Legacy Good Samaritan Medical Center
Presented by Jim Marangoni RN SCNRThank You Art Ashby and Cindy Evans
• Deciding on the issues
• Roles in an infection reduction project
• UTI prevention bundle
• Describe Process and Outcome Monitoring
• Integrate NSQIP Data into UTI reduction efforts: Realtime, Risk Adjusted, Regional
Objectives
Legacy Health – 6 hospitals, regional referral laboratory, research programs, clinics, hospice program and IP rehabilitation center
Urban hospital in NW Portland: 230 Staffed beds, Average Census 130-170 patients
NSQIP since Sept 2008
Multispecialty with OHS
Legacy Good Samaritan Medical Center
Oregon NSQIP Consortium
Catheter Associated - Nosocomial Urinary Tract Infections
April - June 2005 compared to April - June 2006
CAUTI ReductionProduct Conversion to Silver Hydrogel Coated Urinary Catheters
Rates per 1000Patient DaysProjected Net Cost Avoidance:$115,700 based on CAUTIs prevented and projected increasedcost of products
CAUTI Rates 2006-2008: Kern CCUper 1000 device days
Overall* Urinary Tract Infections
* Includes General and Vascular Surgery Cases
Observed Rate: 2.06%Expected Rate: 1.53%O/E Ratio: 1.35Status: As Expected
First Step – Collaborating
Chief Nursing Officer and Quality Improvement Specialist
Legacy Initiative to Focus on Infection Prevention
Led to Development of Infection Prevention Bundles
CAUTI Reduction Strategy
Sterile technique for insertion
Always keep drainage bag below level of the bladder
Empty bag before transport
Prevent dependent loops in tubing
Secure catheter to decrease movement of foley
Pericare daily using soap and water with daily bath
Do not allow the bag to overfill
Do not allow bag to touch floor
Foley CatheterBest Practice Bundle
EPIC Documentation Flowsheet
Best Practices Literature ReviewCAUTI Prevention Bundle DevelopmentEducating staff who come into contact with patients with catheters, from placement to transporting patientsMonitoring Compliance with CAUTI Bundle•Process Monitoring Rounds by CNO and ICPProvide Feedback Regarding Compliance and CAUTI data to staffInteractive Case Reviews with Nursing Staff
CAUTI Prevention Process
Bundle Education
CAUTI Reduction April 2008 – March 2010
71% Reduction in UTI Cases
Symptomatic CAUTI Case CountsJune 2010 – November 2011
Quarterly UTI Realtime NSQIP
Monthly UTI NSQIP
Overall* Urinary Tract Infections
* Includes General and Vascular Surgery Cases
Observed Rate: 0.82%Pred. Obs. Rate:0.93%Expected Rate:1.04%Odds Ratio: 0.89Status: Non-Outlier
Conclusions• The Bundles approach works
• Leadership involvement is essential
• Education, Education and Re-education is required
• Surveillance includes process AND outcomes
monitoring and feedback to the staff
• Involving care staff in case analysis leads to
discovery
Questions?