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NQF-Endorsed®
Safe Practices for Better Healthcare
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
1
Slide Deck Overview
Slide Set Includes:
 Section 1:
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Section 2:
Section 3:
Section 4:
Section 5:
Section 6:
© 2010 TMIT
© 2006 HCC, Inc. CD000000-0000XX
NQF-Endorsed® Safe Practices for
Better Healthcare Overview
Harmonization Partners
The Problem
Practice Specifications
Example Implementation Approaches
Front-line Resources
2
NQF-Endorsed®
Safe Practices for Better Healthcare
Overview
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
3
2010 NQF Safe Practices for Better
Healthcare: A Consensus Report
34 Safe Practices
• Criteria for Inclusion
• Specificity
• Benefit
• Evidence of Effectiveness
• Generalization
• Readiness
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Culture SP 1
2010 NQF Report
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Culture
Structures
and Systems
Culture Meas.,
FB., and Interv.
Team Training
and Skill Bldg.
Risk and Hazards
CHAPTER 2: Creating and Sustaining a Culture of
Safety (Separated into Practices]
 Culture of Safety Leadership Structures and Systems
 Culture Measurement, Feedback, and Intervention
 Teamwork Training and Skill Building
 Risks and Hazards
Consent
& Disclosure
Consent
and
Informed
Consent
Life-Sustaining
Treatment
Care of
Caregiver
Disclosure
Workforce
Nursing
Workforce
Direct
Caregivers
CHAPTER 4: Workforce
• Nursing Workforce
• Direct Caregivers
• ICU Care
ICU Care
Information Management and Continuity of Care
Patient
Care Info.
Read-Back
& Abbrev.
Labeling
Diag. Studies
Discharge
Systems
CHAPTER 3: Consent and Disclosure
• Informed Consent
• Life-Sustaining Treatment
• Disclosure
• Care of the Caregiver
CPOE
Medication Management
CHAPTER 5: Information Management and Continuity
of Care
 Patient Care Information
 Order Read-Back and Abbreviations
 Labeling Diagnostic Studies
 Discharge Systems
 Safe Adoption of Computerized Prescriber Order
Entry
CHAPTER 6: Medication Management
 Medication Reconciliation
 Pharmacist Leadership Structures and Systems
Med. Recon.
Pharmacist Leadership
Structures and Systems
Healthcare-Associated Infections
Influenza
Prevention
Hand Hygiene
Sx-Site Inf.
Prevention
VAP
Prevention
Central Line-Assoc.
BSI Prevention
MDRO
Prevention
UTI
Prevention
Condition- and Site-Specific Practices
Wrong-site
Sx Prevention
Contrast
Media Use
Organ
Donation
Press. Ulcer
Prevention
Glycemic
Control
VTE
Prevention
Falls
Prevention
Anticoag.
Therapy
Pediatric
Imaging
CHAPTER 7: Healthcare-Associated Infections
• Hand Hygiene
• Influenza Prevention
• Central Line-Associated Blood Stream Infection
Prevention
• Surgical-Site Infection Prevention
• Daily Care of the Ventilated Patient
• MDRO Prevention
• Catheter-Associated UTI Prevention
CHAPTER 8: Condition- and Site-Specific Practices
• Wrong-Site, Wrong-Procedure, Wrong-Person
Surgery Prevention
• Pressure Ulcer Prevention
• VTE Prevention
• Anticoagulation Therapy
• Contrast Media-Induced Renal Failure Prevention
• Organ Donation
• Glycemic Control
• Falls Prevention
• Pediatric Imaging
Harmonization Partners
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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Harmonization – The Quality Choir
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The Patient – Our Conductor
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The Objective
Catheter-Associated Urinary Tract
Infection Prevention
 Prevent healthcare-acquired catheter-associated
urinary tract infections (CAUTIs)
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© 2006 HCC, Inc. CD000000-0000XX
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The Problem
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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[http://online.wsj.com/article/SB10001424052970204488304574428950126681432.html]
© 2010 TMIT
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[http://patientsafetyauthority.org/NewsAndInformation/PressReleases/Pages/pr_2009_October_13.aspx]
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The Problem
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The Problem
Frequency
 CAUTIs are the most frequent HAIs in acute care
hospitals
 80% are attributable to an indwelling urethral
catheter
 CAUTIs are associated with increased morbidity,
mortality, hospital cost, and length of stay
[Saint, Infect Control Hosp Epidemiol 2000 Jun;21(6):375-80; Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32]
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The Problem
Severity
 Between 15%-25% of hospitalized patients may
receive short-term indwelling urinary catheters
 In 2002, the Centers for Disease Control and
Prevention estimated that 561,667 CAUTIs
occurred in the United States, contributing to
13,088 deaths
[Warren, Int J Antimicrob Agents 2001 Apr;17(4):299-303; Weinstein, Infect Control Hosp Epidemiol 1999 Aug;20(8):543-8;
Klevens, Public Health Rep 2007 Mar-Apr;122(2):160-6]
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The Problem
Preventability
 Estimated to be 17%-69% with recommended
infection control measures
 380,000 preventable infections and 9,000
preventable deaths related to CAUTI annually
 Limiting catheter use and minimizing the
duration the catheter remains in situ are principal
strategies for CAUTI prevention
 Use of an antimicrobial or silver alloy-coated
catheter reduces risk of CAUTIs
[Saint, Infect Dis Clin North Am 2003 Jun;17(2):411-32; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8; Ciavarella, Infect Control
Hosp Epidemiol 2009 Apr;30(4):404-5; author reply 405-6; Parker, J Wound Ostomy Continence Nurs 2009 Jan-Feb;36(1):23-34]
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The Problem
Cost Impact
 The annual direct medical cost of CAUTI is
estimated to be $565 million in the United States
[Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009]
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Practice Specifications
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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Additional Specifications
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© 2006 HCC, Inc. CD000000-0000XX
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Safe Practice Statement
CAUTI Prevention
 Take actions to prevent catheter-associated
urinary tract infection by implementing evidencebased intervention practices
[Lo, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S41-50; Gould, Guideline for prevention of catheter-associated
urinary tract infections, 2008; Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]
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Additional Specifications
 Document the education of personnel—involved in
catheter insertion, care, management, and removal—
on CAUTI prevention
 Education should occur upon hire and annually
thereafter
 Prior to insertion, educate the patient and family
members about CAUTI prevention
 Identify the patient groups or units on which
surveillance should be conducted, considering
frequency of catheter use and potential risk
 Implement policies and practices to reduce the risk
of CAUTI
[Willson, J Wound Ostomy Continence Nurs 2009 Mar-Apr;36(2):137-54; Kanouff, Crit Care Nurs Q 2008 Oct-Dec;31(4):302-8;
Smith, Am J Infect Control 2008 Sep;36(7):504-35]
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Additional Specifications
 Evidence-based practices include, but are not
limited to, the following:
 Perform hand hygiene immediately before and
after catheter insertion
 Ensure that the supplies necessary are readily
available
 Insert catheters following an aseptic technique
and using sterile equipment
 Leave urinary catheters in place only as long
as indications remain
 Obtain a urine culture before initiating
antimicrobial therapy
[Greene, Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008; Institute for Healthcare
Improvement, Catheter-Associated Urinary Tract Infection (CA UTI) Prevention, IHI Improvement Map, 2009; Joint
Commission Resources, Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, National Patient
Safety Goals, 2010; Barford, BJU Int 2008 Jul;102(1):67-74]
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Additional Specifications
 Measure compliance with best practices,
evaluating the effectiveness of prevention efforts
 Provide CAUTI surveillance data, including
process and outcome measures, to key
stakeholders within the organization
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© 2006 HCC, Inc. CD000000-0000XX
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Example Implementation
Approaches
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
25
Example Implementation Approaches
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© 2006 HCC, Inc. CD000000-0000XX
26
Example Implementation Approaches
 Implement a system for documenting the following
in the patient record:
 indications for catheter insertion
 date and time of catheter insertion
 individual who inserted catheter
 date and time of catheter removal
 Develop and implement facility criteria for
acceptable indications for indwelling urinary
catheter use
[Gokula, Am J Infect Control 2004 Jun;32(4):196-9; Marklew, Nurs Crit Care 2004 Jan-Feb;9(1):21-7]
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Example Implementation Approaches
 Suggested indications for indwelling urethral
catheter use include:
 Perioperative use for selected surgical procedures
 Accurate measurement of urine output in critically
ill patients
 Management of acute urinary retention and urinary
obstruction
 To assist in pressure ulcer healing for incontinent
residents
 As an exception, at patient request to improve
comfort
 Relief of bladder outlet obstruction or congenital
urologic abnormalities
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Example Implementation Approaches
 Following aseptic insertion of the urinary catheter,
maintain a closed drainage system
 Maintain unobstructed urine flow
 Implement an organization-wide program to
identify and remove catheters no longer
necessary; method examples include:
 Automatic stop orders
 Standardized reminders placed into patient
record
 Implementation of daily ward rounds to review
all patients with urinary catheters
[Gould, Guideline for prevention of catheter-associated urinary tract infections, 2009]
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Example Implementation Approaches
Strategies of Progressive Organizations
 High-performing organizations have protocols for
the management of post-operative urinary retention
 Innovations include direct visualization of the
urethra during insertion of catheters
 Implement a system for analyzing and reporting
data on catheter use, including adverse events
[Chapple, 2004 June;93(9)1195-1202; Fenton, Urology 2005 Jun;65(6):1055-8; Agency for Healthcare Research and
Quality, National Healthcare Disparities Report 2008, 2009; Agency for Healthcare Research and Quality, National
Healthcare Quality Report 2008, 2009]
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© 2006 HCC, Inc. CD000000-0000XX
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Front-line Resources
Safe Practice 25
Catheter-Associated Urinary Tract
Infection Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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[http://www.shea-online.org/about/compendium.cfm;
http://www.azdhs.gov/infectioncontrol/pdfs/HAI%20Prevention%20Compendium%20PDFs/CA%20UTI.pdf]
© 2010 TMIT
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[http://www.cdc.gov/media/pressrel/2010/s100202.htm]
© 2010 TMIT
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[http://www.shea-online.org/Assets/files/patient%20guides/NNL_CA-UTI.pdf]
© 2010 TMIT
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[http://www.jointcommission.org/PatientSafety/SpeakUp/]
© 2010 TMIT
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Poster available in Spanish
[http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/ExpeditionPreventingCatheterAssociatedUrinaryTractInfecti
onsAug10.htm?utm_source=email&utm_medium=blast&utm_campaign=cautisep10b1]
© 2010 TMIT
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TMIT National Webinar Series
Catheter-Associated Urinary Tract Infection:
No One Owns It ... We ALL Pay for It! (SP 25)
 Carolyn Gould, MD, MSCR – Topic: The CDC Guideline
for Prevention of CAUTI
 Sanjay Saint, MD, MPH – Topic: CAUTI Prevention: The
Bladder Bundle
 Marcia Patrick, RN, MSN, CIC – Topic: CAUTI
Reduction Using Rapid-Cycle Improvement
 Denise Graham – Topic: APIC Support
 Patti O'Regan, DNP, ARNP, ANP-C, PMHNP-BC –
Topic: The Role of the Patient Advocate
 Go to: http://safetyleaders.org/webinars/indexWebinar_August2010.jsp
(August 19, 2010)
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TMIT National Webinar Series
Healthcare-Associated Infection and You:
Cleaner, Safer Care (SPs 19-25)
 Kathy Warye – Topic: Perspective on the
Development of the Implementation Examples of the
NQF Safe Practices
 Peter Angood, MD – Topic: HAI National Attention
and Harmonization
 David Classen, MD – Topic: HAI Compendium
Harmonization with the Safe Practices
 Julianne Morath, RN – Topic: Implementation
 Jennifer Dingman – Topic: Call to Action
 Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932
(May 14, 2009)
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© 2006 HCC, Inc. CD000000-0000XX
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