Legacy Good Samaritan Medical Center

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CAUTI Reduction

• Legacy Good Samaritan Medical Center
• Presented by Jim Marangoni RN SCNR
• Thank You Art Ashby and Cindy Evans

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Objectives

• Deciding on the issues
• Roles in an infection reduction project
• UTI prevention bundle
• Describe Process and Outcome Monitoring
• Integrate NSQIP Data into UTI reduction efforts
  Realtime, Risk Adjusted, Regional

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Legacy Good Samaritan Medical Center

• Legacy Health 6 hospitals, regional referral
  laboratory, research programs, clinics, hospice
  program and IP rehabilitation center
• Urban hospital in NW Portland 230 Staffed beds,
  Average Census 130-170 patients
• NSQIP since Sept 2008
• Multispecialty with OHS

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Oregon NSQIP Consortium
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CAUTI ReductionProduct Conversion to Silver
Hydrogel Coated Urinary Catheters

• Catheter Associated - Nosocomial Urinary Tract
  Infections
• April - June 2005 compared to April - June 2006

Rates per 1000 Patient Days Projected Net Cost
Avoidance 115,700 based on CAUTIs prevented
and projected increased cost of products
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CAUTI Rates 2006-2008 Kern CCUper 1000 device
days
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Overall Urinary Tract Infections
Observed Rate 2.06 Expected Rate 1.53 O/E
Ratio 1.35 Status As Expected
Includes General and Vascular Surgery Cases
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CAUTI Reduction Strategy

• First Step Collaborating
• Chief Nursing Officer and Quality Improvement
  Specialist
• Legacy Initiative to Focus on Infection
  Prevention
• Led to Development of Infection Prevention Bundles

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Foley CatheterBest Practice Bundle

• Sterile technique for insertion
• Always keep drainage bag below level of the
  bladder
• Empty bag before transport
• Prevent dependent loops in tubing
• Secure catheter to decrease movement of foley
• Pericare daily using soap and water with daily
  bath
• Do not allow the bag to overfill
• Do not allow bag to touch floor

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EPIC Documentation Flowsheet
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CAUTI Prevention Process

• Best Practices Literature Review
• CAUTI Prevention Bundle Development
• Educating staff who come into contact with
  patients with catheters, from placement to
  transporting patients
• Monitoring Compliance with CAUTI Bundle
• Process Monitoring Rounds by CNO and ICP
• Provide Feedback Regarding Compliance and CAUTI
  data to staff
• Interactive Case Reviews with Nursing Staff

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Bundle Education
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CAUTI Reduction April 2008 March 2010
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Symptomatic CAUTI Case CountsJune 2010
November 2011
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Quarterly UTI Realtime NSQIP
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Monthly UTI NSQIP
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Overall Urinary Tract Infections
Observed Rate 0.82 Pred. Obs.
Rate 0.93 Expected Rate 1.04 Odds Ratio
0.89 Status Non-Outlier
Includes General and Vascular Surgery Cases
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Conclusions

• The Bundles approach works
• Leadership involvement is essential
• Education, Education and Re-education is required
• Surveillance includes process AND outcomes
  monitoring and feedback to the staff
• Involving care staff in case analysis leads to
  discovery

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Questions?