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Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
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A focus on Preventing CAUTI
Catheter Associated Urinary Tract Infections or CAUTI’s are preventable and account for 15% of all hospital acquired infections...every day a catheter is in place the risk of infection increases. 

At the start of 2012, Mass General launched a CAUTI Prevention Working Group to design a interventions that would encourage appropriate use of indwelling urinary catheters, correctly securing the catheter, as well as timely removal. And staff responded to the challenge. CAUTI rates in General Care have decreased from 0.94 to 0.38, while the ICU rates decreased from 5.64 to 1.71. (Oct.-Dec. 2013 to July-Sept. 2015).

click here for information about efforts to reduce CAUTI rates at Mass General

MGH NARRATIVES

Improving CAUTI rates at the unit level
The clinical staff of Blake 12 made a commitment to improve their CAUTI rates with one simple evidence based practice:  “Daily review of the need for the catheter.” Every day Donna Slicis, Attending RN on Blake 12, conducted catheter rounds with staff. Using a checklist of the MGH approved indications....more

MGH CAUTI RESOURCES

The most effective means to prevent a CAUTI is to remove the catheter ASAP!

A.R.M. your patients against CAUTI by:

Avoid the use of catheters…consider Alternatives (See toolkit)

Reduce the number of days a catheter is in place by regularly assessing the need for              
the catheter. Remember the most effective means to prevent CAUTI is to remove the
catheter as soon as possible. If the correct POE order template (see toolkit) is used
a daily electronic reminder will be triggered.  Without an order or use of a scripted 
order this step is missed

Maintain the catheter below the level of the bladder and avoid dependent loops. Perform daily catheter care using warm soap and water. Maintain a closed system and avoid disconnecting the catheter from the drainage bag. Use only the sterile port to obtain urine specimens. Secure the catheter to to prevent urethral trauma and traction.  Insert catheters using aseptic technique.

MGH CAUTI Toolkit

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MGH Contacts:

For more information about CAUTI or improvement strategies, please contact your:

 
THE DATA

Infection Control
MGH tracks Catheter Associated Urinary Track (Cauti) infection rates in the ICU areas, and since January  2012, PCS QS conducts surveillance in the general care areas. MGH rates are compared to national benchmarks that are published by the Centers for Disease Control’s National Healthcare Safety Network (NSHN). Additionally, Device Utilization Rates DUR are tracked and reported quarterly.

 

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Utilization Rates click here

Infection Rates click here

IMPROVEMENT INITIATIVES
FYIs

CAUTIs are the most common hospital-acquired infection worldwide and account for up to 15% of nosocomial infections in US hospitals each year. CAUTIs are associated with increased LOS. Duration of catheterization is the single most important risk factor for CAUTI. Urinary catheters are often placed unnecessarily or for convenience and may not be removed promptly when no longer needed.

Since January 1, 2012, the CAUTI rate in all adult and pediatric ICUs (except for the NICU) has been reported to CDC, as mandated by the Center for Medicare and Medicaid Services (CMS). Prevention of CAUTIs as part of a 2012 National Patient Safety Goal.

Beginning in 2011, members of the Infection Control Unit, Patient Care Services, Partners IS, the Center for Quality and Safety and the Surgical Care Improvement Project began meeting as the CAUTI Prevention Working Group to design an intervention that would encourage appropriate use of indwelling urinary catheters, documentation of reason for continued use of catheter, as well as timely removal.

Intervention
The Working Group developed a Provider Order Entry (POE) system with the following elements: Implementation of the POE templates rolled out in July 2012

  1. When ordering an indwelling urinary catheter, providers must choose from a list of acceptable indications. The indications have been derived from national guidelines and vetted with multiple specialties within MGH including general surgery, adult urology, pediatric urology, pediatric quality and safety and the acute pain service.
  2. Based on those chosen indication, providers will receive timed assessment reminders prompting them to re-evaluate the continuing need for the indwelling urinary catheter.

Outcome:
Since implementation of the POE templated orders for catheter removal in July 2012, compliance with the urinary catheter quality measure as part of the Surgical Care Improvement Project (SCIP-9) has increased from 89.9% to 98.9% between Q1 and Q4 2012. Efforts that have contributed to the increase in SCIP-9 compliance include institution of concurrent record reviews for all surgical patients admitted to six inpatient units with the highest concentration of historical SCIP-9 failures (beginning June 2012), the POE intervention requiring documentation of the indication for all urinary catheters (beginning July 2012) and broad educational efforts across the hospital raising the profile of CAUTI Quality Improvement efforts (beginning July 2012).

 


REFERENCES

“Nurse-directed interventions to reduce catheter-associated urinary tract infections”

Oman, K. S., Makic, M. B., Fink, R., Schraeder, N., Hulett, T., Keech, T. & Wald, H. (2012). Nurse-directed interventions to reduce catheter- associated urinary tract infections. American Journal of Infection Control, 40(6), 548-553.

Ben Franklin

 

Did You Know?

Benjamin Franklin is considered to be the inventor of the first flexible urinary catheter.  His older brother John suffered from frequent kidney stones. Ben created a pliable bendable catheter to decrease his discomfort.

 

EXTERNAL REVIEWERS

According to the Centers for Disease Control (CDC), each year, millions of people acquire an infection while receiving care, treatment, and services in a health care organization.

Joint Commission logo
The Joint Commission's National Patient Safety Goal number #7 Focuses on: Reduce the risk of health care associated infections or HAI’s.   Goal number 07.06.01 addresses the implementation of evidence –base practices to prevent indwelling catheter-associated urinary track infections.

More information: Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals at http://www.shea-online.org/about/compendium.cfm

More info on:
National Patient Safety Goal: NPSG.07.06.01

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Joint Commission Accreditation Manual

CMS logo
Centers for Medicare and Medicaid Services (CMS)

Magnet Recognition

Magnet_logoThe American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhancing patient outcomes. Examples of NSIs include, but are not limited to: patient falls, hospital-acquired pressure ulcers, blood stream infections, ventilator-associated pneumonia, and restraint use.

 

 

 

 

 

 

 

 

 

 

 

GLOSSARY OF TERMS

There are numerous terms and acronyms in healthcare that may be unfamiliar. Please click here to visit a Glossary of Terms that may be helpful. And please email any suggested additions.

This month's featured term: CAUTI
When a patient develops a urinary tract infection and has had an indwelling urinary catheter in place for > 2 calendar days, and the patient did not have evidence of an infection on admission, it is considered a healthcare-associated Catheter-associated Urinary Tract Infection or CAUTI. Also, if an indwelling urinary catheter was in place for > 2 calendar days and then removed and the patient develops a UTI on the day of discontinuation or the next day, this is also considered a CAUTI. A combination of specific symptoms, urine culture results and in some cases urinalysis results are used to define a CAUTI

Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
If you have questions or suggestions related to the EED portal, please contact Georgia Peirce at (617) 724-9865 or via email at gwpeirce@partners.org.

updated 5/27/16

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