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Interdisciplinary team approach decreased CAUTI rates in a rehabilitation setting
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An interdisciplinary team approach successfully decreased catheter-associated urinary tract infections in a rehabilitation setting within 3 months, from 36% to 6.6%.
“Best practice guidelines that are published didn’t address the problems that we were seeing in our facility with bladder management and the needs of many of our patients,” Kristina K. Felix, BA, RN, CRRN, CIC, of the Madonna Rehabilitation Hospital in Nebraska, said during a telebriefing in advance of the 38th Annual Educational Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology.
“We looked at every facet of bladder management, including better ways to assist patients to the bathroom in a timely manner, different types of commodes and engaging the entire care team in the bladder management processes,” she said in a press release. “We implemented education with all members of the care team, including patients and family members, so that everyone understood the process and the benefit to the patient of reduced UTIs.”
UTIs were the most common infection type at the 300-bed Nebraska center, of which 55% were catheter-associated urinary tract infections (CAUTIs).
Felix and colleagues created an interdisciplinary team of physical therapists, occupational therapists, nursing staff and education staff to develop a plan to decrease CAUTI occurrence by decreasing catheter use in patients who did not have a medical need. The following underlying contributing factors were identified:
- Patients are admitted to rehabilitation settings from acute care with indwelling catheters in place.
- Patients and families view catheter use as a convenient way to manage incontinence.
- In medically complex patients, catheter removal may not be the priority.
- Different disciplines help with pericare, catheter care and catheterization.
The team then implemented a decathetertization protocol after all members were educated on catheter bagging, tubing placement and securement, and proper hygiene. For patients who needed indwelling catheters, the task force evaluated catheter insertion and educated patients and family members on proper care to prevent infection, risks associated with catheter use, and to be as independent as possible in managing bladder functioning.
CAUTI prevalence rates declined from 36% before the plan to 6.6% 3 months after the plan was implemented. The rates declined even further to 4% or 5% after the project ended, according to Felix.
“It is the job of the infection preventionist to take best practice and research-based guidelines in infection prevention and adapt them to the specific types of patients treated at their facility,” Felix told Infectious Disease News. “In the rehabilitation setting, it is important to include clinicians from all disciplines involved in the care of the patient in the process of adapting guidelines so we can achieve the best outcomes for the patient.
“We prevented possibly up to 30 UTIs per month and at about $1,000 each; we saved quite a bit of money, she said. “It’s a double benefit, for our patients who have benefited from not being sick with a UTI, so they were able to continue with their rehab and their therapy sessions and not miss them due to being ill, and we didn’t have many costs associated with this. It made a significant impact on our patients and also the expense of the facility.” – by Ashley DeNyse
For more information:
- Felix K. #121. Presented at: the Association for Professionals in Infection Control and Epidemiology’s (APIC) 38th Annual Educational Conference and International Meeting; June 27-29, 2011; Baltimore.
Disclosure:Felix reports no relevant financial disclosures.
Infection preventionists are really the key lynchpin. When we look at published national guidelines, for example, the catheter-related bloodstream infection guidelines that recently were published by the CDC's Healthcare Infection Control Practices Advisory Committee, they certainly are very well developed, and they're based on the evidence. The key is, however, you need to take those recommendations and apply them to the population you're taking care of, and this is a clear demonstration of the very significant impact on improving the safety of the rehabilitation clients at that facility.
–Russell Olmsted, MPH, CIC
APIC 2011 President
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