Hospital sees significant decline in CAUTI, CLABSI rates
Kelly R. Gray-Eurom, M.D., M.M.M., FACEP
Patients, staff and others who come to UF Health Jacksonville should know the hospital is experiencing a significant reduction in two types of infections, and it’s largely due to heightened awareness and the implementation of preventive measures and best practices.
Catheter-associated urinary tract infections, or CAUTIs, and central line-associated bloodstream infections, or CLABSIs, are occurring less frequently among patients. The two account for a significant percentage of infections at hospitals nationwide.
“Our doctors, nurses and administrators have been dedicated to improving our quality efforts,” said Kelly Gray-Eurom, MD, the hospital’s chief quality officer. “Patients are receiving a higher quality of care and are experiencing fewer infections and complications. This is the cumulative work of a lot of different people on campus.”
A CAUTI occurs when germs travel along a urinary catheter and cause an infection of the bladder or kidney. Germs can enter the urinary tract when the catheter is being inserted or while it remains in the bladder.
Studies show that among all urinary tract infections acquired in hospitals in the United States, about 75 percent of them are associated with a urinary catheter. Also, about 13,000 deaths are attributed to urinary tract infections every year.
In 2014, UF Health Jacksonville’s goal was to decrease CAUTIs to fewer than six infections per 1,000 urinary catheter days, said Valerie Platt, DNP, a nursing service line administrator and director of clinical services. The hospital created nurse-driven CAUTI teams dedicated to catheter insertion, maintenance and removal. There has been a greater focus on reports and audits, along with more education, training and a strengthening of protocol.
For instance, Platt said nurses are using condom catheters on male patients to decrease CAUTIs and have implemented a decatherization protocol that allows a nurse to remove a Foley catheter once criteria is met without having to get a physician’s order.
The hospital is also using special Theraworx® wipes, which have been shown to decrease the occurrence of CAUTIs when used every eight hours. There has been a significant emphasis on patient education as well.
These measures appear to be working. In the first quarter of 2014, there were 59 CAUTIs hospitalwide. In comparison, there were only nine in the fourth quarter of 2015. From February to May of this year, each month saw three or fewer CAUTIs, with none in June.
A central line, also called a central catheter, is placed in a large vein and used to draw blood, give fluids or administer medications. Bloodstream infections occur when bacteria or other germs travel down a central line and enter the blood.
The Institute for Healthcare Improvement has identified CLABSI as one of the most costly and deadly hospital-associated infections nationwide. Each year an estimated 40,000 bloodstream infections strike hospital patients with central lines.
“We have launched a hospitalwide initiative to decrease infections associated with central lines,” Gray-Eurom said. “It’s being led by the ICU nurses, and they have done some fabulous training programs in the simulation center.”
The Trauma Surgical Intensive Care Unit was the first area to implement a stronger protocol specifically aimed at lowering the CLABSI rate. Christopher Wilson, division director of critical care services, said daily rounds in the 28-bed unit include the evaluation of every IV access on all patients. Detailed notes are kept and shared daily with all involved staff in an effort to personalize care.
Nursing leaders collaborated with the hospital’s product vendors to design a workshop that reiterated correct use of dressing supplies and best practices for the timing of dressing changes.
Clinicians also became more active in identifying and removing unneeded central lines while increasing the use of midlines that have a lower risk for infection. In addition, clinicians are using an electronic CLABSI debrief tool to investigate each infection and collect valuable trends for action.
Since the launch of this initiative in August 2015, the CLABSI rate has continued to decrease in the TSICU. From February through August 2016, the unit has seen just one infection. Across the hospital, the numbers also continue to improve. In May 2014, there were 20 CLABSIs. From February to May of this year, each month saw five or fewer. There were none in June.
“Our patients are safer and are experiencing much better hospitality from our doctors and staff,” Gray-Eurom said. “The whole organization is committed to this.”
Kelly R. Gray-Eurom, M.D., M.M.M., FACEP