The CAUTI Prevention and Reduction Journey: Believe in Zero! Renee Juster, RN, BSN, PHN Infection...
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Transcript of The CAUTI Prevention and Reduction Journey: Believe in Zero! Renee Juster, RN, BSN, PHN Infection...
The CAUTI Prevention and Reduction Journey: Believe in Zero!
Renee Juster, RN, BSN, PHNInfection Prevention Manager
John Muir HealthFebruary 11, 2015
John Muir Health – proprietary and confidential2
Objectives
Upon completion of this presentation, APIC members will be able to:
1. Recognize the value of maximizing standardization and minimizing variation to achieve CAUTI reductions through an unwavering commitment to prevention
2. Understand the criticality of collaborative ownership for hospital wide spread of CAUTI prevention and reduction strategies
John Muir Health – proprietary and confidential3
John Muir Health-Walnut Creek and Concord Medical Centers
Walnut Creek:
Concord:
A 572 bed hospitals recognized as one of the nations, state and region’s premier health care providers by U.S. News and World Report for eight consecutive years. Areas of specialty include high- and low-risk obstetrics, pediatrics, orthopedics, rehabilitation, neurosciences, cardiac, emergency, trauma and cancer care.
A 245 bed hospital recognized as a preeminent center for cancer care and cardiac care, including open heart surgery and interventional cardiology. Areas of specialty include cardiovascular services, along with surgical care for a wide variety of conditions, cancer care and emergency services
John Muir Health – proprietary and confidential4
What’s the Goal???
2013 National Prevention Goals Paved the Way 25% reduction in CAUTI in ICU and ward locations or 0.75 SIR(NHSN
data source)-NOT METPrivate and public partnerships form at national and state levels
(Engagement Networks)….more goals!40% reduction in CAUTI and meet NHSN SIR of 1.5
What goals did we want to achieve in 2014? 10% improvement on 2014 Q1 results by end of 2014
Our starting point:
Walnut Creek: Rate 7.2
Concord: Rate 5.2
John Muir Health – proprietary and confidential5
Gain Perspective-But How?
• Make the commitment to improve and go all in!– California Hospital Engagement Network (CalHEN)
• State level– John Muir Device Related Infection Prevention (DRIP) Team
• Local/Internal level– On the CUSP: Stop CAUTI Cohort #8
• United States level; implement Comprehensive Unit-based Safety Programs (CUSP)
– Project Protect Fellowship • Partnership between On the CUSP: Stop CAUTI and four
partner organizations:– Society for Healthcare Epidemiology of America (SHEA)– Association for Professionals in Infection Control and Epidemiology (APIC)– Society of Hospital Medicine (SHM)– Emergency Nurses Association (ENA).
John Muir Health – proprietary and confidential6
Dare to Dream and Seek Miracles
John Muir Health – proprietary and confidential7
Don’t Forget the Basics-Start with Something!
• Attack Equipment Issues– Take inventory: Who has what where? How many different choices? – Are these things used in the same way by everyone? Do staff pick
the same equipment for the task at hand? – Are the staff set up for success?
Outcome: Critical Discovery! Barriers to improvement directly related to equipment Barriers to improvement directly related to practice
Take Action:
Maximize Standardization and Minimize Variation in both areas of Critical Discovery!
John Muir Health – proprietary and confidential8
Maximize Standardization and Minimize Variation• Kits-Marry the miracle with what already exists• Storage-Location, Location, Location!• Correct Choice-Maintain Autonomy: Make it a Win Win!
John Muir Health – proprietary and confidential9
Urinary Catheter Care Bundle
Maximize Standardization and Minimize VariationUrinary Catheter Care Bundle
INSERTION BUNDLE
Avoiding catheter insertion
Alternatives to try before insertion: Bladder scanning Condom cath, bedpan, female urinal Scheduled toileting, bedside commode In & out catheter
If an indication for catheter is confirmed:
Pre-clean with recommended agent before opening kit
Use the kit and smallest catheter possible
Use a securement device
MAINTENANCE BUNDLE
Avoiding infection while catheter is in place Assess need for catheter every shift Catheter care with recommended agent Q 8h Tubing
Avoid kinks and dependent loops Keep a closed system; avoid breaking seal
Drainage bag
Keep below bladder, not touching floor Prevent contamination of spigot Empty before transport
Urine Testing
Consider urine testing only if systemic signs of UTI - consult with physician
Order as “UA with microscopic (C&S if indicated)”
If catheter in place >72 hrs, change catheter prior to specimen collection (if not placed by urologist or other contraindications)
Obtain specimen(s) from sampling port using sterile technique and yellow tube
Take specimen to lab immediately Changing Catheter: Consult with MD……
If catheter present on admission and still indicated, consult with physician regarding replacement
REMOVAL BUNDLE
Safe removal & avoidance of re-insertion
To facilitate removal:
Assess need for catheter every shift
Utilize Nurse-Driven Protocol
Ensure adequate hydration
Post removal:
Assess for adequate urinary output To avoid reinsertion: Condom caths, bedpan, female urinals Encourage voiding every 2 - 4 hours if
patient has not already voided Scheduled toileting, bedside commode Bladder scanning In & out catheter
This document is available on the JMH intranet at: Cross Campus > Quality Management > Infection Prevention > IP Resources
GUIDING PRINCIPLES
Hand hygiene before and after all activities
Use aseptic technique as appropriate
Use Mosby Skills as the procedural resource
Provide patient/family education SPEAK Up if any aspect of bundle is breached
2/5/15
John Muir Health – proprietary and confidential10
Success!
• Yes, but skepticism remained– Will equipment standardization coupled with minimizing practice
variation and use of an innovative product be enough?
CAUTI Prevention= Practice + Product
John Muir Health – proprietary and confidential11
Walnut Creek Campus Critical Care Units- CAUTI rate
John Muir Health – proprietary and confidential12
Walnut Creek Campus Critical Care Units- Days between CAUTI
2 pack wipes
Foam and Bath wipes-1 out of 3 units
All Critical Care Units-Wipes, Foam, Bath
John Muir Health – proprietary and confidential13
Walnut Creek Campus Critical Care Units- CAUTI rate
Concord Campus Critical Care Units- CAUTI rate
2 pack wipes
John Muir Health – proprietary and confidential14
Fast Forward-2014 Comes to an End
Goal: 10% improvement on 2014 Q1 results by the end of 2014.
CAUTI – GOAL MET
Q1 2014 Q2-Q4 2014 • Concord 5.2 3.4 (35% reduction)
• Walnut Creek 7.2 5.1 (29% reduction)
• Combined 6.4 .5 (30% reduction)
We did hit ZERO on both campuses at one point or another but expecting ZERO to be sustainable over
time is not realistic. The rigor becomes more important.
John Muir Health – proprietary and confidential15
Most Valuable Lessons Learned
• Patience is a virtue• Don’t assume they see what you see
Tell the Story• Data, Data, Data plus what’s happening in the market• Crunch the Numbers• Collaboration/Partnership
– DON’T FORGET THE WOUND CARE NURSES
John Muir Health – proprietary and confidential16
Don’t Give Up- Look Up!“In most cases, the arrival of
innovation, like a quality improvement
initiative, forces us to contemplate
changing the way we live in some
way, large or small. Often our
reaction is annoyance. We don’t
want to be bothered; We are doing
nicely without this idea. Find members
of the group who are admired, trusted
and believe in the idea and set them loose on the group”
-Preventing Hospital Infections: Real World Problems, Realistic Solutions
Sanjay Saint, Sarah L. Krein with Robert W. Stock Oxford University Press 2015
John Muir Health – proprietary and confidential17
Questions?
Thank You!