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    The Plan to Eradicat Catheter-Acquired Urinary Tract Infections

    The Plan to Eradicat Catheter-Acquired Urinary Tract Infections

    The Plan to Eradicate Catheter-Acquired Urinary Tract Infections

    Like many hospitals across the country, LDS Hospital has worked tirelessly to reduce hospital-acquired infections. We’ve made great headway and our hospital has enjoyed really low rates of catheter-acquired urinary tract infections (CAUTIs). However, our hospital Patient Safety and Nursing Practice councils decided about 18 months ago to up our game and work toward zero CAUTIs. We developed a plan to do just that.

    The reasons for eliminating CAUTIs are many. Patients who get a CAUTI feel miserable. They’re likely to spend an extra three to 10 days in the hospital. In older patients, CAUTIs can trigger dementia-like symptoms. And we estimate that each CAUTI adds an average of $10,000 to the cost of care. So there was plenty of motivation to work on this.

    And the good news…in the past nine months, our 160-bed facility hasn’t had a single CAUTI. Not to say we won’t ever have another one at LDS Hospital, but we feel confident that if we can stick to our plan, CAUTIs will be a rare incident here.

    How We're Eradicating CAUTIs

    We developed a plan that had three areas of focus:

    1. Make sure catheters are inserted properly in the first place
    2. Get catheters out as soon as appropriate
    3. Keep the catheter and perineum clean

    Now that doesn’t sound like a rocket science plan, but what we found was that those three simple steps weren’t being done in a standard or consistent way in our hospital. So we leveraged a number of tools to standardize the process.

    Proper Catheter Placement

    First, when placing the catheters, we developed a standard procedure and have set a rule of having two caregivers present at placement. That has given us the opportunity to do coaching and checking.

    Minimizing Length of Time Catheters are Placed

    Second, we’ve created a culture where we seek to remove catheters as soon as appropriate. Our literature reviews have pointed to the fact that the longer a catheter stays in, the higher the risk of infection. Bedside RNs are required to review catheters daily and ask physicians if they can come out. We’ve worked hard to create a culture where our nurses feel comfortable approaching doctors with this question. In our computer charting, we have an automated prompt that asks nurse to review catheter status. Our charge nurses review all catheterized patients at the daily care coordination meeting. And we’ve created an orange label that’s placed on the catheter bag, which displays the start date as a visual trigger to the caregiving team.

    All of these efforts have reduced the number of catheter days at our hospital declining dramatically.

    Keeping the Perineum Clean

    Third, we’ve made a big push to make sure that peri-care takes place on all catheterized patients. As we observed our various caregivers, we realized peri-care was done in a variety of ways. So we created a Standard of Work document, which outlines in detail how peri-care is to be done. This document is posted next to our supply area to remind nurses and CNAs of the procedure. New staff are trained on the proper technique.

    We also realized that peri-care can be uncomfortable for both the patient and caregiver, so we developed scripting to help our caregivers know how to talk about peri-care with patients. In the past it was easy for a patient to say, “No, you don’t need to clean down there,” and all too often the caregiver would oblige. Now we work on a very different outcome. Our scripting is aimed at helping the patient be comfortable, whether it’s educating them as to the importance of peri-care in reducing infections or seeing if they’d be more comfortable to have the care done by a caregiver of another gender, or if they’d like the water to be warmer.

    As a result of these efforts, our peri-care has improved dramatically.

    How do we know? We’ve set up a system where we do periodic audits. We check to make sure foleys are securely fastened, that they’re below the bladder, that drainage tubes don’t have kinks or loops, that orange stickers are on the bag and that peri-care has been documented in the chart.

    And the result? Happier patients, shorter stays in the hospital, and lower costs.

    This article was written by:
    Heather Wall, Operations Officer, LDS Hospital
    Michelle Linder, RN, LDS Hospital