Mission “Not Impossible”Mission “Not Impossible”

Reducing UTIs in the ICUReducing UTIs in the ICU

Jeanine Baskin RN BSN CCRNJeanine Baskin RN BSN CCRN

Novant Health at a GlanceNovant Health at a Glance Novant HealthNovant Health is a not-for-profit integrated healthcare system in is a not-for-profit integrated healthcare system in

Western North Carolina that serves more than 3.4 million people Western North Carolina that serves more than 3.4 million people in 34 counties reaching from southern Virginia to northern South in 34 counties reaching from southern Virginia to northern South Carolina.Carolina.

Mission StatementMission Statement: Novant health exists to improve the health : Novant health exists to improve the health of the communities one person at a time. of the communities one person at a time.

Novant Health Novant Health summary statisticssummary statistics

Over 1,900 active medical staffOver 1,900 active medical staff 670 employed physicians 670 employed physicians 17,705 employees 17,705 employees 2382 licensed beds2382 licensed beds $200 Million+ in Annual Cash Flow $200 Million+ in Annual Cash Flow Population of 3 million in three Population of 3 million in three

marketsmarkets 96,000 inpatient discharges96,000 inpatient discharges

The Healthcare system of The Healthcare system of Novant Novant

summary statisticssummary statistics

7 Inpatient hospitals7 Inpatient hospitals 28 Outpatient facilities28 Outpatient facilities 2 Long-term care facilities2 Long-term care facilities 102 clinic locations102 clinic locations

Forsyth Medical CenterForsyth Medical CenterWinston-Salem, NCWinston-Salem, NC

An 847 bed not for profit, tertiary care An 847 bed not for profit, tertiary care hospital offering a full continuum of hospital offering a full continuum of

emergency, medical, surgical, emergency, medical, surgical, rehabilitative and behavioral health rehabilitative and behavioral health

services. services.

~~SMOKE FREE campus as of April 2SMOKE FREE campus as of April 2ndnd~~

Our Critical Care ServicesOur Critical Care Services 30 Medical /Surgical beds (TICU 30 Medical /Surgical beds (TICU

participant)participant)

10 Neuro / Neurosurgical beds10 Neuro / Neurosurgical beds

8 Cardiovascular Surgical beds8 Cardiovascular Surgical beds

20 Coronary Care beds 20 Coronary Care beds

ICU Process Improvement ICU Process Improvement Team Team Summary of projectsSummary of projects

Multidisciplinary PI/TICU Team Multidisciplinary PI/TICU Team

1) VHA TICU wave 6 participants 1) VHA TICU wave 6 participants

(OCT 2005) (OCT 2005)

VAP, BSI reduction, Sepsis VAP, BSI reduction, Sepsis work work

2) IHI 100K and 5 Million Lives 2) IHI 100K and 5 Million Lives campaigners campaigners (since June of 2005) (since June of 2005)

VAP, BSI initiatives, reducing VAP, BSI initiatives, reducing med errorsmed errors

Houston – We have a Houston – We have a Problem!!!Problem!!!

Jan-06 to May- 06Jan-06 to May- 06Monthly Total ICU UTI Rate

6.4

12.3

9.1

12.212.8

0

2

4

6

8

10

12

14

J an-06 Feb-06 Mar-06 Apr-06 May-06

Jan-06 to May- 06Jan-06 to May- 06Monthly Total ICU UTI Rate

6.4

12.3

9.1

12.212.8

50th NNIS

90th NNIS

0

2

4

6

8

10

12

14

J an-06 Feb-06 Mar-06 Apr-06 May-06

Where do we start???Where do we start???

Attention secret agents (AKA ICU Staff)

The National Nosocomial Infections Surveillance (NNIS) System Report has surveyed selective hospitals in the US since 1970. Their surveillance data is aggregated into a national database. According to their surveillance, the UTI rate in the ICU at Forsyth Medical Center is considerably higher than the national average . . .

The national average is 3.1% for other ICU’s compared to FMC. In the first quarter of 2006, the average was 8.4%

This is a serious and potentially deadly situation.

Mission Not Mission Not ImpossibleImpossible

At the end of this briefing you should know how At the end of this briefing you should know how to reduce high UTI rates at FMC. Always check to reduce high UTI rates at FMC. Always check allergies before using betadine on all patients.allergies before using betadine on all patients.

Reducing UTI’s in the Reducing UTI’s in the ICUICU

The Impossible Team in 1966The Impossible Team in 1966

The Impossible Team in 1996The Impossible Team in 1996

The Plan: The Plan: Mission “Not” Impossible!Mission “Not” Impossible!

“ “The Team”The Team”•Staff NursesStaff Nurses•ManagementManagement• Infection ControlInfection Control

The “Not” Impossible Team in The “Not” Impossible Team in 20062006

Mission Not Mission Not ImpossibleImpossible

Reducing UTIs in the ICU is in Reducing UTIs in the ICU is in your hands!your hands!

““The The mostmost effective way to do effective way to do it, is to do it!”it, is to do it!”

Amelia Earhart 1897-1937Amelia Earhart 1897-1937

What we Did! What we Did! PDSAPDSA

PlanPlan

Do Do

StudyStudy

ActAct

The “DO”The “DO”

Recruited staff nurseRecruited staff nurse• Career Ladder /Sabbatical incentiveCareer Ladder /Sabbatical incentive

1) Increase awareness of the problem1) Increase awareness of the problem Boards with data postedBoards with data posted Flyers place in all bedside notebooks.Flyers place in all bedside notebooks. Posters in break-roomsPosters in break-rooms

2) Education, education, education!!!2) Education, education, education!!! Power point for staffPower point for staff

Placed emphasis on:Placed emphasis on:

HandwashingHandwashing DC all FCs when patients are extubated unless DC all FCs when patients are extubated unless

“medically” necessary.“medically” necessary. Pericare twice dailyPericare twice daily Marking cath bags with insertion of FC datesMarking cath bags with insertion of FC dates Cath secure devicesCath secure devices Sterile techniqueSterile technique Dependent Placement of bags Dependent Placement of bags Catheter size selectionCatheter size selection Emptying the bag and clamping the foley prior to Emptying the bag and clamping the foley prior to

patient’s transferpatient’s transfer

BarriersBarriers

Educating of “all” nursing staff- Low Educating of “all” nursing staff- Low attendance of nurses due to time attendance of nurses due to time constraints.constraints.• Took DVDs to individual podsTook DVDs to individual pods

Changing actual practice

The StudyThe StudyMonthly Total ICU UTI Rate

J an 06 to Mar 07

6.4

12.3

9.1

12.212.8

9.3

8.0

4.8

2.2

5.8

11.8

7.1

7.0

6.2

6.0

0

2

4

6

8

10

12

14

J an-06 Feb-06 Mar-06 Apr-06 May-06 J un-06 J ul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 J an-07 Feb-07 Mar-07

The Act: So what do we do The Act: So what do we do now???now???

Continued awareness via posting, Continued awareness via posting, sharing information, UCICsharing information, UCIC

Continue Education, education, Continue Education, education, education!!! education!!!

New suggested UTI bundleNew suggested UTI bundle

PPlan – Begin a new study, different lan – Begin a new study, different staff nursestaff nurse

DDo - Collecting new bundleo - Collecting new bundle SStudy - Analyze the information we tudy - Analyze the information we

collect.collect. AAct - Where do we need to go from ct - Where do we need to go from

here?here?

““Success is never ending, failure is Success is never ending, failure is never final.”never final.”

Robert Schuler Robert Schuler