Catheter-Associated UTI’s Can Be Avoided!

Invasive devices such as catheters are the leading causes of infection in healthcare facilities. And there is one type of catheter that is responsible for more healthcare-associated infections (HAIs) in hospitals, long term care and home care than any other device – the indwelling urinary catheter.

Here are the facts: More than 1 million cases of catheter-associated urinary tract infections (CA-UTIs) occur each year in U.S. hospitals and nursing homes,and CA-UTIs account for up to 40% of HAIs. It is estimated that 25% of patients in the acute care setting will have an indwelling urinary catheter at some point in their hospitalization, and 69% of patients in medical ICUs hospitalized in NNIS hospitals from 1992-1997 had urinary catheters. 

So what’s the problem?  Catheter-associated urinary tract infections or CA-UTIs are generally assumed to be benign. However, CA-UTIs may be associated with significant complications, such as cystitis, pyelonephritis, infection, prostatitis, epididymitis, orchitis in males, and encrustation; less commonly, bacteremia and complications of metastatic infection including endocarditis, septic arthritis, endophthalmitis, and meningitis may occur. CA-UTIs are the second most common cause of healthcare-associated bloodstream infection. CA-UTIs increase length of stay by 1 to 3 days and add to overall patient costs, especially if bacteremia occurs. In addition, urinary catheters often precipitate unnecessary antimicrobial therapy, and are a major reservoir for resistant pathogens. One study has linked CA-UTIs and surgical site infections.

Can all CAUTI’s be avoided? No, not all catheter-associated urinary tract infections or CA-UTI are preventable. For example, there are certain factors that increase the risk of infection that may not be modifiable in a patient. However, there are many CA-UTI that are avoidable. The fact is, many urinary catheters are left in place longer than necessary, simply because physicians forget to look for the catheter, or reassess whether the patient still needs one.  A report published in the September issue of the journal Clinical Infectious Diseases suggests that hospitals can cut CA-UTI infections by 52% simply by implementing an  automatic reminder in the electronic health record or other system that requires a clinician to check daily on the catheter and determine whether it is still needed.

Need more incentive? As of October 1, 2008, Medicare discontinued reimbursement for the extra cost of treating catheter-associated urinary tract infections that occur while the patient is in the hospital. In addition, there is a national push to “get to zero” in the incidence of reportable healthcare-associated infection rates by the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, and the Association for Professionals in Infection Control (APIC) to name a few. And as of May 2011, The Joint Commission announced a new National Patient Safety Goal to prevent CAUTIs to be fully implemented by 2013.

Follow evidence-based practices! If we are to reduce the numbers of infections, clinicians will need to first follow evidence-based practices such as those in the CDC Guideline for the Prevention of Catheter-Associated Urinary Tract Infections 2009; the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and The Joint Commission; Diagnosis, Prevention and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from IDSA;Clinical Fact Sheets by the Wound, Ostomy and Continence Nurses Society (WOCN); and other professional guidelines, and get back to the fundamentals for the care and maintenance of the urinary catheter.

Training videos can help get clinicians on board. Envision, Inc. has an award-winning staff training video that offers 1 Hour CE credit for nurses, available for free preview prior to purchase at http://www.envisioninc.net/index.php/programs/details/preventing_catheter_associated_urinary_tract_infections/.

Immediate-Use Steam “Flash” Sterilization? Not So Fast!

Every day, acute care and ambulatory surgery centers face challenges on how to lower healthcare-associated infections. In the operating room, a large part of this effort involves the proper cleaning and sterilization of surgical devices and equipment. But with limited numbers of instruments, tight turnaround schedules, and decreasing budgets, many facilities are performing immediate-use steam sterilization (aka “flash” sterilization) in an effort to sterilize items quickly to avoid buying additional surgical instruments. The fact is, rather than save money and time, immediate-use steam sterilization has been implicated in increasing a patient’s risk for infection, which may lead to lawsuits and loss of accreditation for a facility.

Originally, this type of sterilization was intended for use only in an emergency, such as when a one-of-a-kind instrument was contaminated or dropped from the sterile field. Unfortunately, it has now become common place and used too frequently due to time and budget constraints. Because items do not recieve the complete traditional sterilization processing, professional groups and accreditation agencies believe that IUSS should not be  a routine practice, but rather used only in select clinical situations, and in a controlled manner.

“The reason that it’s not looked upon as a good solution is because oftentimes in the tight timeframe that we use, there are chances that corners may be cut; that during that rushed process to get the instrument turned around there could be processes and protocols that are missed completely, or at least not fully complied with. Immediate-use steam sterilization is denoted as a process that is used only in emergencies and only if the devices that are to be sterilized are compatible with that process.” - Natalie Lind, CRCST, CHL, FCS, IAHCSMM Education Director.

In this day and age, healthcare facilities are under great pressure to prevent surgical site infections. It seems obvious that items that do not receive full sterilization cycles are likely to be the source of infections. Surgical Technicians and Central Service professionals must become aware of the issues surrounding this form of sterilization, and the standards, regulations and best practices regarding its use. It is vital that immediate-use steam sterilization be utilized in accordance with professional guidelines; facility policies and procedures; as well as in strict compliance with validated written instructions provided by device manufacturers, sterilization equipment manufacturers, and container or textile manufacturers. This is especially critical for short sterilization cycles, as it takes time for steam to penetrate a sterilizer load and achieve an acceptable sterility assurance level.

In an effort to promote best practices regarding the use of IUSS, a multi-agency position paper was released January 2011 by the International Association of Healthcare Central Service Materiel Management (IAHCSMM), the Association for the Advancement of Medical Instrumentation (AAMI), the Association of peri-Operative Registered Nurses (AORN), the Association for Professionals in Infection Prevention and Control (APIC), the ASC Quality Collaboration,  and the Accreditation Association for Ambulatory Health Care (AAAHC) .  In addition, the Centers for Disease Control and Prevention (CDC) has recommendations, and The Joint Commission has standards regarding proper use and protocols for IUSS that must be followed and closely documented.

Envision, Inc. and IAHCSMM are proud to present a NEW 11 minute staff training program entitled “Protocols for Immediate-Use Steam Sterilization,”  part of the Of Critical Importance staff education series for Central Service and Operating Room professionals who process surgical instruments and devices.  For a preview of the program in it’s entirety, visit www.EnvisionInc.net.

The Case for “Reasonably Preventing” Healthcare-Associated Infections

There have been many studies demonstrating the costs – both in terms of patient suffering and associated interventions – of healthcare-associated infections (HAIs). The most famous of these was the 1999 Institute of Medicine’s “To Err is Human, ” an astounding report describing the evidence of HAIs as a component of patient safety errors. Since that time, numerous evidence-based guidelines by the CDC, APIC, SHEA and AHRQ among others have attempted to provide strategies to prevent infections in the most common HAI’s: catheter-associated bloodstream infections (CA-BSIs), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CA-UTIs), and surgical site infections (SSIs).

Moderate Sedation: Complying With Regulatory and Accreditation Requirements

Moderate sedation or analgesia, also known as “conscious sedation”, involves the use of a medication to provide relief of anxiety and pain. The patient does not lose consciousness, but does not perceive pain to the extent he or she may have otherwise. Each year, millions of procedures using moderate sedation are performed in ambulatory, ancillary, or acute care settings by non-anesthesia credentialed personnel for common procedures such as cardiac catheterization, endoscopy, and colonoscopy. Sedation of some level is often performed in critical care units to help patient’s better tolerate mechanical ventilation; and in the Emergency Department, moderate sedation is often used for endotracheal intubation, fracture reductionand lumbar puncture.

OMC Lowers Surgical Infection Rates. You Can Too!

Its a winning formula:

Patient education + handwashing + surgical site preparation + sterility in operating rooms = low surgical infection rates.

That’s what the Oconee Medical Center in Seneca, SC accomplished after setting a goal of zero infections. According to the state Department of Health and Environmental Control, the Oconee Medical Center reported 4 infections out of 70 hip procedures, 3 infections out of 144 knee replacements, and ZERO infections during 1,445 adult inpatient days and during 499 critical care patient days! When asked how the center achieved these rates, Heather Goss, Marketing Director at the facility cited various efforts:

Strict infection prevention protocols throughout the hospital, particularly related to patient education, hand washing, surgical site preparation, and sterility in ORs
Active surveillance screening for resistant bacteria upon patients arrival
A stand alone Joint Center unit that is segregated from the sick patient population
A partnership with Duke University Medical Center to have access to an infection control network for on-site support and resources

Global Handwashing Day Is October 15

The idea is simple: Washing hands with soap and water removes potential disease-causing organisms from the hands. It is one of the most effective and inexpensive ways to prevent diarrhea and pneumonia in global communities, which together are responsible for the majority of child deaths. Hand hygiene is also the primary method of preventing the transmission of pathogens to and from patients in healthcare settings that result in an estimated 1.4 million bloodstream infections, urinary tract infections, surgical site infections, chest/respiratory infections or gastrointestinal infections every year. Handwashing is clearly important, and yet 60% of the time healthcare professionals fail to clean their hands when indicated!

Drug-Resistant Bacteria Pose a New Threat

Drug-resistant bacteria are making the news again, and this time with the ultimate threat: There are no viable drugs to treat them.

Nearly as long as there have been antibiotics there have been drug-resistant bacterial strains. Selective pressure due to overprescribing as well as improper usage by patients allow bacteria to develop defenses against antibiotics. And after years of warnings by health officials, we are now seeing the presence of superstrains – bacteria that are impervious to all of our available antibiotic medications.

Palliative Care Relieves Symptoms, and Extends Lives

The evidence for the benefits of palliative care is growing. Palliative care is a comprehensive service that improves the quality of life for patients with serious illnesses. It helps patients receive adequate pain and symptom management, avoid inappropriate prolongation of dying, helps patients achieve a sense of control over their illness, as well as helps them make the most of their remaining time.  It is a consultative service where caregivers from various disciplines work together as a unit to consider the list of symptoms and needs of the patient, and then create a practical plan for addressing the physical, emotion, social, cultural,  and spiritual needs to the furthest extent possible. 

From an empathetic and economic perspective, palliative care makes sense; and now a new study shows that palliative care and end-of-life planning when offered early in the diagnosis helps cancer patients lead longer and better lives.  In the 3 year study, 151 patients with advance lung cancer received cancer treatment as well as palliative care.  These patients lived two months longer than those who received cancer treatment without palliative services, and showed marked improvement in overall quality of life.  The study was published in the Aug. 19 issue of the New England Journal of Medicine.

“We were surprised by the magnitude of impact that palliative care had on quality of life, which normally decreases over time in these cancer patients, and the magnitude of the impact it had on depression. The survival benefit was the most surprising thing. Cancer care and palliative care are not mutually exclusive. Providing both is not only feasible, but beneficial. “  Jennifer S. Temel, MD, oncologist at Massachusetts General Hospital (MGH) Cancer Center in Boston and co-author of the study. From: “Cancer Patients Live Longer With Palliative Care,” on WedMD, August 19, 2010. http://tinyurl.com/2arjtno

In fact, psychological and emotional assessments are extremely important in identifying feelings of anxiety, depression, loss of dignity, and helplessness that can result from patients facing or fearing lack of control. Psychological distress can have devastating consequences for the patient, including amplifying the intensity of pain and diminishing the ability to make appropriate treatment decisions.

Ideally, palliative care should begin at the time of diagnosis. However, only 75% of hospitals offer palliative care, it is often offered towards the final days of life, and many physicians fail to offer it to their patients at all, often due to a “rescue mentality” where death is seen as failure.  But palliative care can assist patients and their families in making better decisions about what is helpful and what is fruitless, and help make their time together a healing experience.  Patients and their families need to ask for these services from their physicians and local hospital systems.

“The mission statement of every health system I know is it provide the best care we possibly can to families and patients who will want to come back and see us again. Palliative care fits right in with the mission statement of every health system that I know.” - Thomas Smith, MD, FACP, Medical Director of the Thomas Palliative Care Program at the Virginia Commonwealth University Massey Cancer Center.

Physicians, nursing staff, chaplains, social workers, physical therapists…all those involved in the care of patients can benefit from training on how to provide physical, psychological, social, cultural and advance-care planning assessments; offer patient and family education; have crucial conversations regarding tough decisions; and learn the clinical symptoms of impending death.  Envision, Inc. has an award-winning video developed in conjunction with the Thomas Palliative Care Program, and is ideal for Veteran Affairs hospitals and other health care facilities wanting to improve their end-of-life programs.   For more information on the video, and to see a free preview prior to purchase, please visit  http://www.envisioninc.net/index.php/programs/details/to_care_always_quality_care_at_the_end_of_life/.

Healthcare Worker Influenza Vaccination: Save A Life Today! (It Just Might Be Your Own)

According to flu.gov, in an average year, 5 to 20% of the population will contract seasonal influenza. 200,000 people are hospitalized from flu-related complications, and approximately 36,000 people will die from it.  There is a significant amount of literature that points to the reasons for the spread of influenza: poor hand hygiene, lack of proper respiratory etiquette, and most notably, a lack of immunity to the virus.  While many people will carry a natural immunity from the previous year’s exposure to an influenza strain, strains vary from year to year; and many individuals are a risk of serious illness from influenza should they catch it.  

The start of the flu season will be upon us soon, and once again healthcare workers as a group have an opportunity to decrease the spread of influenza in our communities and in our healthcare facilities. How?  With vaccination.  It is one of the most important things that healthcare workers in hospitals and outpatient settings can do to prevent transmission of influenza to patients, and prevent catching the flu themselves.

The most efficient method of preventing these outbreaks and the associated morbidity and mortality is through pre-exposure vaccination. Healthcare personnel (HCP) are at high risk for acquiring influenza infection due to their exposure to ill patients as well as their exposure in the community. Because those persons who are at greatest risk of developing complications of influenza are exposed to healthcare personnel in a variety of in patient and outpatient settings, an important strategy to decrease exposure to these high risk individuals is to immunize healthcare workers. - APIC Position Paper: Influenza Immunization of Healthcare Personnel, 2008.

Many hospitals have set high benchmarks for personnel vaccination rates driven by research, accreditation requirements and mandatory vaccination policies. And yet, despite recommendations by the CDC, APIC, and other healthcare organizations, and despite the evidence that  vaccination can and does make a difference in lowering patient deaths by 40 percent and improving patient safety, healthcare personnel vaccination rates remain low.  What are the reasons for the 46% vaccination rate, and how can this be overcome?

Here are some interesting facts: Personnel who decline vaccination have egg allergy, religious or philosophical convictions, or a history of Guillain-Barre. But this is a small percentage of those who are unvaccinated year after year. It seems that the remainder are likely to be socially isolated from others who choose vaccination, or simply have misconceptions regarding vaccination.  This is why the most successful campaigns in hospitals today incorporate staff education to target individuals who persistently decline vaccination.

Envision, Inc. has created a 12 minute visual presentation to address questions and concerns staff may have about vaccination in an effort to promote their participation in an influenza vaccination program.  http://www.envisioninc.net/index.php/programs/details/dispelling_the_myths_influenza_education_vaccination_and_prevention/

This program will dispel some of the myths surrounding the flu vaccine by:

• Explaining modes of transmission and the impact on patients
• Describing symptoms of flu, risk factors for complications, and treatment options
• Outlining flu prevention techniques that reduce transmission
• Explaining vaccine options and their possible side effects
• Addressing the need for a declination statement if not vaccinated

Let’s make 2010 the most successful year for healthcare worker vaccination!  The life you save might just be your own.

Sources: Health-Care Worker Vaccination Rates Remain Perilously Low. http://www.sciencedaily.com/releases/2010/03/100317091255.htm

APIC Position Paper: Influenza Immunization of Healthcare Personnel. http://www.apic.org/AM/Template.cfm?Section=Home1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTFILEID=11049

www.flu.gov

www.cdc.gov/flu/

Joint Commission monograph: http://www.jointcommission.org/PatientSafety/InfectionControl/flu_monograph.htm

Patient Falls: Can they be prevented?

It might surprise you to learn that patient falls are the most common hospital adverse event. In fact, an estimated 30% of hospital falls result in serious injury; and 10% of fatal falls for older adults actually occur in hospitals, the very place where patients should be safe!