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?
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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
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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
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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?”
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