Beyond Bundles in Prevention of CAUTI and UTI’s

Abstract

Background: Urinary tract infections (UTIs) are common healthcare-associated infections. Evidenced-based practice (EBP) successes of catheter associated urinary tract infection (CAUTI) bundles has resulted in rates decreasing >50% in community-based nursing homes. The South Texas Community Living Center (CLC SA), our 42-bed long-term care and rehabilitation center, conducts routine infection prevention surveillance. During routine surveillance, the infection prevention team noticed an increase in UTI percentages and CAUTI rates. Thus, we sought to increase compliance with standard CAUTI bundles, and we implemented an intervention called the “bladder bundle.” Methods: A multidisciplinary team (ie, infection preventionist, clinical nurse leader, simulation director, educator, leadership and frontline staff champions) identified and evaluated practices through documentation of audits and safety rounds during April and May of 2017 (FY19 QTR 3). The comprehensive bladder bundle was initiated in June 2017, based on EBP interventions and included education for staff with audit and feedback. The team reviewed the literature and expanded the bladder bundle to include a comprehensive urinary note and oral hydration program for the veterans in addition to the standard CAUTI bundles (ie, minimize catheter use, use with appropriate indications, consider alternatives to catheters, proper insertion and securement). In May 2018, a facility-wide, hospital-wide initiative focused on a new urinary catheter insertion kit, insertion competencies and perineal care to improve outcomes. This initiative was added to our bladder bundle for CLC SA. Results: Before the intervention (FY16 Q3 to FY17 Q2), percentages of veterans with a UTI had increased to 4.65%, in FY17 Q3, this rate had increased to 11.76%. After the intervention (FY17 Q4 to FY19 Q3) the percentage dropped significantly to 0%, and this rate has now been sustained for 8 quarters. Our CLC SA has remained at zero harm and has no NHSN CAUTI has occurred since October 2017 (FY18Q1). The catheterization in bladder days has decreased from 162 days in FY14 to 49 in FY18, and for the first 2 quarters of FY19, there were only 25 days. For the last 8 quarters, documentation compliance has increased, as has use of BB interventions. Conclusions: The continuous improvement project targeted within the CLC SA, with education to staff, audit and feedback tools, and a comprehensive urinary note with the oral hydration program in combination with the standard CAUTI bundles, have improved veteran health outcomes and have expanded provider and nursing practices. The interprofessional team approach enhanced the success of this project.

Funding: None

Disclosures: None