news views Winter 2013
A Publication of the Department of Nursing and Patient Care Services
University of Maryland Medical Center
Conquering CAUTI: Preventing Catheter-Associated Urinary Tract Infections Will Save Lives David G. Hunt, MSN, RN, Director of Nursing and Patient Care Services, Cardiac Care, and Radiology
Urinary tract infections (UTIs) are tied with pneumonia as the second most common type of health care-associated infection, second only to surgical site infections. UTIs account for more than 15% of infections reported by acute care hospitals. Virtually all health care-associated UTIs are caused by instrumentation of the urinary tract – in particular, the placement of a catheter. Catheter-associated urinary tract infection (CAUTI) is serious and can lead to such complications as cystitis, pyelonephritis, gram-negative bacteremia, prostatitis, epididymitis, and orchitis in males. Less commonly, these infections can even lead to endocarditis, vertebral osteomyelitis, septic arthritis, endophthalmitis, and meningitis. Examining the Cost Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost. It is significant to note that more than 13,000 deaths a year in the US are associated with UTIs. Tracing the Causes Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter. Between 25% and 30% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a CAUTI is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed. Best Practices to Prevent CAUTI: ◗◗ Insert catheters only for appropriate indications. ◗◗ Leave catheters in place only as long as needed. ◗◗ Ensure that only properly trained staff insert and maintain catheters. ◗◗ Insert catheters using aseptic technique and sterile equipment (acute care setting). ◗◗ Following aseptic insertion, maintain a closed drainage system. ◗◗ Maintain unobstructed urine flow. ◗◗ Standardize correct specimen collection. ◗◗ Practice care provider hand hygiene, patient catheter hygiene, and standard (or appropriate isolation) precautions according to CDC HICPAC guidelines. UMMC Joins New Nationwide Effort Last year, UMMC joined other hospitals in Maryland in a national CAUTI reduction program. This was locally sponsored by the Maryland Hospital Association (MHA) and sought to drive down the incidence and look for ways to eliminate CAUTI. The focus continued on page 5.
Lisa Rowen’s Rounds: Our Safety Journey Lisa Rowen, DNSc, RN, FAAN, Senior Vice President and Chief Nursing Officer, Nursing and Patient Care Services
At last month’s Staff Nurse Council (SNC), I asked the question I ask at every SNC meeting: “How have we harmed or almost harmed a patient since the last time we met?” The point of the question is to have an honest and transparent safety discussion, so we can discover potential and real safety challenges in our organization. During these open conversations over the years, we have unearthed safety trends that are specific to certain units and others that spread throughout the Medical Center. I’m sure many of you will remember the IV pump issue from a couple of years ago, when we learned our pumps were randomly going blank and ceasing to work when jostled or bumped. After an intensive root cause investigation, we learned we were cleaning the pumps incorrectly, causing too much cleaning fluid to get in between the connections, resulting in the pumps not working reliably. Although this worrisome safety issue happened to many nurses over a period of months across the Medical Center, we only heard about it for the first time at the SNC in our safety discussion. My point is that instead of assuming this could be a hospital-wide issue, each nurse it occurred to assumed it was a single pump issue and did not document the problem. continued on page 8.