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Preventing CAUTI: A patient-centered approach - APIC

Preventing cauti : A patient- centered approachPhoto By francIs BlacK infection prevention community must assure that ongoing cauti prevention programs are inclusive and MaRiLyn HanCHett, Rn, Ma, CPHQ, CiC42 | Autumn 2012 | Prevention Catheter-associated urinary tract infection ( cauti ) is widely recognized in the United States as the most common healthcare-associated infection (HAI), representing an estimated 40 percent of all cauti has been shown to increase patient mortality and morbidity, increase length of stay, and add to the cost of Not only is cauti a challenge in acute care, the prevalence of catheters in nursing homes expands the need for eff ective clinical prevention programs across the health services valid measures for cauti are diffi cult to obtain.

Preventing CAUTI: A patient-centered approach Photo By francIs BlacK / istocKPhoto.com The infection prevention community must assure that ongoing CAUTI prevention

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Transcription of Preventing CAUTI: A patient-centered approach - APIC

1 Preventing cauti : A patient- centered approachPhoto By francIs BlacK infection prevention community must assure that ongoing cauti prevention programs are inclusive and MaRiLyn HanCHett, Rn, Ma, CPHQ, CiC42 | Autumn 2012 | Prevention Catheter-associated urinary tract infection ( cauti ) is widely recognized in the United States as the most common healthcare-associated infection (HAI), representing an estimated 40 percent of all cauti has been shown to increase patient mortality and morbidity, increase length of stay, and add to the cost of Not only is cauti a challenge in acute care, the prevalence of catheters in nursing homes expands the need for eff ective clinical prevention programs across the health services valid measures for cauti are diffi cult to obtain.

2 Utilization of indwelling catheters in non-hospital settings is thought to be high, but estimates vary. Introduction of the updated National Healthcare Safety Network (NHSN) cauti defi nition by the Centers for Disease Control and Prevention (CDC) in 200 has helped defi ne criteria more clearly. Earlier studies may have combined cases of asymptomatic bacteruria with active infections and skewed the published the measurement challenges, cauti is among those HAIs targeted for sig-nificant improvement, based on evidence showing that more than 50 percent of these infec-tions are momentum for changeOver the past three years, nu-merous initiatives have helped escalate and sustain the national demand for improved cauti outcomes.

3 For example, when the Department of Health and Human Services (HHS) introduced the HAI Action Plan in 200 , cauti was among the HAIs targeted for a 25 percent reduction over fi ve years. Also that year, the CDC s Healthcare Infection Control Practices Advisory Committee updated its cauti Guideline. Th e Joint Commission approved a new National Patient Safety Goal specifi c to cauti , and other accrediting organizations have focused on it as long aft er these changes occurred, new federal funding supported extensive state-based HAI prevention activities. Seven states launched collab-oratives targeting cauti as part of their specifi c prevention plans.

4 Eff orts by private orga-nizations such as Leapfrog and the Institute for Healthcare Improvement (IHI) also helped reinforced the need to include cauti among the national prevention recently, the Centers for Medicare & Medicaid Services began requiring cauti re-porting via NHSN for adult and pediatric ICUs in acute care hospitals beginning in January 2012, and for long-term acute care hospitals and inpatient re-habilitation facilities beginning in October 2012. Additionally, the draft of the long-term care (LTC) chapter of the HAI Action Plan focused on target-ing and measuring urinary tract infections in LTC e goal of these major proj-ects is not the elimination of all catheter use.

5 Instead, the goals have been the appropriate use of catheters and the safest pos-sible management during the period when they are necessary. As in the previous national cen-tral line-associated bloodstream infection (CLABSI) reduc-tion eff orts started 10 years ago, prompt device removal is a key component of this enhanced approach . A lesson from the early cauti projects was that traditional approaches were insuffi cient in achieving the im-provement targets identifi ed at both the federal and state levels. A new approach was | Autumn 2012 | 43 Table 1 Using the Four E s of implementation science* to develop a cauti prevention planFields have been completed using examples and are not intended as a comprehensive list.

6 General activityEssentials of cauti prevention (evidence based)Adaptation of interventions for this organizationIdentified gaps (knowledge, skills, behavior, resources, etc.)Measures to address gapsKey resources for implementationEnGAGEE xplain why the interventions are presented to all for prevention is clear, concise, is part of Patient Safety , visible participation by senior leaders and institutional champions (all levels).Determine which groups are already engaged and if others need greater that cauti prevention has a high profile/priority within the organization s safety novel, creative ways to showcase the involvement of senior leaders, including medical to see that all stakeholders are involved.

7 Groups often overlooked include the lab, EVS, and patient : Full engagement is required for the remaining three general activities (educate, execute, and evaluate) to be successful. Address any gaps with a targeted plan, include time HAI Action Plan (2009)See also CDC HAI incidence data, progress reports at evidence supporting the cauti data, including morbidity, mortality and cost regarding use of prevention need for thorough, accurate medical record and reinforce correct indications for catheter use, insertion and previous practices that should not be and reinforce organization standards for new content to what may have been used in the past. Address discrepancies, including practices no longer used.

8 Verify accurate baseline knowledge among staff before : Do not assume that care staff familiar with catheters know current best practices. Outdated information can be difficult to eradicate; long standing care routines are often resistant to Guideline for the Prevention of cauti (2009)SHEA/IDSA Compendium of Strategies to Prevent HAIs in Acute Care Hospitals (2008)ExECUTED esign an intervention cauti staff/patient/family rigorous monitoring and offer frequent a cauti use of a cauti need for alerts to physician and nurses re: potential catheter catheter review to daily and checklist are important but must be analyzed in terms of attitude and behavior. Determine of the structural, programmatic as well as behavioral elements are aligned for successful : Encourage care staff to suggest improvements to the implementation plan.

9 Small adjustments can offer large benefits in the overall success of the Implementation (formerly Elimination) Guide, cauti (2009)EvAlUATER egularly assess performance measures and unintended measures of success and report progress per errors and lapses as opportunity to patients /families in evaluation , celebrate both process and outcome measures for progress towards goals at least once per progress to other local, regional, and national both the program statistics as well as procedural compliance. Include students if they handle catheters. Do not overlook the opportunity for ongoing understanding and use of correct aseptic : Use statistics wisely; do not overwhelm staff with data.

10 Follow up on any complaints or adverse events in a non-punitive measure. Consider use of organizational results to state, regional and national data, as available. Consider use of CDC cauti SIR reporting in from Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008 Oct 6;337:a1714*Implementation science: the use of scientifically valid methods to promote the integration of research findings and other best practices into the evolving standard of care. In this way, research not only moves from the laboratory to the beside, but also results in improved, safer and more cost effective reference: Saint S, Howell J Krein SL, Implementation Science: How To Jumpstart Infection Prevention Infect Control Hosp Epidemiol.


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