Deborah R. Campbell, RN-BC, CCRN, MSN
Pediatric Cardiovascular CNS
Kentucky Hospital Association
Children’s Hospital Association QTN faculty

Clinical Consultant for Carefusion
◦ Work to be presented was completed without
commercial support




Review evidence based interventions to
prevent CAUTI
Discuss bundle concept as relates to CAUTI
prevention
Discuss CAUTI prevention as a team sport
Discuss ‘safety culture’ aspects of CAUTI
prevention

Sterile insertion technique (Consider a kit)
◦ Smallest, softest catheter that will do the job



Ensure adequate hydration
Hand hygiene
Perineal care
◦ BID with soap and water, PRN BM (Products)




Keep bag below the level of bladder
Prevent bag, tubing from touching floor
Avoid dependent loops, kinks
No disruption of closed system

Obtain specimens using aseptic technique
◦ Only if absolutely necessary
◦ Remove and replace for C&S





Empty the bag when1/2-2/3 full (Q4hrs?)
Each patient should have own graduated
cylinder
Daily observation for signs, sx of UTI
Isolation of diagnosed CAUTI pt from anyone
with a catheter
Utilize a securement device








Bladder scanning- non-invasive, easy, quick
Intermittent catheterization v. in-dwelling
caths- better for patient, more work for staff
Ditch the bath basins
CHG baths- microbe burden
Appropriate nurse staffing
Antibiotic or silver-coated catheters
Hydrogel catheters- discourage biofilm
adherence
Catheter valves- store urine in bladder v. bag
◦ More physiologic as well, decreases need to re-train







Is there a “magic bullet?
Are there certain, specific items
1+1=3
Synergy?
Pathogen dose v. immune response
Bundles act as checklists
Bundles act as curriculum
Recipe v. culture




Policy change is not = to practice change
QI 101- Educate, Implement, Audit, Improve,
SUSTAIN
All at once or step-wise?
How do I choose from the menu?
◦
◦
◦
◦
Problems known to exist at your place
Acceptable to your front line staff
Ways to measure already in place (LAST)
RCAs on CAUTIs that occur

Is there a best way?
◦ Direct Observation
 Peers
 Supervisors, educators, CNSs
◦ Self-audits
◦ Secret Shoppers

Sampling
◦ Include weekends, nights
◦ Attempt randomness by setting specific days, times

Met your goals consistently, decrease
frequency-BUT never less than quarterly.

Make the right action the default
◦
◦
◦
◦
◦
Opt-outs v. necessity to overtly choose
Nurse driven protocols
Standardization
Redundant processes
From the IHI- Everyone chooses (or is assigned) a
focus area for which they provide input
 5 audits per day per person (on HAPU, CLABSI, CAUTI,
SSI or VAP)

Care team members other than primary RN
◦
◦
◦
◦
◦
◦
◦
Nurses helping out (regular, floated, agency)
PCAs
X-ray technicians
Respiratory therapists
Transporters
Family members
Patients themselves

Decrease the number of insertions/transfers
with catheters
◦ ED
◦ OR

Success is possible!
◦ Emergency room staff education and use of a
urinary catheter indication sheet improves
appropriate use of foley catheters. Presented by RM
Gokula, MD, MA Smith, MD, and J Hickner, MD,
Lansing, Michigan

Can’t define it, but we know it when we see it
◦ Non-heirarchical
◦ Healthy team dynamics
 First names
 Safe to question, interrupt
(Scripting!)
◦ Patient-Centered
◦ No blame-it’s all about the process
◦ Personal accountability (1 patient, 1 action at a
time)
 Link participation to annual evaluations

Build concept that patient well-being is
everyone’s responsibility
◦ Individual
◦ Team
◦ No carve-outs
 Rules apply to everyone, regardless of discipline


Think pro-actively- “what could harm this
patient today?”
Effective for more than one outcome
◦ Infections
◦ Unplanned device removals
◦ Med Errors



Videos, e.g. Josie King
Think of patient in front of you being your
mother, grandfather, child
VA campaign
◦ “Have you ever killed someone with your bare
hands?”