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Background
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.
Methods
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.
Results
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).
Conclusions
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.
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Article Info
Identification
Copyright
© 2020 Published by Elsevier Inc.
