Chasing Zero. Reducing Hospital Acquired Conditions in the Intensive Care Unit

Abstract

Background: Catheter-Associated Urinary Tract Infections (CAUTI) are the most commonly reported hospital-acquired condition, and the rates continue to rise. More than 560,000 patients develop CAUTI each year, leading to extended hospital stays, increased health care costs, and patient morbidity and mortality.</p><p>Purpose: There was an increased incidence of CAUTI in the intensive care units as noted by Infection Prevention. The goal was to decrease CAUTI rates to below the NDNQI mean (<1.19) by September 2015. </p><p>Methods: There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (A) prevention of inappropriate short-term catheter use, (B) nurse-driven timely removal of urinary catheters, and (C) urinary catheter care. Nursing screening and assessment and evidence-based management of urinary retention and incontinence is essential to reduce catheter overuse. The intensive care units adopted the American Nurses Association evidenced-based tool that incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments, as well as alternatives for retention and incontinence; timely removal; and a checklist on catheter insertion, cues for essential maintenance and post-removal care. </p><p>The specific initiatives that were implemented were: </p><p>1. Daily foley rounds by a multi-disciplinary team</p><p>2. Standardization of the foley kit between ED/OR/ICU as patients were arriving without urometers and necessitating breaking the seal and replacing the collection bag. </p><p>3. Isolating foley catheter care with the use of “M-Care” wipes</p><p>4. Elimination of unnecessary urine cultures via a prompt within the EMR that reminds staff of the indications for urinary cultures. </p><p>5. Stabilization of catheter with “Stat-lock” device rather than an elastic strap which was causing migration of the catheter. </p><p> 6. Working with transport technicians and educating them to empty the foley bag before the patient travels for procedure(s) outside of the ICU</p><p> 7. Placing neon color stickers on the foley bag to serve as a reminder to all which read “keep bag below the bladder” particularly when patients were being ambulated. </p><p>Findings/Implications: Both the MICU and SICU had reductions in CAUTI incidence with a zero incidence of CAUTI as of 3Q15. CAUTI can be prevented through applications of evidence-based guidelines.