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Selected Category: CAUTI

Why So Many Foleys?

Categories: CAUTI, Clostridium difficile, Healthcare-associated infections

Wendy Kaler, CLS, MPH,CIC

Wendy Kaler, CLS, MPH,CIC

Guest Author: Wendy Kaler, MPH, CIC
Dignity Health Clinical Lead for CAUTI Prevention

At Dignity Health, our goal is to reduce the rate of hospital-acquired infections (HAI) by 40 percent and readmissions by 20 percent before 2015, and we are well on our way. We have introduced specific evidence-based practices and bedside intervention activities to evaluate full adoption of safe preventive practices and assure coordination of care at the bedside with clinicians, including physicians. When I am provided the opportunity to share my experiences with Dignity Health’s “No Harm Campaign” to prevent catheter-associated urinary tract infection (CAUTI), I am often asked “why is it so difficult to get Foleys discontinued?”

Weighing the Benefits and Risks of Using a Foley

During training, physicians and nurses are made aware of the advantages of indwelling urinary catheters indwelling urinary catheters, but oftentimes the instructors do not focus on the associated risks of these devices. With competing priorities and time constraints, health care providers do not prioritize indwelling urinary catheters as a device that should be assessed daily for need, especially in the critical care units. Historically, the intensive care unit (ICU) staff believed that all critical care unit patients need a Foley. Lack of good alternatives available to provide bladder management and output measurement have contributed to this practice. Bedside nurses are ultimately managing the Foley and the advantages for them are understandable, including reducing the amount of time they must spend managing the bladders of their patients and keeping their patients skin dry. However, bedside nurses need to be aware that the risks to the patient are greater than the advantage to themselves. For example, if a patient develops a UTI and is treated with antibiotics, they are at an increased risk to develop multi-drug resistant organisms or C. difficile infection.

Despite Progress, three-quarters of a million infections threaten hospital patients each year

Categories: Antimicrobial Resistance, BSIs, CAUTI, CLABSI, Clostridium difficile, Healthcare-associated infections, Long Term Care (LTC), NHSN, State HAI Prevention

National and State Healthcare-associated Infections Progress Report. This report is based on 2012 data, Published March 2014

National and State Healthcare-associated Infections Progress Report. This report is based on 2012 data, Published March 2014

Despite Progress, three-quarters of a million infections threaten hospital patients each year
National and state data detail threat of healthcare-associated infections and opportunities for further improvements.

CDC released two reports today – one, a New England Journal of Medicine (NEJM) article detailing national healthcare-associated infection estimates, and the other an annual report on national and state-specific progress toward U.S. Health and Human Services HAI prevention goals. Together, the reports show that progress has been made in the effort to eliminate infections that commonly threaten hospital patients, but more work is needed to improve patient safety.

The NEJM article updates the burden numbers for healthcare-associated infections in hospitals.  On any given day, 1 of every 25 patients had 1 or more infections related to their hospital stay.   That means about 722,000 infections a year related to medical care.  One of every 9 patients who gets an infection will die during their hospitalization.

This article sounds the alarm about threats we need to address now.  It tells us that lung infections, gut infections, surgical infections and infection from urinary catheters are harming the most patients.

Some of the top pathogens attacking patients are: 

  • C. difficile, or deadly diarrhea,
  • Staph, including the drug-resistant type known as MRSA,
  • a family of germs known as Enterobacteriaceae, that includes CRE the “nightmare bacteria,”

The second report, CDC’s National and State Healthcare-associated Infection Progress Report, includes national and state-by-state summaries of infection types that are commonly required to be reported to CDC. The Progress Report looked at data submitted to CDC’s National Healthcare Safety Network (NHSN), the nation’s healthcare-associated infection tracking system.   On the national level, the report found a:

  • 44 percent decrease in central line-associated bloodstream infections between 2008 and 2012
  • 20 percent decrease in infections related to the 10 surgical procedures tracked in the report between 2008 and 2012
  • 4 percent decrease in hospital-onset MRSA bloodstream infections between 2011 and 2012
  • 2 percent decrease in hospital-onset C. difficile infections between 2011 and 2012
  • 3 percent increase in catheter-associated urinary tract infections

At the federal and state levels, CDC uses this information to find facilities that need help and target resources where they are most needed.

To access both reports and to see the updated healthcare-associated infection data, see CDC’s website: www.cdc.gov/hai.

Watch a new video on Healthcare-Associated Infections.

HICPAC – Taking the Lead on Safe Healthcare Practices

Categories: CAUTI, Healthcare-associated infections, HICPAC

Jeffrey Hageman, MHS

Jeffrey Hageman, MHS

Jeffrey C. Hageman, M.H.S.
CDC Epidemiologist and Executive Secretary of HICPAC
CDC’s Division of Healthcare Quality Promotion

Each morning when I review news headlines about the latest medical research identifying a new cure or danger, questions pop into my head. Was the research study designed correctly? Was the information collected accurately? Does this new research finding mean the older recommendations don’t need to be followed? Fortunately, there are groups of experts who review the evidence, ask these questions, and develop recommendations so that clinicians have the best information available to practice safe care.

One important group that advises the Centers for Disease Control and Prevention (CDC) and the Secretary of Health and Human Services (HHS) is the Healthcare Infection Control Practices Advisory Committee (HICPAC). HICPAC is a federal advisory committee composed of 14 external infection control experts who come from a variety of medical fields such as infectious diseases, nursing, surgery, critical care medicine, and public health. HICPAC also has a consumer advocate representative, as well as representation from both other federal agencies and professional organizations. HICPAC’s primary function is to issue recommendations in the form of guidelines for the prevention of healthcare-associated infections. Guideline topics range from how to prevent catheter-associated urinary tract infections (CAUTIs) and surgical site infections (SSIs) to how personnel should clean medical equipment and rooms between patients.

CAUTI– Preventing the Most Common HAI (Part 2)

Categories: Antibiotic use, CAUTI, Healthcare-associated infections

Linda R. Greene, RN, MPS, CIC

Linda R. Greene, RN, MPS, CIC

Linda R. Greene, RN, MPS, CIC

As an infection preventionist who is addressing this issue on a daily basis, I agree with Dr. Gould’s interpretation.

Despite the fact that urinary tract infections( UTI’s) are the most common healthcare-associated infection (HAI’s), they have traditionally not received the same level of attention as have other HAI’s. Most UTI’s are associated with the presence of a urinary catheter. Urinary catheters are used frequently in healthcare settings, however many of these catheters are not necessary and are sometimes inserted without appropriate justification. Often, this leads to overuse and misuse of antibiotics to treat these infections, which can lead to the emergence of drug-resistant bacteria. Because UTI’s can compromise one of the largest reservoirs of multidrug-resistant bacteria in healthcare settings, it is essential that we find ways to minimize their occurrence.

What are we doing about this? The Association of Professionals in Infection Control and Epidemiology (APIC) continues to work on ways to bring science to the bedside. In 2008, we developed a catheter-associated urinary tract infection (CAUTI) elimination guide. This CAUTI guide was developed to serve as a comprehensive tool to questions posed by our members. The APIC elimination guides are developed in sync with guidelines released by CDC, thereby helping to translate evidence into clinical practice and sharing strategies and tools which others have found to be successful.

CAUTI– Preventing the Most Common HAI

Categories: Antibiotic use, CAUTI, Healthcare-associated infections

Dr. Carolyn Gould

The other day, I was watching my colleague Dr. Sanjay Saint on Medscape and began thinking, “How can we better communicate that urinary tract infections (UTIs) are more than just nuisance infections, and that they are preventable?” So, I want to focus this blog post on one of the most common, yet most preventable, of the healthcare-associated infections catheter-associated urinary tract infections (CAUTIs).

In looking at the overall number of healthcare-associated UTIs, I am overwhelmed by both the burden and the myths associated with catheter use. Today, UTIs account for more than 30 percent of HAIs in acute care hospitals, and most of these are caused by urinary catheters. Perhaps the fact that many providers out there still believe that certain conditions, such as incontinence, are best managed with catheters is contributing to the CAUTI burden. The reality is that because infection control measures – including removing catheters as soon as possible – aren’t always followed, CAUTIs are causing illness among patients, longer hospital stays, and unnecessary antibiotic use. And more antibiotic exposure puts patients at greater risk for developing multidrug-resistant organisms and Clostridium difficile infection.

 
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