“Enhancing Patient Care Through Research” Tuesday 24 th May 2016
“ The role of care bundle in the prevention of Catheter-associated urinary tract infections” A review of literature
Presented By : Anju S Menon Staff Nurse-Surgical Cork University Hospital
What are Care Bundles? Urinary Catheter Care Bundle Literature Review Care bundle components & Prevention of CAUTI
Standards of care are generally defined by evidence based guidelines, e.g. infection control guidelines: SARI guidelines (Ireland) CDC guidelines (USA) EPIC/NICE guidelines (UK)
At least 35- 50% of HCAI’s are associated with only 5 patient care practices: Use and care of urinary catheters Use and care of vascular access lines Therapy and support of pulmonary functions Surveillance of surgical procedures Hand hygiene and standard precautions
What are they & why use them?
A Care Bundle is a collection of interventions (usually 3-5) that are evidenced based A Care Bundle is a means to ensure that the application of all the interventions is consistent for all patients at all times thereby improving outcomes
Many thousands of UTIs are linked to the insertion of an indwelling catheter (Saint 2000) UTI is the most common Health Care acquired infection 80% related to urinary catheters in Acute Hospitals Ireland 40% of hospitalized patients In Ireland are catheterized at some stage during admission (SARI 2009)
To optimize the care of patients who require urinary catheterization during acute care To ensure that urinary catheters are removed as soon as clinically indicated.
12 standards 1. Governance 2. Implementation of infection prevention and control 3. Infrastructure 4. HR 5. Communication 6. Hand hygiene 7. Prevention of cross infection 8. Invasive medical devices 9. Microbiology laboratories 10. Outbreak management 11. Surveillance 12. Antimicrobial resistance
A CAUTI rate analysis in 4 general medical units in a 120 bedded hospital in New Haven ↓ pre and post interventional cohort ↓ 32 CAUTI in 2002-pre interventional ↓ 10 CAUTI -post interventional approach ↓ 2 -CAUTI in the 3 rd post interventional phase in 2004. (Topal et al 2005).
A bundle of evidenced based interventions implemented ↓ Used in 28-bed unit Acute Care Medicine Unit,(US) ↓ significant reduction in CAUTI. 0-CAUTI in 2012 ↓ ( Carter et al 2014)
Interventional nurse directed catheter removal In a 300 bed community teaching hospital in Connecticut ↓ 50% hospital wide reduction in catheter use ↓ 70% reduction in CAUTI over a 36 month period ↓ This study focused on reduction in catheter associated urinary tract interventions ↓ ( Parry et al 2013)
A multidisciplinary team ↓ Implemented urinary catheter bundle ↓ Focus - continual assessment and prompt catheter removal. ↓ Results included an overall reduction of 71% in catheter device days and a 56% reduction in catheter use (Andreessen et al 2012).
By meta-analysis (11 studies)reviewed ↓ The rate of CAUTI (episodes per 1000 catheter- days) was reduced by 53% by use of evidenced based interventions ↓ Using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. (Meddings et al 2014)
NHS Greater Glasgow - A district general hospital ↓ Quality improvement (QI) initiative
■ Cycle 1: Bundle tested on 1 patient ■ Cycle 2: Bundle modified and tested on 1 patient ■ Cycle 3: Modified bundle tested on 5patients ■ Cycle 4: Modified bundle tested on all patients ■ Cycle 5: Modified bundle implemented with all patients with a urinary catheter
Despite the variation, CAUTI rates were relatively low QI approach to catheter use and catheter care can reduce catheter usage and ensure the patient receives optimal research-based care. (Mavin et al 2015)
Insertion Insert only for specific reasons -Monitoring Urinary output in critical ill -Bladder outlet obstruction or neurogenic bladder dysfunction -Prevent contamination of sacral wounds -Terminal care Competent HCW to insert Aseptic technique Closed system with bag below bladder
Management Review need for catheter daily Empty when ¾ full and use clean container for each patient Secure catheter to leg/abdomen Urine samples from sampling port only Hand hygiene & PPE before and after any catheter care
SARI Guidelines on Prevention of Catheter Related Urinary Tract Infections published 2011 Care Bundle is published with the guidelines(HPSC-HSE)2011
1) Check the clinical indication why the urinary catheter is in situ – is it still required? 2) Check the catheter has been continuously connected to the drainage system.
3) The patient is aware of his/her role in minimizing the risk of developing a urinary tract infection or ensure routine daily meatal hygiene is performed. 4) Regularly empty urinary drainage bags as separate procedures, each into a clean Container
5) Perform hand hygiene and wear gloves and apron prior to each catheter care procedure; on procedure completion, remove gloves and apron and perform hand hygiene again .
As many as 65% – 70% of cases of CAUTI may be preventable with current evidence-based strategies. CAUTI is the most preventable HAI (Umsheid et al 2011)
Summary Findings suggest that 100% prevention of HAIs may not be attainable with current A Care bundle is a simple tool used to evidence-based prevention strategies; improve reliability in care delivery. however, comprehensive implementation of such strategies could prevent hundreds of In relation to Urinary Catheter: thousands of HAIs and save tens of Points to Remember Thousands of lives and billions of dollars. • Don’t put them in-unless clinically (Umsheid CA, et al 2011) indicated • Look after them properly • Get them out ASAP
www.hpsc.ie Centers for Disease Control and Prevention (2011). Guidelines for the prevention of intravascular catheter-related infections. O Grady et al Health Information Quality Authority (2009). National Standards for the Prevention and Control of Healthcare Associated Infections. Health Protection Surveillance Centre. (2009). SARI Prevention of Intra- Vascular related Catheter Infections in Ireland. Topal.J.,Conklin.S.,Camp.K.,Morris.V.,Balcezak.T.&Herbert.P.(2005)Prevent ion Of Nosocomial catheter associated urinary tract infections through computerised feedback to physicians and a nurse directed protocol. American Journal Of Medical Quality, 20(3), pp. 121-1 Control, Volume 41, pp. 1178-1181. Parry.F.M.,Grant.B.& Sestovic M.(2013) Successful reduction in catheter- associated urinary tract infections:Focus on nurse -directed catheter removal. American Journal of Infection Control, Volume 41, pp. 1178-1181. Umsheid CA, et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hospital Epidemiology 2011; 32:101-14.)
Centers for Disease Control and Prevention (CDC). (2014). Catheter- associated urinary tract infection event. Retrieved from http://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf Dailly, S. (2011). Prevention of indwelling catheter-associated urinary tract infections. Nursing Older People, 23(2), 14 – 19. Carter,N.M., Reitmeier,L., Goodloe ,R.L .(2014). An Evidence-based Approach to the Prevention of Catheter Associated Urinary Tract Infections. Urologic Nursing, 34(5):238-240. EPIC 2: National Evidence-Based Guidelines for Preventing Healthcare- Associated Infections in NHS Hospitals in England (2007) Saint S. Clinical and economic consequences of nosocomial catheter- related bacteriuria. Am J Infect Control. 2000 Feb.28:68 – 75. Andressen ,L.,Wilde.m.h.,&Herendeen,P.Preventing catheter-associated urinary tract infections in acute care: the bundle approach. Journal of Nursing Care Quality. Baltimore, Maryland, 27, 3, 209-217 9p, July 2012. ISSN: 1057-3631.
Meddings,J.,Rogers.M., Krein S L., Fakih J M., Olmsted R N.,& Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:4 277-289. Mavin, C, & Mills, G (2015), Using quality improvement methods to prevent catheter-associated UTI, British Journal of Nursing, vol. 24, pp. S22-S28 .
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