Transcript Slide 1

Waging the War on CA-UTI’s
Evelyn White, RN,BAAS,IP
Brenda Jones, RN,IP
NHSN Surveillance
• The CDC defines an HAI as a localized
or systemic condition resulting from an
adverse reaction to the presence of an
infectious agent(s) or its toxin(s).
• There must be no evidence that the
infection was present or incubating at
the time of admission to the acute care
setting. This is in reference to all HAIs.
Symptomatic UTI
Patient has at least 1 of the following signs
or symptoms with no other recognized
cause: fever (>38C), urgency, frequency,
dysuria, or suprapubic tenderness.
and
patient has a positive urine culture, that is,
≥100,000 microorganisms per cc of urine
with no more than 2 species of
microorganisms.
Patient has at least 2 of the
following signs or symptoms with
no other recognized cause: fever
(>38C), urgency, frequency,
dysuria, or suprapubic tenderness
and at least 1 of the following:
• Positive dipstick for leukocyte esterase
and/ or nitrate
• Pyuria (urine specimen with ≥10,000
WBC/mm or
• ≥3 WBC/highpower field of unspun
urine)
• Organisms seen on Gram’s stain of
unspun urine
• At least 2 urine cultures with repeated
isolation of the same uropathogen (gramnegative bacteria or Staphylococcus
saprophyticus) with ≥1,000 colonies/mL
in non-voided specimens
• ≤100,000 colonies/mL of a single
uropathogen (gram-negative bacteria or
S saprophyticus) in a patient being
treated with an effective antimicrobial
agent for a urinary tract infection.
• Physician diagnosis of a urinary tract
infection.
• Physician institutes appropriate therapy
for a urinary tract infection.
These are definitions for patients > 1
year of age. Definitions for infants are
little different. There are a number of
places where you can find the all the
CDC/NHSN definitions for HAI and here
is one website:
http://www.azdhs.gov/infectioncontrol/
pdfs/5haicasedefinitions2008.pdf
Asymptomatic UTI
Patient has an indwelling urinary catheter within 7
days before the culture.
and
Patient has a positive urine culture, that is, ≥100,000
microorganisms per cc of urine with no more than 2
species of microorganisms.
and
Patient has no fever (>38C), urgency, frequency,
dysuria, or suprapubic tenderness.
Patient hasn’t had an indwelling urinary catheter
within 7 days before the first positive culture.
and
Patient has had at least 2 positive urine cultures,
that is, ≥100,000 microorganisms per cc of urine
with repeated isolation of the same microorganism
and no more than 2 species of microorganisms.
and
Patient has no fever (>38C), urgency, frequency,
dysuria, or suprapubic tenderness.
• CMS-Centers for Medicare and Medicaid
Services
• CDC-Centers for Disease Control
• NHSN-National Healthcare Safety
Network
• APIC-Association for Professionals in
Infection Control and Epidemiology
• IDSA-Infectious Diseases Society of
America
• SHEA-Society for Healthcare
Epidemiology of America
IHI-Institute for Healthcare
Improvement
IHI Statistics
• CA-UTI is the most common
hospital associated infection:
40% of all HAIs
1 million cases annually
(hospitals & nursing homes)
• 12-25% of all hospitalized
patients receive a urinary
catheter
Continued,
• Increased length of stay 0.5 – 1 day
• Estimated cost per case of CA-UTI
range from $500-$3000.
• Cost to healthcare system up to
$450 million annually according to
CMS.
• CA-UTI not documented as present
on admission can no longer code
patient to higher reimbursement
DRG for Medicare.
For discharges occurring on or after
October 1, 2008, IPPS hospitals
(basically that means acute care
hospitals) will not receive additional
payment for cases when one of the
selected conditions is acquired during
hospitalization (i.e., was not present
on admission). The case would be
paid as though the secondary
diagnosis were not present.
Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Pressure Ulcer Stages III & IV
Falls and Trauma:
Fracture•
Dislocation•
Intracranial Injury•
Crushing Injury•
Burn•
Electric Shock•
Catheter-Associated Urinary Tract Infection
(UTI)
Vascular Catheter-Associated Infection
Manifestations of Poor Glycemic Control
Diabetic Ketoacidosis•
Nonketotic Hyperosmolar Coma•
Hypoglycemic Coma•
Secondary Diabetes with Ketoacidosis•
Secondary Diabetes with Hyperosmolarity•
Surgical Site Infection, Mediastinitis, Following
Coronary Artery Bypass Graft (CABG)
Risks of Acquiring UTI
• Age, gender disease process
hygiene practices
• Methods of catheterization
• Duration of catheter use
• Quality of catheter care
• Host susceptibility
Reasons for Increased
Foley Catheter Use
•Complex medical care
•Increased acuity
•Severity of illness
•Decreased staffing levels
Foley Catheter
Management Strategies
•Good hand hygiene
•Provide good personal patient hygiene
•Maintain closed F/C system
•Force fluids
•Educate associate on correct catheter
insertion and care
•Ensure drainage and unobstructed urine
flow
The Role of the IP in
Reducing CA-UTIs
• Assisting in policy and procedure
writing
• Introducing evidence based
practices
• Consultation on interventions
• Facilitation of quality improvement
projects
Advantages in using
Bundles:
• Decrease morbidity
and mortality
• Improve patient
outcomes
• Cost savings
UTI
BUNDLE
●Use alcohol gel hand hygiene before
placing Foley catheter.
●Use silver/hydrogel coated Foley
catheters.
●Use the smallest diameter size of the
Foley catheter.
●Do not inflate the balloon prior to
insertion.
●Thoroughly wash peri area with soap and
water before the sterile catheterization
procedure.
●Insert Foley catheters with aseptic
techniques.
●Secure Foley catheter to the thigh using
Cath Secure from Pyxis.
●Maintain a closed system.
●Maintain the tubing above the gravity
drainage bag.
●Use luer lock with gravity to remove
all the water from the balloon to
facilitate pre-inflated shape of the
balloon
●Identify patients who no longer need a
Foley catheter and discontinue with a
physician order
●Proper location of the gravity drain
bag below level of the bladder at all
time
●Keep Foley catheter bag off the floor
●Daily peri care with soap and water
●Scrub hub on the Foley with alcohol
before taking a specimen with luer
lock syringe
● Keep the spigot on the Foley
catheter gravity drain bag from
touching the sides of the graduated
container
Evidence Based
Guidelines
• APIC CA-UTI Elimination Guide
www.apic.org/CAUTIGuide
• SHEA-IDSA Compendium
http://www.sheaonline.org/about/compendium.cfm
• CDC
http://www.cdc.gov/ncidod/dhqp/gl_catheter
_assoc.html#
N.b. An update to CDC guidelines is expected in early 2009