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Governance and Improvement​	Surgical Safety Checklist​
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Heart Failure Core Processes​	Venous Thromboembolus (VTE)​
High-Alert Medication Safety​	Ventilator Bundle​
Infection Prevention: MRSA​	​

 

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Use this table to quickly find a mentor for the prevention of Catheter-Associated Urinary Tract Infections with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.

Name	Location	Teaching	Urban / Rural	Pediatric	Bed Size
Bellin Memorial Hospital	Green Bay, WI	no	Urban	no	167
Beth Israel Medical Center	New York, NY	yes	Urban	no	1106
Blessing Hospital	Quincy, IL	yes	Rural	no	434
Cape Coral Hospital	Cape Coral, FL	no	Urban	no	250
Holy Spirit Hospital	Camp Hill, PA	no	Urban	no	322
Palmetto Health Baptist	Columbia, SC	no	Urban	no	428
Palmetto Health Richland	Columbia, SC	yes	Urban	no	649
Sentara Norfolk General Hospital	Norfolk, VA	yes	Urban	no	543
St. Joseph's Mercy Health Center	Hot Springs, AR	no	Rural	no	296
ValleyCare Health System	Pleasanton, CA	no	Suburban	no	242

 

Bellin Memorial Hospital – Green Bay, WI
Availability Status: Available to answer requests
Licensed Beds: 167
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: January 2010
Mentor Contact Name: Carol Bess, RN, BSN, Infection Preventionist
Mentor Contact Email: cabess@bellin.org
Mentor Contact Phone: 920-433-3416

We started measuring catheter utilization in January 2010. We require all inpatient areas to count catheter utilization as an ongoing measure. When we began measuring, we had a high of 45% catheter utilization in March of 2010. Our work team led many initiatives assess catheter necessity and if a catheter was deemed necessary to remove the catheter promptly when no longer needed.  The majority of the work was done in 2011. In November of 2011, we attained our lowest utilization of indwelling catheters at 17% utilization.

Indwelling catheter utilization went from a high of 45% to a low of 17%.

This graph accounts for all CA-UTIs in our acute care nursing units and our inpatient rehab unit.  In 2010 (our baseline), a CA-UTI was reported on average every 15 days.  For our current 120-day cycle, we are averaging 37 days between CA-UTIs. (Our target was 30).  It's been 27 days since our last infection.  (See data on days between infections.) After our current 120-day cycle, we will set a new target for the next 120 days.

Keys to success:

Our first challenge was to reliably collect catheter days in all of our inpatient departments. We then developed a policy related to the prevention of catheter-associated urinary tract infections.  The policy had specific components to guide the staff regarding the prevention of catheter associated urinary tract infections:

• Clear indications for indwelling catheters
• Daily review for necessity
• Bundle of care and maintenance if a catheter was indwelling
• Alternatives to indwelling catheter placement

See the Bellin foley removal flow diagram.

Mentor designation - 4/13/12

 

 

Keys to success:

1.  Interdisciplinary teams consisting of physicians, nurses, nurses assistants, transporters with identification of "champions" from each discipline.
2.  Feedback of urinary catheter UTI surveillance data on a quarterly basis to identify rates of infection at baseline and after interventions.  Data presented to interdisciplinary teams as well as Administration and Board of Trustees.
3.  Set goals:  Avoid unnecessary urinary catheters, care for catheters as per recommended guidelines (keep collection bag below the level of the bladder at all times including patient transport), daily review of catheter necessity with prompt removal when indicated.
4.  Daily reminder on rounds:  "Does patient still require a urinary catheter? If so, why?"
5.  Education and validation of competancy regarding urinary catheter insertion, care and maintenance with a focus on emptying collection bag with nursing assistants.
6.  Began on one unit, then spread through hospital.
7.  Fully automated in our CPO system.
8.  Individual units now own process - data collection, data aanlysis, development of solutions

 

2011 Data:

Computer and manual audits of patients with a urinary catheter

1.  99% compliance with insertion of urinary catheters using aseptic technique.
2.  99% compliance with knowledge that patient has a urinary catheter
3.  95% compliance with documentation of approved indication.
4.  95% compliance with hand hygiene
5.  99% compliance of emptying collection bag using a separate collecting container for each patient and preventing spigot from touching the collecting container
6.  95% compliance with maintaining collection bag below the level of the bladder during transport.
7.  95% compliance with use of Foley securement device
 
a) Urinary catheter-associated UTI rate:  Sustained rate of zero on majority of units with decreases noted on remaining units from 4.6 per 1,000 urinary catheter days to 0.5 per 1,000 urinary catheter days

b)  SIR significantly reduced from 1.4 in 2009 to 0.3 in 2011 (p < 0.05)

c) 66% of patient care areas were able to maintain a zero CA UTI rate > six months

d) Urinary catheter duration decreased by three days and utilization decreased from the 64th percentile to less than the 50th percentile when compared to other NHSN hospitals; units between 25th and 50th percentile.

e) 15% increase in patients in an ICU or step-down unit who no longer had a urinary catheter during their hospitalization

f) As a result of the decrease in CA UTIs, there was an associated reduction in multi-drug resistant E. coli and K. pneumoniae, from 1.3 to 0.8 per 1,000 discharges

g) Reduction in CA UTIs has saved the Medical Center $320,000 in avoided costs each year since 2009

Mentor designation - 5/20/09
Information updated - 6/8/12

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Blessing Hospital – Quincy, IL
Availability Status: Available to answer requests
Licensed Beds: 434
Teaching / Non-Teaching Status: Teaching
Setting: Rural
Start Date of Intervention Work: May 2008
Mentor Contact Name: Carleen Orton, RN, BSN, CIC, Infection Control Coordinator; Vickie Roberts, RN, Infection Prevention Nurse  
Mentor Contact Email: Carleen.Orton@blessinghospital.com; Vickie.Roberts@blessinghealthsystem.org
Mentor Contact Phone: 217-223-8400 ext. 6386 (Orton) or ext. 6393 (Roberts)

Our catheter-associated urinary tract infection rate fell from 105 in fiscal year 2008 (69,787 patient days) to 30 in fiscal year 2009 (67,848 patient days) to 19 in FY 2010 (67,368 patient days).

Mentor designation - 3/16/10
Information updated - 6/1/11

 

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Holy Spirit Hospital – Camp Hill, PA
Availability Status: Available to answer requests
Licensed Beds: 322
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: February 2008
Mentor Contact Name: Joyce Snyder, RN, BSN, Assistant Nurse Manager; Betsy Davison, RN, BS, CWON, Wound Care Specialist
Mentor Contact Email: jasnyder@hsh.org; bdavison@hsh.org
Mentor Contact Phone: 717-763-2501; 717-763-3085

Keys to our success:

Developed multidisciplinary team consisting of nursing, wound care, infection control, nurses aides and nursing management to assist in tackling this initiative.
 
Applying evidence-based practice, in March 2008 we began a housewide staff education program for the "Ex-Foley-Ate" Campaign (importance of assessing need, appropriate indications, urinary catheter care, cost associated with UTI, prexisting UTI's, policy update to include usage of bladder scanner for residual urine). Used campaign buttons with an "Ex-Foley-Ate" (with a red X) logo.
 
In August 2008, we undertook a back-to basics approach (proper insertion and care techniques requiring return demonstration by 100% of all non-RN staff).
 
Annual competency requirement for RN, CNA and technicians appropriate to role.

Staff participation in trialing products such as leg straps to improve compliance.

Physicians documentation of existence of pre-existing UTI upon admission (required within 48 hours of admission). 
 
Units that achieve no UTI's for three consecutive months were given a cake and gift cards as well as housewide acknowledgment.

2012 update: We still meet quarterly as a committee. Infectious Disease nurses collect our statistics. We research each that occurs to determine what happened and how to correct it in the future. During 2011 we had 21 HA UTIs.It was our lowest year since we started the program.  Being persistent is the only way to succeed.

Holy Spirit Hospital has had a 66 percent reduction in urinary cathether-associated UTI's.  Prior to our Performance Improvement Team's initiative, our yearly average for urinary cathether-associated UTI's (per 1,000 device days) was 5.9 in 2007 and 5.6 in 2008.  In 2009, our urinary cathether-associated UTI rate was 2.0 (per 1,000 device days).  We have had 16 consecutive months where our urinary cathether-associated UTI's have been no higher than 3.6 per 1,000 device days and - for 13 of the 16 months - the rate was at or below 3.0 per 1,000 device days.
 
Monthly track Foley catheter and non-Foley catheter associated urinary tract infections. Our UTI infection information is reported monthly at our hospital-wide Quality Council.

 

Mentor designation - 6/2/2010

Information updated - 5/30/2012

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Palmetto Health Baptist – Columbia, SC
Availability Status: Available to answer requests
Licensed Beds: 428
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: April 2008
Mentor Contact Name: Heather Mann
Mentor Contact Email: Heather.Mann@palmettohealth.org
Mentor Contact Phone: 803-296-3392

The team has been working to implement both an insertion bundle and care and maintenance measures. The elements are as follows:

Care & Maintenance Measures

• Daily assessment of catheter necessity
• Catheter secured
• Tamper-evident seal intact
• Drain tubing is properly positioned and secured (no dependent loops)
• Drain bag properly positioned (below bladder and not touching floor)
• Drain bag is not overfilled
• At least daily catheter hygiene

 

Insertion Bundle 

Note:  Since the data for the urinary catheter insertion bundle were high and infection control is finding only extremely rares instances of CA-UTI due to insertion issues, the team made the decision to discontinue the insertion audits with every insertion beginning in April 2009.  It is always the expectation that staff insert urinary catheters using the bundle and this is addressed in ongoing education and training.

• Assessment of catheter necessity
• Hand hygiene
• Clean the urethral meatus prior to catheter insertion
• Use a single-use packet of lubricant
• Aseptic insertion technique
• Catheter secured
• Sterile closed drainage system

Keys to success:

1) Representation on the team from all appropriate departments:  nursing, nurse technicians, quality, emergency department, education, infection control, surgery, intensive care, information technology, physicians
2) Standardization of catheter kits to include all items necessary to complete the insertion bundle
3) Revised policies and procedures
4) Staff education regarding CA-UTIs and the care and maintenance and insertion bundles
5) Management (nurse managers, charge nurses, supervisors, etc.) hold staff accountable for meeting the expectations outlined in the bundles

See Palmetto Health's nurse-driven foley removal order/protocol.

 

Mentor Designation - 5/20/09
Information Updated - 7/28/11

 

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Palmetto Health Richland – Columbia, SC
Availability Status: Available to answer requests
Licensed Beds: 649
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: May 2008
Mentor Contact Name: Heather Mann
Mentor Contact Email: Heather.Mann@palmettohealth.org
Mentor Contact Phone: 803-296-3392

The CA UTI bundles were spread housewide beginning in early 2009 and the team continues to track data on an ongoing basis to demonstrate compliance with the bundles.  Beginning in October 2009, the team began an emphasis on reducing urinary catheter days and began an active process to collect urinary catheter days housewide (urinary catheter days were only collected in intensive care units previously). 

The initial test unit for this project was a Cardiac Care Unit (Intensive Care Unit) and the second test unit was a Cardiac Telemetry Unit.  Initial project activity began in April of 2008, with active data collection on a "care & maintenance bundle" as well as an "insertion bundle" beginning in June and July of 2008 in the test units including the elements listed below:

 

See graphs of their results.

 

Mentor Designation - 5/20/09
Information Updated - 7/28/11 

A quality improvement project focusing on care elements aimed at preventing UTIs in the ICU was instituted in 2007. A five-element indwelling urinary catheter management bundle was introduced, including use of silver-impregnated catheters, proper care of perineum and catheter, maintenance of intact closed system, application of stabilization device, and timely removal of Foley.  In addition, several change measures were instituted over this two-year period, including, but not limited to: trial and implementation of a stabilization device that was deemed most reliable, reporting number of UTIs per unit every week, improving hand hygiene of all disciplines, and creation of a reward program.  Executives were engaged by checking bundle compliance during executive rounds. In early 2009, a tool was created and adopted for insertion/continuation of in-dwelling urinary catheter.  

From 2007 through 2009, a 67% reduction in symptomatic UTIs along with a 6% reduction in Foley device utilization ratio (DUR) was achieved in our ICU. Overall, the most prominent UTI reduction occurred when the Foley DUR was reduced as a result of the introduction of the criteria tool.

Symptomatic UTIs and Foley DUR were decreased with the implementation of a five-element Foley management bundle. Through this improvement Sentara Norfolk General Hospital (SNGH) achieved an estimated cost avoidance of $16,800 in the ICU setting. The project proved easily applicable to other settings, as well. Since 2007, a 67% reduction in UTIs was achieved in all ICUs throughout Sentara Healthcare. Program components are now being spread to the medical-surgical units.

Mentor Designation - 11/04/2010

 

 

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Our continued keys to success are:
 
1. Our "HOPE" UTI bundle concept includes medical necessity urinary catheter criteria, hand hygiene, urinary catheter care and techniques, bladder scanning, and use of silver-impregnated catheters. This process starts in nursing orientation for all new nursing unit staff and is reviewed as an annual competency for all nursing staff at Nursing Skills Days.
 
The acronym HOPE represents the 4 criteria-based foley necessity guidelines that our facility focuses on:
 
Hemodynamic: Critically ill or post-op patients who need urine output measured accurately
Obstruction/Retention: An anatomic or physiologic outlet obstruction
Palliative Care: Comfort Care (i.e., end-of-life care, immobility, etc.)
Exclusion/Prevention of wound contamination.
 
2. Development of systems/tools to document urinary catheter justification included in the nursing admission assessment and daily documentation; urinary catheter criteria utilizing the HOPE UTI Bundle; drainage bag dating is a standard of care; use of a securing device; evaluation for symptoms of a urinary tract infection; and Physician Assessment of Foley Catheter Necessity signed MD sticker in the medical record. This sticker is placed by night charge nurse. This sticker identifies the MD's reevaluation plan if the foley catheter is to remain in place.
 
3. Performance Improvement tools to measure compliance of bundle elements which are monitored daily by night charge nurses when they are obtaining foley catheter device counts. Infection Control performs spot chart audits to check for compliance. Hand off communication reports includes "Is the foley catheter necessary?" Overall compliance is additionally monitored by Quality Management when they are evaluating SCIP core measures.

4. Infection Control Manager had been working with the nursing units to reduce CA-UTI but a formalized plan was introduced in June 2010. This plan included key nursing input for development of bundle and introduction of the process changes. The bundle provided evidence-based literature, Infection Control standards and practices, and statistics to support the importance of a dedicated process change. The IC Manager sought and obtained buy in and support from the physicians and administration in leading the successful implementation of the HOPE Bundle to reduce CA-UTI rates and foley days.

5. Inspiring the nursing units through competition and posting of unit rates has been a positive action toward the quest for a zero CA-UTI rate. Disseminating information regarding our success with reducing our CA-UTI rates through the Infection Control Newsletter, Medical Staff Newsletter, and reviewing our goals and statistics at interdisciplinary committee meetings. IC Manager for ValleyCare Health System is a Mentor Hospital for the BEACON Patient Safety Collaborative.

 

Information updated - 5/30/2012