Patient care associates and clinical technicians are integral to CAUTI-prevention efforts, including Medical Intensive Care Unit PCAs (l-r): Shivara Tucker, Carmen Santiago, Sherri Saulsbury, Karina Sanchez, Nicole Sanzo-Nieves and Brendan Hallett.

Bacteria, beware: Team’s mission is to eliminate catheter-associated infections

A team of experts is deploying some new strategies in Yale New Haven Hospital’s ongoing fight against one of the most common types of hospital-acquired infections.

For years, YNHH has been working to eliminate catheter-associated urinary tract infections (CAUTIs) which, in addition to causing patients discomfort, increase their length of stay and cost of care.

Evidence-based practices for catheter insertion, maintenance, surveillance and removal initially reduced CAUTIs, but when rates started rising in 2017, a performance improvement team began exploring additional measures. One area of focus is catheter maintenance. The team has launched a “bundle” of evidence-based practices focused on twice-daily catheter care and cleaning.

“Catheter care is an important, recommended practice and shouldn’t be confused with incontinence care,” said team member Anna Lisa Fischer, RN, patient service manager, Surgical Intensive Care Unit (SP 6-1 and 7-1). She co-chairs the group with Kevin Sigovitch, RN, patient service manager, Saint Raphael Campus Emergency Department.

Building on previous CAUTI-prevention efforts, the team is working to reduce the use of Foley catheters. For patients who do require them, removing the catheter as soon as possible is an essential part of the reduction initiative, Fischer said. On quarterly “Foley Fridays,” clinicians can use an electronic tool to audit the number of Foley catheters in use and determine whether CAUTI prevention procedures are being properly followed. If a CAUTI occurs, it is reviewed by Infection Prevention and a multidisciplinary team to identify improvement opportunities, on the unit and hospital-wide.

The performance improvement team began to pilot the new catheter-care practices on several nursing units in May, and rolled them out to all units at YNHH last month. The team is also beginning to examine practices around how and when urine is collected for cultures.

The team has been led for the past several years by Ena Williams, RN, interim chief nursing officer. Jeannette Bronsord, RN, director of nursing, Surgical Services, became a sponsor this year and Richard Martinello, MD, remains as Infection Prevention sponsor. The interdisciplinary team includes physicians specializing in medicine and urology, nurses, clinical outcomes leaders, Information Technology Services staff and members from other areas. With a unique opportunity to engage patient care associates and clinical technicians to help reduce CAUTIs, the group has mobilized these staff members and nurses from inpatient care areas to serve as champions.