Chasing Zero. Reducing Hospital Acquired Conditions in the Intensive Care Unit
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Purpose: There was an increased incidence of CAUTI in the intensive care units as noted by Infection Prevention. The goal was to decrease CAUTI rates to below the NDNQI mean (<1.19) by September 2015.
Methods: There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (A) prevention of inappropriate short-term catheter use, (B) nurse-driven timely removal of urinary catheters, and (C) urinary catheter care. Nursing screening and assessment and evidence-based management of urinary retention and incontinence is essential to reduce catheter overuse. The intensive care units adopted the American Nurses Association evidenced-based tool that incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments, as well as alternatives for retention and incontinence; timely removal; and a checklist on catheter insertion, cues for essential maintenance and post-removal care.
The specific initiatives that were implemented were:
1. Daily foley rounds by a multi-disciplinary team
2. Standardization of the foley kit between ED/OR/ICU as patients were arriving without urometers and necessitating breaking the seal and replacing the collection bag.
3. Isolating foley catheter care with the use of “M-Care” wipes
4. Elimination of unnecessary urine cultures via a prompt within the EMR that reminds staff of the indications for urinary cultures.
5. Stabilization of catheter with “Stat-lock” device rather than an elastic strap which was causing migration of the catheter.
6. Working with transport technicians and educating them to empty the foley bag before the patient travels for procedure(s) outside of the ICU
7. Placing neon color stickers on the foley bag to serve as a reminder to all which read “keep bag below the bladder” particularly when patients were being ambulated.
Findings/Implications: Both the MICU and SICU had reductions in CAUTI incidence with a zero incidence of CAUTI as of 3Q15. CAUTI can be prevented through applications of evidence-based guidelines.