National Expansion Catheter-Associated Urinary Tract Infection Immersion Call

1. On the CUSP: Stop CAUTI National Expansion Catheter-Associated Urinary Tract Infection Immersion Call

2. Overview of Today’s Call • Why this initiative is important • Project overview: • Expected outcomes • What it requires • Comprehensive Unit-Based Safety Program • Data requirements • What are the next steps

3. Project Goals • Reduce CAUTIs in participating units by 25% • Appropriate placement • Appropriate continuance • Appropriate utilization • Improve patient safety culture on participating units

4. Project Overview

5. National Project Team

6. Why This Initiative is Important • 600,000 patients develop hospital acquired UTIs per year • This accounts for 40% of all hospital acquired infections • Catheter associated infections (CAUTI) comprise 80% of these cases

7. Why This Initiative is Important • 5 million urinary catheters placed per year (US) • 80% of UTIs are catheter associated • Catheter-risk of bacteruria: • Per day: 5% • 1 week: 25% • 1 month: 100%

8. Why This Initiative Is Important Reduction in UC use by about 20% at St. John Hospital in Michigan Similar levels of reduction seen in hospitals across Michigan (unpublished data)

9. CUSP & CAUTI Interventions CUSP CAUTI • Care and Removal Intervention • Removal of unnecessary catheters • Proper care for appropriate catheters • 2. Placement Intervention • Determination of appropriateness • Sterile placement of catheter 1. Educate on the science of safety 2. Identify defects 3. Assign executive to adopt unit 4. Learn from Defects 5. Implement teamwork & communication tools

10. Care and Removal at a Glance Intervention Group (1 - 2 units) Week 1-3 10 days Pre-intervention: UC data collection w/analysis of need Intervention: UC data collection w/analysis of need plus nursing staff education/ intervention. Rationale given to obtain orders to dc non needed Foleys with nursing Week 3-4 10 days Week 5-12 8 days Post-intervention: UC data collection w/analysis of need, once a week for 8 weeks Quarterly Post-intervention: UC data collection w/analysis of need, once a week each quarter

11. Insertion at a Glance Intervention Group (ED or OR) Pre-intervention: UC data collection w/analysis of need Intervention: UC data collection w/analysis of need plus nursing staff education/ intervention. Rationale given to obtain orders to dc non needed Foleys with nursing Post-intervention: UC data collection w/analysis of need, once a week for 8 weeks Post-intervention: UC data collection w/analysis of need, once a week each quarter

12. Expected Outcomes Increased awareness of appropriate indications for indwelling urinary catheter use Reduced use of indwelling urinary catheters Improved caregiver accountability to assess need and trigger UC discontinuation when UC no longer necessary Reduced risk of urethral trauma with reduction in utilization Reduced patient discomfort

13. Expected Outcomes Reduction in bacteriuria Reduction in symptomatic UTIs Shortened Length of Stay Decreased Cost per stay Improved sensitivity to “patient dignity”

14. Comprehensive Unit-based Safety Program (CUSP) An Intervention to Learn from Mistakes and Improve Safety Culture • Educate staff on science of safety http://www.safercare.net • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools Timmel J, et al. Jt Comm J Qual Patient Saf 2010;36:252-260.

15. What Participation Requires Hospital Unit The Hospital Unit will need to: Participate for the length of the project Assemble team Assign team leader (10% effort) Engage executive champion Engage physician champion Submit data Hold monthly patient safety meetings Listen to content and coaching calls

16. What Participation Requires Data Submission

19. Data Collection Schedule

20. What are the Next Steps

21. Who to Contact with Questions Kristina Davis, Research Specialist, HRET kdavis@aha.org 312-422-2644