Resident Distraction as a Strategy to Improve Perineal Care and Reduce Catheter Associated Urinary Tract Infections in Long-Term Care

Abstract

<h3>Background</h3> Catheter Associated Urinary Tract Infections (CAUTIs) can lead to sepsis and death in the elderly. Despite good compliance with the CAUTI bundle, the CAUTI rates in the 116 bed long-term care facility were stagnant. Safety huddles are utilized by patient safety after an event and was trialed by Infection Prevention and Control to explore its effectiveness after an infection event. Combativeness in residents surfaced as the root cause. Our objective was to reduce CAUTI incidence by taking a team approach where one member would distract combative residents during perineal care. <h3>Methods</h3> Baseline period was January 2016 to March 2017. A tool was developed for the huddle process which included practices related to CAUTI (catheter insertion and maintenance including irrigation, perineal care and catheter care). The tool was reviewed with front line nurses and nursing assistants caring for each resident within a week of identifying the CAUTI. These huddles revealed good knowledge of the CAUTI bundle, catheter care and maintenance. Three huddles were conducted between January and April 2017 and a common barrier of combativeness in residents during peri-care was identified. Intervention period (distracting the resident to reduce combativeness) was from April 2017 to September 2018. <h3>Results</h3> During the study period CAUTIs were reduced by 73% from a baseline CAUTI rate of 1.86 per 1000 urinary catheter days (with 12 CAUTI and 6,440 catheter days in a 15-month period) to 0.51 per 1000 urinary catheter days during the intervention period (4 CAUTI and 7,909 catheter days in an 18-month period) (p-value 0.02). <h3>Conclusions</h3> The event huddle revealed resident combativeness as the root cause for inability to perform excellent perineal care. Providing distraction through a team approach during perineal care has resulted in dramatic reduction in CAUTI incidence at this long-term care facility.