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CAUTI Prevention at BIDMC
Michael Cocchi, Jean Gillis, Aleah King, Graham Snyder, Lauge Sokol-Hessner, Kathryn Zieja
Introduction/Problem
Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infection
(HAI) and a source of potential harm for patients. At BIDMC, indwelling urinary catheter (IUC) use and
CAUTIs remain more frequent than expected national and local benchmarks. In addition to decreasing
the quality of care patients receive, CAUTIs significantly contribute to the withholding of reimbursement
dollars from public and private payers (about $3.7 million are at stake through CMS and BCBS programs)
and affects BIDMC’s reputation. The ICUs started to implement multiple interventions to reduce CAUTI
and use of IUCs in 2015; this work spread to Farr 3, Farr 9, and Rosenberg 7 in 2016, and is continuing
to spread to Farr 2 and 12 Reisman in 2018.
Aim/Goal
• Decrease the Device Utilization Ratio (DUR, the measure of frequency of IUC use) below the NHSN
median (for ICUs) or 25th percentile (for Med/Surg)
• Decrease the Standardized Infection Ratio (SIR, the adjusted measure of CAUTI) below 1
The Team
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•
•
•
•
Health Care Quality
Infection Control
Urology
Patient Care Services
Leadership and CAUTI champions from the following units:
12 Reisman
CCU
Farr 2
CVICU
Farr 3
Finard ICU
Farr 9
MICU-A
Rosenberg 7
MICU-B
Neuro ICU
SICU
TSICU
* = work impacts all Med/Surg floors
Interventions
Shared Data
ICU & Med/Surg
Champions
ICU & Med/Surg
Educational Materials
ICU & Med/Surg*
Best Care Practices
Bundle Audit
ICU & Med/Surg*
Daily Team Catheter
Review Audit
ICU & Med/Surg
Catheter Removal and
Post-Removal Guidelines
ICU
MetaVision Changes
ICU
New Products
ICU & Med/Surg*
Insertion, Care, and Discontinuation Policy
ICU & Med/Surg*
Units notified and review CAUTI cases
ICU & Med/Surg
CAUTI patient/family education
ICU & Med/Surg*
Revised POE Order
ICU & Med/Surg*
Draft Hospital-wide IUC guideline
ICU & Med/Surg*
Female external catheter Trial
ICU & Med/Surg*
New Med/Surg CAUTI Taskforce
focused on FA2, FA9, 12R
For more information, contact:
Kathryn Zieja, Health Care Quality Senior Project Manager, kzieja@bidmc.harvard.edu
�CAUTI Prevention at BIDMC
Michael Cocchi, Jean Gillis, Aleah King, Graham Snyder, Lauge Sokol-Hessner, Kathryn Zieja
Results/Progress to Date
Unit specific highlights:
• FY18 Q1 is the first quarter that TSICU did not have any CAUTI
• FY18 Q1 is the first quarter that the Neuro ICU’s catheter usage (DUR) is better
than their goal
• During the entire fiscal year of 2017, MICU-B did not have any CAUTI
• During the entire calendar year of 2017, Finard ICU did not have any CAUTI and
catheter usage (DUR) for every month was either at or better than their goal
Lessons Learned
SIR Notes:
- The Med/Surg units reported to NHSN changed starting FY18. FY18 data includes 12R, 5S, 7S, 8S, FA2, FA5, FA7, RB7 to FA9
Data prior to FY18 includes 12R, 5S, 8S, FA2, FA3, FA8, FA7, FA9, RB7
- NHSN changed the baseline data used to calculate the expected number of infections for the SIR.
For FY17 – FY18: NHSN uses 2015 data as baseline to calculate the expected number of infections
For FY15 – FY16: NHSN used 2013 data as baseline to calculate the expected number of infections
= Better than Expected (SIR <1, p value <0.05)
= As Expected (SIR=1, or any SIR p value > 0.05)
= Worse than Expected (SIR >1, p value <0.05)
• Multiple sustained interventions are required to impact catheter use (DUR) and
CAUTI (SIR)
• Incorporating assessment of the need for an IUC into existing workflow is
important and challenging
Next Steps
•
Lower is Better
Lower is Better
•
•
•
•
•
•
DUR Note: FA3 and RB7 data are no longer reported to NHSN due to unit reclassification
Interdisciplinary Indwelling Urinary Catheter Guideline, a consolidated reference
for education and local improvement interventions, will be rolled out in FY18Q3
PureWick female external catheter will be rolled out in FY18Q3
Additional POE changes will be built and implemented in FY18Q3: add PostIUC Removal Algorithm into workflows across BIDMC, simplify the straight cath
order, & more
Neuro ICU subgroup will explore different interventions in FY18Q3
Unit leadership will continue to review each CAUTI case and identify if anything
could have been done differently to prevent the CAUTI in FY18Q3 and FY18Q4
All order sets with an IUC order in POE will be identified for possible update in
FY18Q3
Work towards establishing a CAUTI preventability model will continue in
FY18Q3 and FY18Q4
For more information, contact:
Kathryn Zieja, Health Care Quality Senior Project Manager, kzieja@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kathryn Zieja (<a href="mailto:kzieja@bidmc.harvard.edu">kzieja@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
Infection Control
Urology
Patient Care Services
Nursing
Project Team
Michael Cocchi
Jean Gillis
Aleah King
Graham Snyder
Lauge Sokol-Hessner
Kathryn Zieja
Leadership and CAUTI champions from the following units:
CCU
CVICU
Finard ICU
MICU-A
MICU-B
Neuro ICU
SICU
TSICU
12 Reisman
Farr 2
Farr 3
Farr 9
Rosenberg 7
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
CAUTI Prevention at BIDMC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety