tract Infection (CAUTI) Toolkit. Department of Health & Human Services. Retrieved on July 6th, 2017 from https://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

CAUTI – Background

Extended Hospital Stays 2 – 4 Days

Increased Health Care Costs $0.4 – $0.5 billion per year nationally

Patient Morbidity and Mortality Estimated 13,000 attributable deaths annually

Unnecessary antimicrobial use1

1Centers for Disease Control. (2009). Catheter-associated Urinary Tract Infection (CAUTI) Toolkit. Department of Health & Human Services. Retrieved on July 6th, 2017 from https://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

CAUTI – Local Problem

2015 2.9 CAUTIs per 1000 Device Days Infection

Rate Total 7 CAUTIs for 2015

Goal Reduce CAUTIs by implementing the CAUTI Bundle

best practice guidelines using the electronic medical record system.

CAUTI – Design & Implementation

In 2009, the Centers for Disease Control & Prevention (CDC) published updated guidelines for prevention of CAUTIs1.

These guidelines included recommendations for a CAUTI Bundle.

1Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., Pegues, D. A., Pettis, A. M., Saint, S., Yokoe, D. S. (2014). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update, Infection Control and Hospital Epidemiology, 35, 5. Retrieved on July 26th, 2017 from http://www.jstor.org/stable/10.1086/675718#fndtn-rf31

CAUTI – Design & Implementation

What is a CAUTI Bundle? Use of appropriate technique for catheter insertion Ensure appropriate management of indwelling

catheters Special approaches for prevention of CAUTIs1

1Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., Pegues, D. A., Pettis, A. M., Saint, S., Yokoe, D. S. (2014). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update, Infection Control and Hospital Epidemiology, 35, 5. Retrieved on July 26th, 2017 from http://www.jstor.org/stable/10.1086/675718#fndtn-rf31

CAUTI – Design & Implementation

Project Team Clinical Systems Analyst Clinical Systems Manager Information Technology Infection Control Nurse Practitioner Nursing Director Operations Nursing Manager Medical-Surgical RN ICU RN Physician Education

CAUTI – Design & Implementation

One month project time line Weekly meetings with Project Team Testing completed non-production environment by key subject

matter experts Informal education and training

CAUTI –How Health IT was Utilized

Pre CAUTI Urinary Catheter Insertion order (Foley Insertion)

Provider places Urinary Catheterorder and completes the Urinary

Catheter Type.

CAUTI –How Health IT was Utilized

Provider places Urinary Catheterorder and completes the required field ‘Urinary Catheter Protocol’.

Post CAUTI Urinary Catheter Insertion order (Foley Insertion)

CAUTI –How Health IT was Utilized

The Urinary Catheter Order triggers a Urinary Catheter

Insertion/Discontinuation task for the nurse.

Urinary Catheter Insertion/Discontinuation Nursing Task

CAUTI –How Health IT was Utilized

Once the urinary catheter is inserted, the nurse opens the Urinary Catheter Insertion/Discontinuation task and completes the insertion of the foley.

Urinary Catheter Insertion Flowsheet Documentation

CAUTI –How Health IT was Utilized

Hourly assessment and documentationof the urinary catheter.

Routine Hourly Nursing Documentation

CAUTI –How Health IT was Utilized

Urinary Catheter Necessity Review with Provider Task

A Urinary Catheter Necessity Review with Provider task triggers 48 hours after the

initial catheter insertion order.

CAUTI –How Health It was Utilized

Urinary Catheter Necessity Review with Provider Task

If the patient meets indication for continuation of urinary catheter, the

system will trigger an additional task for necessity for review with the provider in

24 hours.

CAUTI – Value Derived

2015 - Baseline Period 2.9 CAUTIs per 1000 Device Days Infection Rate Total 7 CAUTIs

2016 – Evaluation Period 1.28 CAUTIs per 1000 Device Days Infection Rate Total 3 CAUTIs

reduction after implementation

CAUTI –Value Derived: Patient Safety

525559

757

597 600645 623

472

724

1 13

21

0 02

1

-0.5

4.5

9.5

14.5

19.5

24.5

0

100

200

300

400

500

600

700

800

Total CAUTIs

Total Device Days Total # of CAUTIs Log. ( Total # of CAUTIs)

Compliance Audits

CAUTI –Value Derived: Patient Safety

1.9 1.79

3.963.35

1.67

0 0

4.23

1.38

-1

0

1

2

3

4

5

6

7

8

9

10

# of CAUTIs/1000 Device Days

# of CAUTIs/1000 Device Days Linear ( # of CAUTIs/1000 Device Days)

Compliance Audits

CAUTI –Value Derived: Finance

$758 $758

$2,274

$1,516

$758

$0 $0

$1,516

$758

$0

$500

$1,000

$1,500

$2,000

$2,500

CAUTI Costs

CAUTI Costs Linear (CAUTI Costs)

Compliance Audits

CAUTI –Value Derived: Finance

$5,306

$2,274

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

2015 2016

CAUTI Costs

2015 2016

Decrease in CAUTI Costs

CAUTI – Surveillance

CAUTIs are included in our Clinical Excellence Indicator (CEI) Bundles report performed by the quality department. This information is updated and published on our organization’s web portal for all staff member to view on a monthly basis .

CAUTI – Future State

2017

• Future State - HOUDINI Bundle (Hematuria, Obstruction, Urologic surgery, Decubitus, Intake & Output, Neurogenic bladder dysfunction, Immobilization)

04.2012•EMR Go Live with standard urinary catheter documentation.

09.2014•CAUTI workflow design with bundle documentation changes.

Change Management

Electronic health record change process when a possible optimization is

identified.

Thank you!