Poster Abstracts/ American Journal of Infection Control 41 (2013) S25-S145 S67

Environment of Care/Construction/Remediation

Presentation Number 6-320A Quality Control Study of Practice of UrinaryCatheterization and Knowledge among JuniorMedical Staff

Muhammad R. Cheema BSc, MBBS, MRes, F2, Wirral UniversityTeaching Hospital, Wirral, Merseyside, UK

BACKGROUND/OBJECTIVES: Our study was conducted in theinpatient setting of Department of Elderly Medicine. A highpercentage of indwelling catheters at discharge had been observed.Despite symptomatic benefit from placing a urinary catheter, theyare often implicated in causing recurrent urinary tract infections,discomfort, and retention resulting from catheter blockage and areassociated with an increased frequency of readmission. Our studyaimed to ascertain whether these catheters were being placed forappropriate indications.METHODS: In the first cycle data was collected over a period of two2 weeks from notes of 61 elderly patients with urinary catheters.Medical notes were used to identify the indications for catheteri-zation and to assess proper documentation pertaining to procedureof catheterization. This documentation comprised date, time,indication of catheterization, personnel name, catheter size,volume and colour of urine drained, use of aseptic technique andantibiotic prophylaxis given. To evaluate the knowledge among thestaff regarding indications, complications and documentation ofcatheterization, questionnaire survey was carried out.After theinitial cycle the ward managers and junior staff (junior doctors andnurses) were made aware about the findings of the audit throughthe presentation of the results in local grand round meeting.Lectures were given to the junior staff regarding the indications forcatheterisation. Ward managers and nurses in charge of elderlypatients ward were informed about disseminating the knowledgeregarding the indications and complications of catheterisation tothe nursing staff. A repeat cycle of the audit was conducted 6months after the intervention was carried out to assess the impactof the intervention.RESULTS: Our study revealed that 90% of total catheterizations inthe first cycle were performed with complete/adequate documen-tation and for appropriate indications as per the IDSA guidelines.However, in the second cycle after the intervention, 95.5% of totalcatheterisations were performed for the appropriate indications. Inthe first cycle,documentation of the date of procedure, the indica-tion for catheterization use of aseptic technique: 100% agreed.Do-cument if prophylactic antibiotics were given and if a sample wassent for analysis: 77% of agreed. Document the volume of urinedrained: 97.4% agreed. 89.7% of them agreed they would documenta description of the urine drained and 87% of them acknowledgedthey would document if it was a difficult procedure or not.Aftera period of 6 months post intervention, the results of the secondcycle were encouraging. It showed positive attitudes and practicesafter the intervention. There were fewer number of inappropriateurinary catheterisations. Largely, the urinary catheterisation wasperformed for the appropriate indications (95.5%) in accordancewith the IDSA guidelines for catheterisation. Less number ofunclear indications were seen (4.5%) in the second cycle ascompared to the 1st cycle (10%).

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CONCLUSIONS: Responses to the questionnaire demonstrated goodawareness of what needed to be documented among staff. How-ever, the practice of documentation did not reflect the awarenessdemonstrated in the questionnaire in the first cycle. The awarenessalso improved in the second cycle after intervention. The work alsohighlighted that there is a significant gap between the knowledgeregarding urinary catheterisation and the practice performed bythe junior staff. However, reinforcement with lectures has shownan improvement in this practice. This highlights the knowledgedeficit which can be addressed with more effective educationalinterventions at both the undergraduate level (eg curriculumchanges) and at the postgraduate level (eg training and assessmentas part of hospital induction).

Presentation Number 6-321Round and Round We Go: The Development of anEffective, Sustainable Multidisciplinary RoundingProcess

Kim Strelczyk RN, MSN, ACNS-BC, CIC, Consultant, Specialists inInfection Prevention & Control, LLC; Christie Vandygriff RN, BSN,Infection Preventionist, Covenant Health

ISSUE: Regulatory and accrediting agencies have recently increasedscrutiny of the environment in hospital surveys. Many findings arecited in “Infection Control” chapters. In early 2012, our acute carehospitals were surveyed by the Centers for Medicare/MedicaidServices (CMS) and cited for a number of environmental issues.There is very little information published or available in InfectionPrevention (IP) courses regarding “how to” effectively conductenvironment of care (EOC) rounds. Historically, EOC rounds wereconducted only twice a year at our hospitals, we had no stan-dardized tool, and no scoring mechanism. In addition, we foundthat Department Managers (DM) did not realize their responsibilitytoward assuring a clean and safe environment.

PROJECT: We developed 5 teams of experts from IP, EnvironmentalServices (EVS), Plant Operations (PO), and Safety. IPs served asTeam Leaders for teams. Schedules were developed to ensure thatall clinical areas were rounded upon monthly and all others quar-terly. Eleven outpatient areas/clinics were included. A standardoperating procedure was developed. A rounding tool was created

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