"Decreasing Foley Catheter UTIs"
Decreasing Foley Catheter UTIs Riverside County Regional Medical Center Trena L Rich, MSN, ARNP, BC, CIC Infection Preventionist August 5 2008 Why this initiative? • End of 4th quarter 2005 changed from one type of silver foley drainage system to another – Cost containment – Nursing complaints about splashing when draining the bag • New drainage device easier to use and less splash than old product – New product had needleless specimen port What our rates were before the change began • Overall CA-UTI rates – 2.69 per 1000 patient days • CA-UTI on adult ICU rate was – 13.15 per 1000 device days – 12.77 per 1000 patient days • NOTE: Could not calculate rates housewide based on device days as it was only in the adult ICU where device days was collected 14 13.15 12.77 12 CA-UTI per 1000 Pt days 10 8.34 8 7.88 6.15 6 4 3.14 3.03 2.69 2.6 1.91 2 2.34 change of foley Changed back to previous system, 4th qtr 05 foley systems 4th qtr 2006 1.1 0 2005 2006 2007 2008 Housew ide pt days ACCU pt days ACCU device days When did the change begin? • October 2005 – Began changing out old product with new – Most of primary components in house by December 2005 Our AIM was to….. • Continue decreasing CA-UTI rates – Improve patient outcomes • Contain cost – Of product – Of Infections • Provide a safer product for nursing to use What did we test/do? We tested …… • Prior to change out, had product trialed on 2 units that had highest number of catheterized patients on average – Had large, positive response from nursing to change to KDS • Worked with PEC • Worked with Vendor – Vendor had to provide in-services – Initially and then quarterly We implemented…. • The changeover • Noted decreased CA-UTI rates on adult ICU within 1st month of change – Housewide rates also decreased – Rates slowly crept back up • Noted unusually high Candida infections – Contacted the Vendor and in-services given for the 3rd time – Rates went back down for a few weeks, then began increasing again • Bacterial rates consistent, but Candida continued to increase Infection Prevention and Control • Could not explain • Rates continued to slowly increase – Candida rates remained elevated – Bacterial rates began climbing • Multiple interventions – Retraining of staff – Prevalence study on multiple units – Worked with physician staff – Foley catheter policy developed • Rates remained high Challenges we faced – Difficulty occurred in getting all of the KDS product components in house – Vendor coordinating changeover left the company • No replacement for months – Facility was never completely changed over to the KDS system • Believed to have contributed to increased rates • Confusion of staff – BIC latex – KDS silicone How we overcame challenges • Had to prove a “problem” existed – Able to show all steps taken to try and decrease rates – Provided most current rates to required committees • Had KDS vendor bring in an ICP – Performed a comparative review of our CA-UTI rates Results of Comparative study • Old-1: – Three month BIC period: October 1, 2004 – December 31, 2004 – Nine (9) CAUTI identified during this period – Rate: 0.77 Infections per 1000 Patient Days (9 infections/11,692 patient days) • New: – Three month KDS period: January 1, 2007 –March 31, 2007 – Thirty (30) CAUTI identified during this period – Rate: 2.1 Infections per 1000 Patient Days (30 infections/14,523 patient days) Observed Increase in UTI-Targeted Antimicrobial Use Increase (%) Overall Total 76% increase in UTI targeted total antimicrobial use with KDS Antimicrobial Use in group compared to BIC group Project Patients [7 patients (BIC); 29 patients (KDS)] IV Use 65% increase in UTI targeted IV antimicrobial use with KDS group compared to BIC group [6 patients (BIC); 17 patients (KDS)] Oral Use 92% increase in UTI targeted oral antimicrobial use with KDS group compared to BIC group [1 patient (BIC); 12 patients (KDS) Risk of getting treated for a NUTIc was 3 times greater in the KDS group (p=0.009) Change Back to Old System • Presented comparative data to appropriate committees • Enlisted assistance from physicians to change back to BIC system – Worked out cost neutral plan – Found cost of initial BIC product was incorrectly entered into payor system • Changing back required ICC to report CA-UTI rates monthly to see if rates consistently remained low – If the rates didn’t go down or stay down, consideration would be given to returning to KDS Change Back to BIC • All KDS product removed and all BIC product brought in at one time • Significant in-servicing provided by BIC • Able to provide computer access training on Foley catheter care to nursing staff – Free CEU offered to staff who completed the program Where we are now Since going back to old Foley system, we have accomplished…. • Point prevalence data collected and reported – Use results as a means of reeducating staff on correct techniques to use – Decreased confusion for nursing • Ongoing access to computer training for staff • Most importantly – Rates declined Our data shows…… Point Prevalence Results Foley Management Point Prevalence Review 100% 90% 80% 70% % Compliance 60% 50% 40% 30% 20% 10% 0% KDS Cath Tamper Seal No Tubing Bag Not Bag Not Temp Secured to Intact Dependent Secured to Touching Over Filled Sensor Body Loops Bed Floor Used CA-UTI After Change Back to BIC Foley System • Old-2: – Three month BIC period: January 1, 2008 – March 31, 2008 – Eighteen (18) CAUTI identified during this period – Rate: 1.1 Infections per 1000 Patient Days (18 infections/15,933 patient days) Example of Economic Impact on Length of Stay • Length of Stay (Based on published literature*) B IC Group KDS Group N = 18 NUTIc N = 30 NUTIc * Published additional LOS for 68.4 Days 114 Days (18 NUTIc x 3.8 days) (30 NUTIc x 3.8 days) UTI: 3.8 days Room Rate per day $136,732 – $301,507 $227,800 – $502,512 ($1999 – $4408) * Classen, D. Assessing the effect of adverse hospital events on the cost of hospitalization and other patient outcomes. U of Utah, 1993 (thesis) Next Steps What we plan to test in the future • Securement devices – To decrease pistoning effect – Lessening urethral irritation • Continued monitoring of positive urine cultures – Noting trends that may need intervention of some kind Trena L Rich, MSN, ARNP, BC, CIC Infection Preventionist Riverside County Regional Medical Center Moreno Valley, CA 951 486 4693 firstname.lastname@example.org Questions / Comments