Urine-8 Project: Next Step
Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice
Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services
Trinity Medical Center – Quad Cities
Urine-8 Committee Members
 Michelle Blackmer, MSN, FNP-BC, RN
 Stan Buck, RN, RNFA
 Pam Elliott, MBA, BFA
 Chris Hansen, MS, RN
 Diane Laake, RN, CMSRN
 Paula Maddox, MSN, RN, CCRN
 Kathryn Marhoefer, MBA, RN
 Michelle Mathias, BSN, RN
 Mary A. Petersen, MSN, RN (Committee Chair)
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CAUTI Statistics Nationwide
80% of HA UTIs are caused by urinary
catheters
5% deaths from HAIs are urinary
catheter associated
Cost of a CAUTI is estimated at
$500-1000, $2800 if bacteremia
Source: Michigan Keystone Project, 2008
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Trinity CAUTI Rates
CAUTIs 2006-2009
Raw
Rate /1000 pt days
#
2006
103
1.1
Year
2007
77
0.87
2008
89
0.86
2009
69
0.82
Rate / 1000 Foley days
4.25
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First Step
 Determine specific nursing opportunities


1.
2.
to decrease foley related UTI’s
Conducted a one-day prevalence study
Primary aims of the study included
Quantify the level of use of indwelling
urinary catheters
Determine the level of adherence to
guidelines
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Methods
 2007, 2008 & 2010 all units on each
campus surveyed
 List obtained identifying all patients with
Foley and RN providing direct care
 Data collector directly observed the
catheterized patients and interviewed RN
 Data was collected on a standardized form
 2011 & 2012 implemented Adaptive Design
methodology
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Foley Practice Areas Reviewed
 Presence of a Foley catheter
 Catheter secured to the pt’s abdomen or leg
 Tamper Evident Seal intact (TES)
 Tubing extended to prevent the development of
dependent loops of drainage tubing
 Tubing secured to patient bed or chair to prevent
pulling on system
 Drainage system not touching the floor
 Urine bag not over filled with urine
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Percentage %
Percentage (%) of Compliance
with Total Foley Practice Areas
2007
2008
2010
8
9
10
SBAR
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Catheter Associated Urinary Tract Infection
(CAUTI) Prevention URINE-8
1
2
Good hand hygiene
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Proper peri care:
 Daily with bath, fecal incontinence, presence of
discharge or drainage and at bedtime
 Document peri-care
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Secure catheter to patient with a Stat Lock
 Change Stat Lock every 7 days
 Do not use Stat Lock on edematous patient
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U/A upon catheter insertion when symptoms present
▪ Document symptoms in Care cast
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Do not break the red seal
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Remove as soon as medically able
*SCIP – Remove by the end of post-op day 2
Inserted by qualified staff
 Sterile technique when inserting catheter
Unobstructed urine flow
 No kinks, bends, or dependent loops
 Keep urine bag off the floor
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Trinity CAUTI Rates
CAUTIs 2006-2011
Raw
Rate /1000 pt days
#
2006
103
1.1
Year
Rate / 1000 Foley days
2007
77
0.87
2008
89
0.86
2009
69
0.82
4.25
2010
18
0.18
0.97
2011
18
0.19
0.9
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Trinity SCIP Data 2009 & Today
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Nurse Driven Urinary
Catheter Removal Protocol
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Lessons Learned
 Nurse to Nurse Collaboration is a practiced
skill
 Physician collaboration is key
 Physician and Nurse communication /
education is paramount
 Adaptive Design and daily monitoring
drives successful implementation
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Conclusion:
 HAI’s represent a direct threat to patient
safety, healthcare quality and they are costly.
 The Urine-8 project has consistently decreased
the infection rate and identified the positive
financial impact directly attributed to
evidence-based nursing practice.
 The next step of adding the nurse driven
catheter removal protocol will continue to
decrease unnecessary Foley days and serve as
a tool to meet SCIP criteria and avoid CAUTI.
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