When the critical care unit team at Baptist Golden Triangle embarked on a KATA in May 2016, like other Baptist hospitals, their focus centered on lowering catheter-associated urinary tract infection (CAUTI) and central line-associated bloodstream infection (CLABSI) rates
With 44 team members in the 18-bed ICU, 25 percent of the team consisted of nurses with more than 10 years of experience. Work began by observing current catheter practices and the results were interesting. Experience didn’t necessarily dictate better results.
“We learned everybody was doing it differently. The majority was doing certain steps, but then they would change steps later in the process,” said Sandy Holman, MSN, nurse manager of critical care.
Certain practices were easily identified and changed, like requiring that two nurses were present instead of one, especially for female patients. Also, a reality for providers is dealing with the morbidly obese population in Mississippi, which can be difficult patient when it comes to catheter insertion.
“We also now carry two catheters into the room with us in case we fail on the first one,” said Sandy.
CAUTI rates not only were affected by the insertion of catheters but decisions surrounding the removal. “We had a challenge taking them out as well. They’re very easy to remove, but in some cases, needed to be removed earlier. Sometimes this was related to a shift change or just convenience,” said Sandy.
Having physician support lent even greater credence for the changes. “We had a lot of doctor engagement, especially with pulmonologist Dr. Ryu Peter Tofts, who led the effort to engage others and encourage orders to remove catheters, following Centers for Disease Control and Prevention (CDC) recommendations,” said Sandy.
Additionally, a process change addressed whether or not all patients required a catheter, like those on a ventilator. “This does require more work on a nurse’s part because there is more manual care like turning patients and cleaning,” said Sandy.
From May to December 2016, catheter days decreased by 20 percent. To date, the ICU team has gone 94 weeks without a single CAUTI.
With CLABSI, the team focused on dressings and dry times through an earlier TWI. “We looked at how long to clean the central line site. We discovered a lack of training about when to change the clear blue caps on a line,” said Sandy.
In the end, the team agreed that open communication about process and policy and strong physician engagement led to real changes with infection rates. “The best thing is the team was successful,” Sandy said.