American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Prevention of CAUTIs Description and Results

Description of the QI Activity

In-services for sterile insertion technique of urinary catheters were provided to all subspecialties in the OR by the OR educator and Infection Control practitioner.

All patients requiring a post op indwelling catheter would have a Statlock applied for securement. In-services to Post Anesthetic Recovery room by the nurse educator were provided to all staff members.

A review by nurse educators of the existing patient information sheets regarding catheter care identified the need to update and develop teaching sheets with more specific guidelines for catheter care. These guidelines were based on best practices.

The QI initiative started in May 2012.

NSQIP SAR Date Service Decile Odd Ratio
July 2011-June 2012 All Cases 9 H 1.76
July 2011-June 2012 Gynecology 10 H 2.42

Resources Used and Skills Needed

  • Ten staff members for the QI team (OR Nurses, OR Educator, PAR/DCS Educator, DCS Care Coordinator, Gynecology Ward Educator, Surgical Clinical Reviewers, Gynecologist, Infection Control Practitioner, Quality Improvement Consultant, NSQIP Surgeon Champion, Nurse Educator.
  • No costs beyond normal operations – within normal operations, cost of Statlock securement device increased and usage increased.
  • No additional funding needed

What Were the Results?

NSQIP non risk adjusted and risk adjusted data was used to indicate improvements. Observations of sterile insertion technique and use of Statlocks were audited.

Risk Adjusted Data Results

NSQIP SAR Date Service Decile Odd Ratio
Jan – Dec 2012 All Cases 6 1.11
Jan – Dec 2012 Gynecology 7 1.20
July 2012 – June 2013 All Cases 3 0.73
July 2012 – June 2013 Gynecology 2 0.64

Setbacks and Changes

Some barriers to the project were staff time to meet as a team, but strong management support allowed for staff to be released to attend team meetings.

January 2013 RIH switched to procedure targeted (Colorectal), numbers of Gynecology surgeries audited decreased.

Tips for Others

  • Don’t reinvent the wheel, canvas what other facilities have been doing to determine if any interventions will work at your site.
  • Strong leadership engagement is essential.
  • Share data and information to front line staff.

References

Bard Medical (2012). STATLOCK ® Foley Stabilization Device. Retrieved December 3, 2012 from http://www.bardmedical.com/UrologicalDrainage/STATLOCKFoleyStabilizationDevice

BC Pharmacists (2012). Drug schedules regulation to the pharmacy operations & drug scheduling act of BC. Retrieved November, 2012 from http://library.bcpharmacists.org/D-Legislation_Standards/D-4_Drug_Distribution/5012-Drug_Schedules_Regulation.pdf

Bhardwaj, R., Pickard, R., & Rees, J. (2010). Documented adherence to standards and guidelines: an audit. British Journal Of Nursing (BJN). p. 19S26-30.

CLPNBC (College of Licensed Practical Nurses of British Columbia). (2009). Baseline Competencies for LPNs’ Professional Practice. Retrieved November 21, 2012 from https://www.clpnbc.org/PDF/CLPNBCBaselineCompetencies.aspx

CRNBC (College of Registered Nurses of British Columbia). (2012). Scope of Practice for Registered Nurses. Retrieved from http://www.crnbc.ca/Standards/Lists/StandardResources/433ScopeforRegisteredNurses.pdf

CRNBC (College of Registered Nurses of British Columbia). (2012). Assigning and Delegating to Unregulated Care Providers. Retrieved from https://www.crnbc.ca/Standards/Lists/StandardResources/98AssigningDelegatingUCPs.pdf

Hooton, T., Bradley, S., Cardenas, D., Colgan, R., et al. (2010) IDSA Guidelines Urinary Catheter Guidelines. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the infectious diseases society of America. Clinical Infectious Diseases. March, p. 625-663.

Interior Health Authority (2010). Prevention & control of catheter associated urinary tract infections (IX0200). Infection Prevention & Control Practices.

Interior Health Authority. (2005). Best Practice Guidelines for Catheter care. Clinical Practice Consultant Home Care Nursing.

Smith, J. M. (2006) Current concepts in catheter management. Urinary and fecal incontinence. (3rd ed.) Chapter 10, pages 269-308. Philadelphia: Elsevier, Inc.

Tomaaselli, Nancy; J.C. Colwell, M.T. Goldberg & J. Carmel (2004). Urinary diversions: surgical interventions. Fecal and urinary management principles. pages 184-206.