In 2013 our ICU had a total of seven CAUTI incidents for a rate of 5.7 and a standard infection rate of 4.40. Any SIR score greater than one indicated a higher infection rate than predicated. Unfortunately, the ICU/PCU continued to have problems with CAUTI's the first QTR of 2014 with a total of 4 CAUTI infections identified. This prompted quick action to prevent further CAUTI infections.
In July 2013, infection control had developed a nurse driven urinary catheter necessity protocol. This empowered nurses to remove urinary catheters as soon as their patients no longer met criteria. CAUTI champions were chosen from all inpatient units at CHS University. In June 2014, charge nurses started reporting the room numbers that had indwelling catheters, along with the necessity for the catheter, and the number of days. Our unit also began completing the orange stickers and placing date of insertion on all urinary catheter bags. Our unit pays close attention to the number of days a urinary catheter is in place, because our last 4 CAUTI's were from urinary catheters that were in place for longer than 7 days. Education was completed by our CAUTI champion on unit, Rose Clarke, regarding proper urinary catheter care and placement of urinary catheter bag.
Our team did an excellent job over the next few years changing the culture on our unit. We quickly went from a culture of everyone in ICU needs a urinary catheter to a culture of "your patient has a urinary catheter, do they need it, can we remove it?" Staff were educated that it was no longer acceptable for patients to keep urinary catheters because they are getting lasix, not able to get out of bed, or on the ventilator. Rose was a strong role model on our unit by practicing what she was educating by removing her own patients' urinary catheters as soon as possible.
Now it is not unusual to work days where there are 0 urinary catheters in our ventilator patients. This has not been an easy task. It is difficult in the ICU as you do not have as much access to nursing assistants. Having to go in frequently and place the patient on the bedpan, take them to the bathroom, and change their linens can make for a very challenging day. I am so proud of my teammates. They do it because they know it is the right thing for their patients. They don't complain. If a patient comes to the unit with a urinary catheter that does not meet criteria, they make sure it is removed as soon as possible. I am constantly reminded of what an excellent team we have at CHS University.
Urinary catheter necessity is also discussed daily during our ICU multidisciplinary rounds. Dr. J has been very supportive of our initiatives and continues to help us identify patients that fit the criteria for removal of urinary catheter.
This past month, Rose implemented a new staff reward system for CAUTI prevention called CAUTI Cash. CAUTI cash is rewarded to staff whenever they are proactive in removing urinary catheters. For example, if a nurse "extubates and exfoliates" simultaneously. Nurses can also be rewarded with CAUTI cash if seen: labeling a urinary collection bag, no dependent loops in their urinary catheter tubing, an orange sign hanging in the room, emptying a bag prior to transporting a patient, stat-lock is placed in proper position. This was initiated Nov. 1st. Staff can cash in their CAUTI cash for meal tickets, car washes, movie tickets, starbucks and to "move to the bottom of the float" list.
Nurse Honorees: Rose Clarke, BSN, RN, CN II, Mary Shue, BSN, RN and Natalie Speagle, BSN, RN, CN II