CAUTI: What are we testing? - Christoph Lecznar, BSN, RN, CCRN, TCRN Interim Nurse Clinician, Surgical-Trauma ICU VCU Health, Richmond, VA ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
CAUTI: What are we testing? Christoph Lecznar, BSN, RN, CCRN, TCRN Interim Nurse Clinician, Surgical-Trauma ICU VCU Health, Richmond, VA christopher.lecznar@vcuhealth.org 1/4/2021
Problem
Catheter Associated Urinary Tract Infections (CAUTI) are
noted to have detrimental effects on mortality, morbidity,
hospital length of stay, and facility reimbursement.
CAUTI 1/4/2021 2
About Us
• Academic Level 1 Trauma medical center
• Surgical Trauma ICU 28-bed unit
• 2019 3rd AACN Beacon Award: Silver
• Variety of specialties including:
• Emergency General Surgery
• Trauma
• Liver and Kidney Transplants
• Surgical Oncology
• Orthopedics
• Urology
• Colorectal
• Otolaryngology
CAUTI 1/4/2021 3
Background
• In 2008 CMS deemed CAUTI to be a “never event” tying it to reimbursements. (Saint et al. 2009)
• CDC states 17-69% of CAUTIs may be preventable with recommended infection control
measures.(NHSN, 2021)
• UTIs are the 5th most common type of HAI, with an estimated occurrence of 9.5% reported by
acute care hospitals.(NHSN, 2021)
• Every day a catheter is in place, the risk of CAUTI is increased by 3-7%.(NHSN, 2021)
• Current recommendations for prevention include educational strategies, catheter avoidance,
policies for catheter insertion, daily review of necessity(Shuman et al., 2018), and urine testing
stewardship(Mullin et al., 2017) have been reported to decrease CAUTI rates.
CAUTI 1/4/2021 4
Methodology
First Notification Implementation of
of CAUTIs practice change
2019
2020
• Delay in notification of CAUTIs: COVID related Modifiable risk factors: 7 Day period
• Daily CHG bathing – 98%
• Drill downs resulted 90% did not meet testing
• Daily assessment of need – 100%
criteria • Foley Care – 100%
• 98% had all of the “nursing” modifiable risk • Active Foley order – 63%
factors • Reflex testing ordered – 50%
• Did it meet testing criteria? – Only 10% met criteria
CAUTI 1/4/2021 5Methodology
• Collaboration with medical director
• What is the criteria for testing?(O'Grady et al. 2008)
• ACCCM/IDSA guidelines for fever workup
• Kidney Transplant recipients
• Neutropenia
• Recent GU surgery
• Evidence of urinary Obstruction
• Pregnant
• Why were we testing if patients didn’t meet
criteria?
• Fever
• Are we testing the most accurate sample?
CAUTI 1/4/2021 6Intervention
Education to Nurses and Implementation of Practice
Providers Change
• Difference between CAUTI and
CAASB If we do test, replace the Foley
• Evidence on CAUTI and catheter.
symptoms
Sabir et al. sought to find the
• Difference between Cystitis and Why? Biofilm incidence of biofilm-based CAUTI
Pyelonephritis
• 1070 patients – 840 (78.5%)
• A functioning catheter is source male & 230 (21.5%) female
control
• Incidence of biofilm 73% (785
• Evidence of CAUTI and Fever patients)
• Indications to test • Medan duration after which
biofilm was detected 5.01 +/-
1.31 days
CAUTI 1/4/2021 7Intervention
Multi-Disciplinary Follow up:
• Nursing was instructed to escalate any UAs to Charge Nurse or Unit
Leadership, AND to Attending Physician
• When UA was ordered and sent, I followed up with RN individually
• I forwarded to Medical Director for provider accountability
CAUTI 1/4/2021 8Timetable
Date of our Last Education Presented Began collecting
CAUTI provided to education to prevalence data
nursing staff via Acute Care
Notified PowerPoint and Surgical Services.
September 14, LMS Provided ANCC,
2020 AAPA, and CME
credit.
CAUTI 1/4/2021 9Results
September 15th- December 23rd
57 Day x 28 Beds = 1,596 possible Data Points
56 times bed was empty during prevalence
1540 total data points
121 Total Urinalyses sent to lab
75 were sent as Pre-op/ED work up
7 Met Criteria – Urine obstruction, Recent GU surgery or Organ Donation
39 UAs sent that did not meet criteria
CAUTI 1/4/2021 10Results
STICU Urine Culture Rate
13 13
12.3
11.9
Urine Cx p/100 device days
11.1 11
10.4 10.7
10.2 9.9
8.8
8.4 8.3 8
6.3
5.9 5.9 5.6 5.8
4.9 5
3.8
2019 2020
2.4
Implementation
0
CAUTI 1/4/2021 11Results
0
Number of CAUTIs since practice change
CAUTI 1/4/2021 12Conclusion
A focus on urine testing stewardship, implementation of a urine specimen practice change, and
multidisciplinary accountability has resulted in 0 CAUTIs and decreased urine testing.
This practice change can be implemented on any unit in any inpatient setting.
Our success with urine testing stewardship is due to the collaboration with medical director.
Without her support testing would continue to be an issue.
Cost of a new Foley Catheter can be compared to cost of CAUTI. However, when factoring this
cost it should be factored with additional length of stay, antibiotics, and potential detrimental
effects of antibiotic usage, ie increased risk of C-Diff, etc.
CAUTI 1/4/2021 13Contact
Christoph Lecznar, BSN, RN, CCRN, TCRN
Interim Nurse Clinician, Surgery Trauma ICU
VCU Health, Richmond, VA
804.828.9616 (office)
Christopher.lecznar@vcuhealth.org
CAUTI 1/4/2021 14References
Mullin, K.M., Kovacs, C. S., Fatica, C., … Fraser, T. G. (2017). A multifaceted approach to reduction of catheter-associated urinary tract infections in the intensive care
unit with emphasis on "stewardsip of culturing". Infection Control & Hospital Epidemiology 38(2), 186-188. http://doi.org/10.1017/ice.2016.266
National Healthcare Safety Network. (2021). NHSN Patient Safety Component Manual. Centers for Disease Control and Prevention. Accessed on January 4, 2021.
Retrieved from https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
O'Grady, N., Barie, P. S., Bartlett, J. G., … Masur, H. (2008). Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College
of Critical Care Medicine and the Infectious Diseases Society of America. Critical Care Medicine 36(4), 1330-1349. http://doi.org/10.1097/CCM.0b013e318169eda9
Sabir, N., Ikram, A., Zaman, G., … Ahmed, P. (2017). Bacterial biofilm-based catheter-associated urinary tract infections: causitive pathogens and antibiotic resistance.
American Journal of Infection Control 45(10), 1101-1105. http://doi.org/10.1016/j.ajic.2017.05.009
Saint, S., Meddings, J. A, Calfee, D., … Krein, S. L. (2009). Catheter-associated urinary tract infection and the medicare rule changes. Annals of Internal Medicine
150(12), 877-884. http://doi.org/10.7326/0003-4819-150-12-200906160-00013
Shuman, E. K., & Chenoweth, C. E. (2018). Urinary Catheter-associated infections. Infectious Disease Clinics of North America 32(4), 885-897.
http://doi.org/1016/j.idc.2018.07.002
Tambyah, P. A., & Maki, D. G. (2000). Catheter-associated urinary tract infections in intensive care unit patients. Infection Control and Hospital Epidemiology 11(36),
1330-1334. http://doi.org/10.1017/ice.2015.172
Tedja, R., Wentink, J., O'Horo, J. C., Thompson, R., & Sampathkumar, P. (2015) Catheter-associated urinary tract infections in intensive care unit patients. Infection
Control & Hospital Epidemiology 36(11), 1330-1334. http://doi.org/10.1017/ice.2015.172
CAUTI 1/4/2021 15You can also read
