CAUTI (Catheter Associated Urinary Tract Infection)

Reduction Project

Instructions / Guidelines

Objectives

Reduce Catheter Associated Urinary Tract Infections (CAUTI)

Meet SCIP Guidelines established by TJC (Beginning October 1, 2009)

Protecting 5 Million lives from harm

Provide evidenced based guidelines for foley catheter removal

Foley Catheters Cause

 Infections,  Length of stay (0.5-1 day),  Cost $$$ ($500-$3000/event),  Antibiotic Usage ( drug resistance), Patient Discomfort ,  Risk of falls (tethered to bed1 point restraint),risk of skin breakdown, DVT and pneumonia due to immobility

Urinary Tract Infection (UTI) and Indwelling Catheters

UTI - #1 Healthcare Associated Infection (HAI) directly associated foley catheters,

40% of all HAI are caused by UTI; 80% of these are secondary to foley catheters,

Risk of infection  5% each day,  25% @ one week, 100% @ 1 monthfoley is in use

When to Discontinue Foley Catheters?Beginning ~ January 1, 2010

Foley Catheter Decision-Making Algorithm (See Addendum #1)

Foley Catheter Checklist (See Addendum #2)

Foley Catheter Checklist Sticker (See Addendum #3)

MD alert sticker (See Addendum #4)

Nursing Assessment in GECE(See Addendum #5)

Post “STOP Nauti Cauti” Flyer On the Unit to remind staff to D/C the Foley (See Addendum #6)

How does this apply to nursing?

Nurses need to advocate for the removal of unnecessary foley catheters.

Use of the criteria-based guidelines that are specific to each unit.

Mandatory education in eILN beginning January 2010

Nursing Guidelines

Use the decision-making algorithm.

Use Criteria-Based Foley Catheter Checklist daily for patient’s with indwelling foley catheters

If no criteria on the checklist are met, obtain a doctor’s order to D/C the foley catheter

Some of the “OTHER” possible indications that may be used for exclusion of foley catheter removal (Remember: DOCUMENTATION is necessary for exclusion rationale!):head injury; spine not clear; clinical need, i.e. chemically paralyzed and sedated,24 hour urine collection; crush injury; pelvic fracture; strict hourly I&O

Alternatives to Foley Catheters

External Catheter (Texas or Condom Catheter)

In Out Catheter (Less risk of infection than indwelling foley catheter)

New Ultrasorb pads (Replaced Chux)

Timed toileting

Foley Catheter Days: Beginning January 1, 2010, collect the number of patients with foley catheters at the same time EVERY day. Fax monthly to 7815(EX: some units are adding this to the charge nurse report and gathering the # of Foley Catheters in the AM during safety huddle)

Education in employee portal beginning January, 2010

Addendum #1

Addendum #6 Unit Flyer

Foley Catheter Days 2010
January / February / March
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL

Recommendation:

Count the number of patients on your unit with a Foley at the same time every day.

At the end of the month total the column and fax to 7815

Foley Catheter Days 2010
April / May / June
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL

Recommendation:

Count the number of patients on your unit with a Foley at the same time every day.

At the end of the month total the column and fax to 7815

Foley Catheter Days 2010
July / August / September
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL

Recommendation:

Count the number of patients on your unit with a Foley at the same time every day.

At the end of the month total the column and fax to 7815

Foley Catheter Days 2010
October / November / December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL

Recommendation:

Count the number of patients on your unit with a Foley at the same time every day.

At the end of the month total the column and fax to 7815

CAUTI 12-2009 KW