Objectives

1. Preventing Catheter-Associated Urinary Tract Infections (CAUTI) in a Rehabilitation Facility -- Meeting the Standards Lisa Harris RN CIC, Leslie Forrester MA MSc, Jennifer Grant MDCM FRCPC Vancouver Coastal Health Authority, Division of Medical Microbiology and Infection Control Objectives Interventions Conclusions 1. Determine CAUTI and UTI rates on a spinal rehabilitation ward. 2. Assess practices to prevent CAUTI. 3. Identify practice gaps with new practice guidelines (1) 4. Change practices to meet standards. 5. Provide ongoing surveillance and feedback to care providers. • UTI rates are high in spinal cord rehabilitation clients • Best practice is not always followed • Intervention, including: • Education • Implementation of standards • Ongoing surveillance and feedback • has a measurable impact in reducing CAUTI rates Introduction Future Steps GF Strong Rehabilitation Center provides in-patient rehabilitation to clients with spinal cord injury, acute brain injury, arthritis and neuromuscular disease. Urinary catheters are most prevalent in the spine injury and acute brain injury client groups. Surveillance for CAUTI began with a point prevalence study, which identified spinal rehabilitation patients as being at highest risk. Monthly surveillance continued for all wards. Review of the new guidelines identified differences in practice and opportunities to decrease CAUTI. Innovative new practices were introduced to facilitate practices that are appropriate for both healthcare and for eventual client discharge. Figure 1: novel leg-bag arrangement Left picture is day bag Right picture is night bag system • Ongoing surveillance and timely reporting of results • Review clean technique taught to clients (for home use) • Review changing indwelling catheter at one month interval • Develop video of aseptic technique • Expand guideline practices to wards at other sites Results Figure 2: Results of point prevalence study. References Surveillance • Gould, C.V. et al. HICPAC Guideline. Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. ICHE, April 2012, vol. 31, no.4. • VCH U-100 urinary catheter guidelines • Point Prevalence Study: A point prevalence study was conducted by chart review on a single day in April 2010. Patients were identified as having a catheter and/or a UTI based on nursing notes, microbiological data and treatment records. • Surveillance: The microbiology database was searched retrospectively for urine culture results. The client chart was reviewed to identify if the clinical team identified UTI (e.g. treated with appropriate antibiotic) and if patient had a catheter in place. Catheter days data was not collected. • Reporting: Surveillance data was reported monthly to physicians, client-care coordinators, educators, and administrators. Acknowledgements • The authors gratefully acknowledge the contributions of the staff and physicians at GF Strong Rehabilitation Center and the Microbiology Department at Vancouver General Hospital Fig 3: UTI rate overall showing statistically significant decrease in rates of UTI Fig 4: Ongoing surveillance of CAUTIs. Downward trend on SCI ward depicted with dotted line