Chasing zero. Reducing hospital acquired conditions in the intensive care unit

Abstract

<p><strong>Background:</strong> 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><strong>Purpose:</strong> 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 (&lt;1.19) by September 2015.</p> <p><strong>Methods: </strong>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 &ldquo;M-Care&rdquo; 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 &ldquo;Stat-lock&rdquo; 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 &ldquo;keep bag below the bladder&rdquo; particularly when patients were being ambulated.</p> <p><strong>Findings/Implications:</strong> 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.</p>