Legacy Good Samaritan Medical Center

Presented by Jim Marangoni RN SCNRThank You Art Ashby and Cindy Evans

• Deciding on the issues

• Roles in an infection reduction project

• UTI prevention bundle

• Describe Process and Outcome Monitoring

• Integrate NSQIP Data into UTI reduction efforts: Realtime, Risk Adjusted, Regional

Objectives

Legacy Health – 6 hospitals, regional referral laboratory, research programs, clinics, hospice program and IP rehabilitation center

Urban hospital in NW Portland: 230 Staffed beds, Average Census 130-170 patients

NSQIP since Sept 2008

Multispecialty with OHS

Legacy Good Samaritan Medical Center

Oregon NSQIP Consortium

Catheter Associated - Nosocomial Urinary Tract Infections

April - June 2005 compared to April - June 2006

CAUTI ReductionProduct Conversion to Silver Hydrogel Coated Urinary Catheters

Rates per 1000Patient DaysProjected Net Cost Avoidance:$115,700 based on CAUTIs prevented and projected increasedcost of products

CAUTI Rates 2006-2008: Kern CCUper 1000 device days

Overall* Urinary Tract Infections

* Includes General and Vascular Surgery Cases

Observed Rate: 2.06%Expected Rate: 1.53%O/E Ratio: 1.35Status: As Expected

First Step – Collaborating

Chief Nursing Officer and Quality Improvement Specialist

Legacy Initiative to Focus on Infection Prevention

Led to Development of Infection Prevention Bundles

CAUTI Reduction Strategy

Sterile technique for insertion

Always keep drainage bag below level of the bladder

Empty bag before transport

Prevent dependent loops in tubing

Secure catheter to decrease movement of foley

Pericare daily using soap and water with daily bath

Do not allow the bag to overfill

Do not allow bag to touch floor

Foley CatheterBest Practice Bundle

EPIC Documentation Flowsheet

Best Practices Literature ReviewCAUTI Prevention Bundle DevelopmentEducating staff who come into contact with patients with catheters, from placement to transporting patientsMonitoring Compliance with CAUTI Bundle•Process Monitoring Rounds by CNO and ICPProvide Feedback Regarding Compliance and CAUTI data to staffInteractive Case Reviews with Nursing Staff

CAUTI Prevention Process

Bundle Education

CAUTI Reduction April 2008 – March 2010

71% Reduction in UTI Cases

Symptomatic CAUTI Case CountsJune 2010 – November 2011

Quarterly UTI Realtime NSQIP

Monthly UTI NSQIP

Overall* Urinary Tract Infections

* Includes General and Vascular Surgery Cases

Observed Rate: 0.82%Pred. Obs. Rate:0.93%Expected Rate:1.04%Odds Ratio: 0.89Status: Non-Outlier

Conclusions• The Bundles approach works

• Leadership involvement is essential

• Education, Education and Re-education is required

• Surveillance includes process AND outcomes

monitoring and feedback to the staff

• Involving care staff in case analysis leads to

discovery

Questions?