Education on Basics Results in Significant CAUTI Reduction, Cost Savings

Abstract

PHOENIX — Staff at the 162-bed Henry J. Carter Nursing Facility in New York City achieved a 78% reduction in the rate of catheter-associated urinary tract infections (CAUTI) with training on basic care and strict adherence to preventive practices, Emalyn Bravo, RN, MA, LNHA, reported at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference. “We emphasized the concept that CAUTI prevention is about basic, simple care,” said Ms. Bravo, associate director of performance improvement at the facility. The nursing facility participated in a year-long project with the Agency for Healthcare Research and Quality’s (AHRQ) budding Safety Program for Long-Term Care to reduce CAUTI and other health care–acquired infections. Between September 2015 and July 2016, the facility’s CAUTI rate declined from 3.28 per 1,000 catheter days to 0.72 per 1,000 catheter days, resulting in a 73% cost reduction for the facility (from $30,470 down to $8,310), Bravo reported at the meeting. Moreover, the cost savings attributable to eliminated antibiotic use during the project period were almost $26,000, she added in a later interview with Caring. Education and training included webinars and coaching calls by program coordinators from The Joint Commission and AHRQ, as well as competency assessments, care checklists, daily huddles, and weekly sharing of data within the facility. More than 200 staff (including physicians, registered nurses, licensed practical nurses, certified nurse assistants, housekeepers, and nursing home leaders) received some kind of education or training during the year, and five staff members (one LPN and four CNAs) were appointed “CAUTI champions” to encourage and lead staff through the project. A key factor in CAUTI prevention, Bravo said at the conference, was the timely evaluation of residents admitted with Foley catheters from acute care hospitals. During the course of the program, 15 of 21 residents admitted with Foleys had their catheters removed. “The sooner we remove the catheter, the less risk there will be for infection,” she emphasized in the interview. “Hospitals use Foley catheters all the time, and when they discharge, they [don’t] discontinue them.” The other key to their CAUTI reduction was education and vigilance about basic care concepts such as aseptic insertion of Foley catheters and proper catheter care (such as using routine hygiene, maintaining a closed drainage system and unobstructed urine flow, and keeping the drainage bag below the level of the bladder at all times). With education, CNAs began avoiding the shortcuts that previously led to catheter contamination, Ms. Bravo told Caring. The facility’s Foley catheter utilization rate among its 130 long-term care residents remained steady throughout the project at about 6% because of clinical necessity, but the residents with long-term use neither developed UTI nor were hospitalized. CAUTI can lead to complications such as cystitis, pyelonephritis, bacteremia, and septic shock, each of which can result in hospitalizations, increased mortality, and declines in function and mobility. “We do believe that education is an investment and ignorance is expensive,” Ms. Bravo said at the meeting. The indwelling urinary catheter should not substitute for nursing care of residents with incontinence, she emphasized. Nor should it serve as a means of obtaining urine for culture or other diagnostic testing when the resident can voluntarily void. As participants of the AHRQ project, staff at the Henry J. Carter Nursing Facility also learned more about current CAUTI surveillance definitions, interpretation of urine diagnostics, and judicious use of antibiotics. “If there’s no symptom like fever or pain, we don’t send for a culture … and we’re more proactive about [pushing] more nourishment and fluids,” Ms. Bravo told Caring. A key factor in CAUTI prevention was the timely evaluation of residents admitted with Foley catheters from acute care hospitals. Based on the experience at her facility and at several hundred other nursing homes that participated in the AHRQ project, the agency fine-tuned its Toolkit to Reduce CAUTI and Other HAIs in Long-Term Care Facilities (www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/index.html). The Carter facility’s experience was also described in the March issue of JAMDA (J Am Med Dir Assoc 2017;18:B18). Christine Kilgore is a freelance writer in Falls Church, VA.