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Studies have shown that often physicians don’t know a Foley has been placed in a patient, or that its use has been continued beyond necessity.” – Rich Lyon, BA, MA, JD, RN, CIC, infection control coordinator for Mercy Medical Center
ing the previous 12-month period, says Lyon. Step 2 was to talk with Mercy’s prime vendor, Medline Industries, about potential solutions, including the company’s one-layer foley catheter kit.
CAUTI occurrence data had already been collected prior to the changes, so patient care managers and directors could see their performance on a unit-by-unit basis.
Training Older kits stack their components, so that the nurse ust take them out, stack them somewhere on the sterile field, and retrieve them as needed, explains Lyon. “That’s inconvenient for the nurse, and nurses have so much more to do now than they did in the past.” In contrast, Medline’s kit is in one layer, so nurses don’t have to stack or unstack anything. Choosing a catheter wasn’t difficult, he says. “We wanted to go latexfree, which we had prior to this. And we wanted silver-coated catheters because of their antimicrobial action.” Medline offered both, and Mercy proceeded to trial the kit in three patient care units. After a successful trial, the new product (and mandatory training program) was rolled out to the rest of the hospital. A baseline of
Lyon was especially attracted to the ERASE CAUTI online training program. All staff involved in inserting foley catheters or in foley catheter care were instructed to view the online training modules and take tests on the material presented. They were able to access the modules via terminals at the hospital (including those in the medical library) and on their home computers. After three or four days, each additional day that a foley catheter is in, the risk of infection increases by 5 to 8 percent, says Lyon, citing studies. So Mercy stressed education on insertion technique, particularly in the emergency department and the OR. In the ICU, where many catheterassociated urinary tract infections occur, the emphasis was on post-insertion catheter care. That means cleaning of the insertion
site at least daily, and more if the patient’s condition necessitates it; and discontinuing catheterization as soon as possible. “With any major change in products, you will often encounter misgivings or resistance by the end-user staff,” says Lyon. “It is crucial that they be provided adequate product change rationale and support training to help ease the transition.” In fact, when asked to identify the single most important factor in Mercy’s success in reducing CAUTIs, he answers, “Education, education, education, reinforcement and continual performance feedback to the nursing staff and physicians.”
Physicians and patients Nurses and OR techs aren’t the only ones involved in Mercy’s CAUTI reduction program. Physicians and patients are part of the program as well. “Studies have shown that often physicians don’t know a foley has been placed in a patient, or that
Aligning practice with policy to improve patient care 65