Clinicians at Arkansas Methodist Medical Center (AMMC) are changing the way they assess and perform urinary catheter insertions -- and it's working. With the help of Medline Industries, Inc.'s ERASE CAUTI Foley catheter management system, which combines evidence-based principles and training with a revolutionary one-layer tray design, AMMC has seen a 21 percent reduction in catheterizations and catheter-associated urinary tract infections (CAUTIs). Urinary tract infections (UTIs) account for 40 percent of all healthcare-associated infections according to the CDC. Urinary catheters are associated with the vast majority of those healthcare-acquired UTIs.
"The one-layer tray design is labeled in a specific sequence that helps guide our nurses during the catheterization process to adhere to current CDC recommendations, including aseptic technique," said Lisa Bridges, RN, infection preventionist at AMMC. "To help us reduce catheterizations, we are requiring our entire nursing staff to take the program education on the alternatives to catheterization. Plus, the new tray has a checklist to help the nurse make a decision on whether catheterization is appropriate for the patient and assure that the education transfers into everyday clinical practice."
As measured by the number of catheterizations performed in March and April 2009 versus the same time in period in 2010, AMMC reduced the number of catheterizations from 192 to 151, a 21 percent drop (based on adjusted patient day). This decrease contributed to the hospital achieving zero CAUTIs in April 2010, compared to three in April 2009, according to Bridges.
Another leading factor causing CAUTI is leaving a catheter in place for more than two days after surgery. The new Surgical Care Improvement Project (SCIP) recommends removal of catheters within 24 to 48 hours post-operatively. In the first quarter of 2009, only 20 percent of the catheters AMMC placed in the operating room were being removed within two days. With the implementation of the ERASE CAUTI program, the removal rate increased to 50 percent in the first quarter of 2010.
"With the Foley InserTag and checklist sticker placed on the patient's chart, nurses and physicians knew exactly when the catheters had been placed," said Bridges, "and were able to remove them in the necessary 24 to 48 hours after surgery."
Also, inserted in the tray is a patient education care card that looks like an actual get well card. According to Bridges, the card is a more effective way to educate patients about the procedure, including the risks and complications associated with closed system Foley catheters.
"Before, we had to print our education from the computer, and it was not something the patient or the clinician normally took time to review," said Bridges. "The patient care card has significantly improved our ability to provide patients and families with a tool to help them better understand the proper care and maintenance of the catheter, signs and symptoms of CAUTI and how they can help reduce the chances of developing CAUTI."
AMMC, a 129-bed inpatient facility located in Paragould, Ark., has more than 200 nurses on staff. Almost 25,000 patients visit the hospital's emergency room annually; a total of 4,196 patients are admitted; and physicians perform 795 inpatient and 1,827 outpatient surgeries.