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According to the Centers for Disease Control and Prevention (CDC), urinary tract infections (UTIs) are the most common healthcare-acquired infection, accounting for nearly 40 percent of all nosocomial infections. This has become a major issue for hospitals since the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospitals for hospital-acquired UTIs in October 2008. To help hospitals reduce UTI incidence, VHA Inc., the national healthcare alliance, brought 21 Pennsylvania hospitals together in September 2008 to share best practices around UTI prevention and accelerate the ability of hospitals to implement prevention strategies. The participating hospitals have reduced symptomatic urinary tract infections by 32 percent and seen a 3.6 percent drop in the number of day’s patients use catheters while hospitalized, a major cause of infections.
“UTIs are costly and can complicate a patient’s condition and/or outcome,” said Marilyn Rudolph, RN, BSN, MBA, vice president of performance improvement at the Pennsylvania office of VHA. “Through comprehensive data review and coaching calls that allow participating hospitals to share information and collaborate, VHA is helping its member hospitals provide better patient care.”
One hospital participating in the VHA UTI program is Jefferson Regional Medical Center in Pittsburgh. The medical center was already exploring comprehensive measures for reducing UTI incidence in its patients and joined the VHA program to enhance its efforts. The hospital has developed and implemented more than 20 action items to help decrease UTI rates including:
· A physician order sheet that addresses criteria for Foley catheter use on a daily basis
· A protocol and competency for urinalysis, and culture and sensitivity collection
· A pamphlet for patients and family’s addressing the care of and indication for a Foley catheter
· Hospital-wide education and mandatory competencies concerning Foley care and insertion
“Every UTI prevented is a phenomenal outcome for our patients and a financial success for the hospital,” said Nancy Winkleblech, RN, BSN, MS, ET, manager of the respiratory care unit at Jefferson Regional. “We are on target to decrease the number of catheter-associated UTIs by 50 percent this fiscal year, and have reduced catheter use device days by 15 percent.”
Jameson Memorial Hospital in New Castle, Penn., embraced the UTI program as a system-wide patient safety initiative. Judith Douglass, RN, BSN, director, Jameson Hospice of Lawrence County and catheter-associated UTI project manager, conducted comprehensive staff training that taught staff about how patients get UTIs and why. The facility also created specific training sheets tailored to each staff members job, from housekeeping to nutrition staff, to ensure they all understood what to look for and how they could help prevent UTIs and what signs to look for so they could assure adequate treatment. Tips included calling nursing immediately if the tube or bag is touching the floor and ensuring that the bag is properly concealed while the patient is in transport. To make UTI prevention easier for nursing staff, special catheter kits were also created that include all necessary components, including a patient education tool.
“Now, all of our employees are aware of what they can do to prevent UTIs,” said Douglass. “Implementing basic strategies, like a bimonthly education newsletter specifically focused on UTI prevention and performance, and using simple paper bags to conceal urine bags while patients are being transported, have helped us to reduce our UTI rates by 50 percent!”
Barbara Romig, RN, MSN, CPHQ, director of clinical practice at The Reading Hospital and MedicalCenter in West Reading, Pa., saw participation in the VHA program as an opportunity to learn from other hospitals. The hospital has seen a 28 percent decrease in catheter use days and a decrease to less than one catheter-associated UTI per 1,000 catheter days in the first quarter of 2009. Key to its success has been:
-- Implementation of a nurse-driven evidence based protocol that does not require physician approval to remove a catheter (except for special cases)
-- Detailed drill-down of all catheter-associated UTIs by a quality analyst with feedback to clinicians as needed
-- Survey to identify barriers, followed by comprehensive staff education about misconceptions and importance of catheter removal and keeping bag below the patient’s bladder
-- Leadership rounding with a focus on quality outcomes, including prevention of catheter-associated UTIs
-- Development of a patient brochure
-- Signage on carts reminding staff, “Did you remove a Foley today”
-- Stickers on urine bags indicating insertion date and other key information
According to Romig, “We have a diverse team leading this initiative and the team approach has been paramount to our program’s success.”