Infection control

New campaign focuses on CAUTI reduction

‘Take Every PreCAUTIon’ provides hospitals with resources and tools to prevent infections

After reading this article, you will be able to:

• Identify why CAUTIs are common in hospitals
• Evaluate ways to prevent CAUTIs
• Explain the cost savings of new technology such as antimicrobial catheters

Catheter-associated urinary tract infections (CAUTI) are the most common hospital-acquired infections (HAI). In fact, CAUTIs account for approximately 36% of HAIs, according to a March/April 2007 Public Health Report. CAUTIs are also associated with high costs, high lengths of stay, and unnecessary antimicrobial use, which can lead to further complications.

Prevention of CAUTIs requires the appropriate techniques—namely, don’t use a catheter if the patient doesn’t need one—and technology. Enter the “Take Every PreCAUTIon” campaign launched by Bard Medical at the June Association for Professionals in Infection Control (APIC) conference in New Orleans. 

The campaign aims to provide healthcare professionals with evidence-based techniques and technology that can help reduce this common but easily preventable infection. The program offers free, easy-to-use, customizable tools that can be used to establish policies and procedures to ensure consistent practices among healthcare professionals.

Additionally, as many hospitals already know, CMS announced in 2008 that it would no longer reimburse hospitals for the additional costs associated with CAUTIs. This has drawn a lot of attention to the infection, particularly in the C-suite, says Jaime Ritter, MPH, CIC, clinical manager at Bard Medical in Covington, GA. 

“Prior to [the CMS ruling], I think generally people felt that UTIs were kind of inevitable; if you put a Foley catheter in and left it in long enough, eventually a urinary tract infection would occur,” Ritter says. “And lucky or unlucky for CMS participants, most UTIs occur in patients over the age of 65, so most of them fall into the Medicare payment system. Prior to October of 2008, the hospital used to be able to add a comorbidity code to potentially get reimbursement. Well, that’s not the case anymore, so I think that really spurred a lot of people to look at UTIs more seriously.”

Ensuring compliance with tools

The simplest way to prevent a CAUTI is to avoid using a Foley catheter, which is the main source of infection, particularly when it’s left in too long. 

But vowing not to use Foley catheters is easier said than done. Some patients require Foley catheters, but the best way to ensure compliance is to have a clear-cut policy that ensures staff members understand the appropriate steps to take when evaluating a patient. 

“It’s hard when you look at UTIs because I think that a lot of infection preventionists say, ‘Well, we’re just going to get the Foley catheters out early,’ or ‘We’re just going to do better maintenance once they are inserted; we are going to make sure they are secure,’ or ‘We’re just going to stop using Foley catheters altogether,’ ” says Ritter. “None of that is really completely realistic, and it takes a lot of resources to do any of those things. So when we put together the campaign, we wanted something that would offer the infection preventionists a series of tools. The first is to assess the program: ‘What do I actually have, what do I need to put in place, and what can I improve on?’ ”

Once you have a clear-cut policy and procedure, you’ll need to periodically educate staff on following the policy. The “Take Every PreCAUTIon” campaign offers surveys and daily assessments. 

It’s also important to empower nurses to follow the procedures correctly. Many nurses haven’t had any training on inserting a Foley catheter since nursing school, Ritter says, so supplying them with the appropriate equipment and establishing a strict procedure helps the process run smother. 

“Nobody goes back and reminds people about Foley catheters,” Ritter says. “Foley catheters are very similar to any other procedure in healthcare, which is ‘see one, do one, teach one, and now you’re a master of it.’ ”

Combining HICPAC and APIC guidelines 

Many facilities have already implemented APIC’s Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs), and many have recently begun using the Healthcare Infection Control Practices Advisory Committee’s (HICPAC) Guideline for Prevention of Catheter-Associated Urinary Tract Infections, 2009. Both provide guidelines and best practices for preventing CAUTIs. 

The “Take Every PreCAUTIon” campaign combines the practical approach of the APIC guidelines with the evidence-based practices of the HICPAC document, according to Ritter.

“When we look at what policies and procedures you have in place, we took those things from the HICPAC documents, such as which patients should get a Foley catheter, and then the things that are suggested in the APIC elimination guide, which talk more about empowerment for early catheter removal,” Ritter says. “So we’ve tried to combine those two things to make them applicable for really any healthcare facility that may pick up the package and try and implement it.”

The cost associated with better technology

Part of Bard Medical’s “Take Every PreCAUTIon” campaign includes pushing hospitals toward better catheter technology, including silver alloy catheters with hydrogel coating or antimicrobial catheters. This is a 1B recommendation in the HICPAC guidelines, which state: “If the CAUTI rate is not decreasing after implementing a comprehensive strategy to reduce rates of CAUTI, consider using antimicrobial/antiseptic-impregnated catheters.”

As always, hospitals struggle with the cost associated with these products, and nurses often face even more of a struggle proving to administration that they are worth the money.

The “Take Every PreCAUTIon” campaign offers a very basic CAUTI tray that includes essentials such as hand sanitizer and wipes to clean patients before prepping them for a Foley catheter. Also included in the tray are a securing device and a checklist with questions for the nurse to consider, as well as a chart sticker that serves as a visual reminder that the patient has a Foley catheter. The cost associated with this new tray is only 25 cents more per tray, says Ritter. But the silver alloy–coated catheters end up being $5 more. 

In the past, Bard has worked with staff to perform cost analysis by doing housewide surveillance and comparing the cost associated with new technology with the cost savings of preventing infections. “Now, putting in ‘Take Every PreCAUTIon,’ we’ll also be able to add in—as we move forward—the cost associated with reduced Foley catheters because one of the things we want to make sure is that we don’t overuse Foley catheters,” Ritter says. “If you are going to use a Foley catheter and the patient needs it, then we believe you should use something that is proven to reduce infections, but if the patient doesn’t need a catheter, then you shouldn’t use it at all.”

Source 

Briefings on Infection Control, September 2010, HCPro, Inc.