Evidence Based Practices to Prevent HAIs/CAUTI and Improve Resident Safety

Transcription

1 AHRQ Safety Program for Long term Care: HAIs/CAUTI Evidence Based Practices to Prevent HAIs/CAUTI and Improve Resident Safety

2 Objectives Upon completion of this module, participants will be able to: Describe the goals and benefits of the national long term care (LTC) collaborative to reduce HAIs/CAUTI and improve safety culture; Review the evidence based practices in HAI/CAUTI prevention; and Highlight the role of the prescriber in promoting evidencebased practices in HAI/CAUTI prevention. 2

3 Annual Impact of HAIs in LTC Setting 3

4 LTC Project Goals Primary Goals reduce HAIs/CAUTI and improve safety culture Develop/adapt evidence based CAUTI elimination and safety practices and resources for LTCFs Reduce CAUTIs and HAIs Improve safety culture Secondary Goals support expanded infection prevention efforts for C. diff, UTI, MDROs, etc. by providing education to: Improve hygiene practices (hand, environmental) Promote antibiotic stewardship Promote catheter stewardship Reduce re hospitalizations

5 Benefits of the LTC Program Improve the Nursing Home Compare Quality Measures Enhance data collection skills and prepare for mandatory reporting of infection data (NHSN) Benchmark against other LTC facilities (project level and nationally) Improve communication and relationships with referring hospitals that may results in reduced readmissions Improve compliance with survey requirements related to quality of care, infection control, etc.

6 The Important Role of the Clinician 6

7 Actively Engage Staff Using T.E.A.M.S. and C.A.U.T.I. C.A.U.T.I. Infographic: T.E.A.M.S. Infographic: 7

8 Assessing Catheter Necessity Catheters in newly admitted and readmitted residents should be assessed for necessity Every resident, when clinically possible, deserves a chance to be catheter free Remember, a resident cannot develop a CAUTI if they do not have a catheter NHSN CAUTI definition does NOT include suprapubic, straight nor condom catheters 8 8

9 CAUTI Surveillance Criteria CAUTI Criteria NHSN Definitions Pocket Card View Onboarding 2 materials on the NHSN definition for CAUTI here: 9

10 Avoid Unnecessary Urine Cultures Chronically catheterized patients have bacteriuria 99% of the time Bacteriuria can be symptomatic or asymptomatic Urine cultures, dip sticks and the presence of pyuria cannot be used to distinguish between CAUTI and asymptomatic bacteriuria (ASB) Non Specific Bacteriuria Signs Urine color Urine smell Urine sediment Cloudy urine ASB CAUTI Nicolle L.E., Bradley S., Colgan, R., et al. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults.Clin Inf Dis 2005; 40:

11 Ordering Unnecessary Urine Cultures Can Lead to Resident Harms Urinary catheter present Cloudy, odorous urine, sediments Inappropriate use of urine culture Over inflated CAUTI rates Inappropriate Treatment and Antibiotic Overuse Miss the correct diagnosis More resistant organisms, Clostridium difficile, increased cost, further health complications Resident Harms 11

12 Strategies to Reduce Unnecessary Urine Cultures and Overuse of Antibiotics Reduce unnecessary urine cultures Review urine culture data Assess whether s/s present to collect urine cultures Reduce the overuse of antibiotics Review antibiotic use data 1 Confirm s/s and positive urine culture Determine if appropriate antibiotic prescription was given Identify clinical situations driving antibiotic use (e.g., asymptomatic bacteriuria, UTI prophylaxis) Communicate with nurse, staff, residents and families the harms of starting antibiotics not clinically indicated Creating a Culture to Improve Antibiotic Use in Nursing Homes. CDC s The Core Elements for Antibiotic Stewardship in Nursing Homes. 12

13 Communication is Critical and TeamSTEPPS Can Help! Effective and clear communication between multidisciplinary teams and nurses and providers leads to better: Recognition of acute change of condition (ACOC) Timely intervention Improve treatment decision making Overarching ACOC management TeamSTEPPS for Long term Care version: 13

14 How You Can Help Be familiar with the NHSN CAUTI Surveillance definition Avoid obtaining unnecessary urine cultures Initiate care plan discussions with staff, residents and families to review ways to prevent CAUTI and harms together Document clinical indications for the catheter Document signs and symptoms of CAUTI Prescribe antibiotics only when appropriate 14

15 Stay Updated with Useful Resources 1. AHRQ Safety Program for Long term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety 2. TeamSTEPPS for Long term Care 3. LTC Safety Toolkit 4. NHSN CAUTI Definition Pocket Cards 5. Antibiotic Stewardship Brochure 6. Letter to LTC physicians re: clinical interventions to reduce CAUTI from Dr. Lona Mody 7. C.A.U.T.I Infographic 8. T.E.A.M.S. Infographic 15

16 References Module 1: Improving Communication and Decisions about Antibiotic Use in Nursing Homes. June Agency for Healthcare Research and Quality, Rockville, MD. patient safety/patient safety resources/resources/nh aspguide/module1/index.html Al Qas Hanna, Am J Infect Control 2013;41 (12): Centers for Medicare and Medicaid Services, Long Term Care Minimum Data Set, Resident profile table as of 05/02/2005. Baltimore. MD. Centers for Disease Control and Prevention (CDC). (2015). Infographic: Antibiotic Stewardship in Nursing Homes. Accessed on 09/23/15 at antibiotic stewardship nursing homes.pdf. CDC. (2014). Antibiotic Use in Nursing Homes. Accessed on 06/23/15 at factsheet nursinghomes.pdf. CDC. Healthcare Infection Control Practices Advisory Committee (HICPAC) approved guidelines for the Prevention of catheter associated urinary tract infections, Available at CDC. Identifying Healthcare associated Infections (HAI) for NHSN Surveillance (online). Accessible at: CDC, National Center for Health statistics, 1999 National Nursing Home Survey. Nursing Home Residents, number, percent distribution, and rate per 10,000, by age at interview, according to sex, race, and region: United States, Loeb, M et.al. Antibiotic use in Ontario facilities that provide chronic care. J Gen Intern Med 2001; 16: National Healthcare Safety Network (NHSN). Long term Care Facility (LTCF) Component Healthcare Associated Infection Surveillance Module: UTI Event Reporting [online]. Mody L, Bradley SF, Galecki A, et al. Conceptual model for reducing infections and antimicrobial resistance in skilled nursing facilities: focus on residents with indwelling devices. Clin Infect Dis. 2011;52: PMID: Nicolle L.E., Bradley S., Colgan, R., et al. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults.Clin Inf Dis 2005; 40: Richards CL. Infections in residents of long term care facilities: an agenda for research. Report of an expert panel. J Am Geriatr Soc 2002;50: Smith PW, Bennett G, Bradley SF, et al. SHEA/APIC Guideline: Infection prevention and control in the long term care facility. Infect Control Hosp Epidemiol 2008; 29: PMID: Stone ND, Ashraf MS, Calder J. Surveillance Definitions of Infections in Long Term Care Facilities: Revisiting the McGeer Criteria. Infect Control Hosp Epidemiol 2012;33(10): Trautner, B. (2014). Demystifying CAUTI: When to Culture and When to Treat. AHRQ Safety Program for Long term Care: HAIs/CAUTI. Wagner, LM., Roup, B.J., Castle, NG. Impact of infection preventionists on Centers for Medicare and Medicaid quality measures in Maryland nursing homes. Am J Infect Control 2014; Jan 42(1):