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Cauti ppt
The document discusses a structured teaching program on prevention of catheter-associated urinary tract infections (CAUTI) and application of catheter care bundles. It defines CAUTI and risk factors. It explains the catheter care bundle which is a set of evidence-based interventions to reduce CAUTI rates when implemented collectively. The teaching program covered CAUTI prevention guidelines including appropriate catheter indication and removal, aseptic insertion, maintenance of closed drainage, and hand hygiene.
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Cauti ppt
- 1. PREVENTION OF CAUTI ANDAPPLICATION OF CATHETER CARE BUNDLE Ms JASMIN DEBORA, Professor, Department of Medical Surgical Nursing. Ms .N. Swetha, Msc .Nurse Department of Medical Surgical Nursing. Nurses caring catheterized clients in MICU and SICU NRI General Hospital, Chinakakani,Guntur. Topic BY GROUP Hospital
- 2. STRUCTRED TEACHING PROGRAMME ON PREVENTIONOF CAUTI AND APPLICATION OF CATHETERCARE BUNDLE
- 3. GENERAL OBJECTIVES At theend of the teaching session, the participants will be able to acquire knowledge on UCCB maintenance and practice catheter care bundle guidelines in prevention of CAUTI. SPECIFIC OBJECTIVES •define the CAUTI •describe the epidemiology of CAUTI •list down the causes of CAUTI •explain the pathogenesis of CAUTI •enlist the prevention guidelines for CAUTI •define care bundle •define catheter care bundle
- 4. •define catheter carebundle •identify the aim of CAUTI maintenance bundle •distinguish the purpose of CAUTI bundle •enumerate the principles of CAUTI bundle •explain the insertion of Catheter • explain the maintenance of Care bundle •demonstrate the CAUTI maintenance bundle checklist
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- 6. CAUTI increase patients mortality, morbidity,length of hospital stays and cause an economic burden to the health care system CAUTI The centre for disease control and prevention (CDC) mentioned that, catheter associated urinary tract infections were the most common health care associated infections. CAUTI INTRODUCTION
- 7. A Catheter associatedurinary tract infection occurs when germs enter the urinary tract through the urinary catheter & cause infection. CAUTI The risk of CAUTI can be reduced by ensuring that catheters are used only when needed and removed as soon as possible CAUTI Catheters are placed using proper aseptic technique and closed sterile drainage is maintained,. CAUTI
- 8. CAUTI >30% ofHAIs reported to NHSN. Estmated >560,000 nosocomial UTIs annually. Estimated 13,000 attributable deaths annually. Leading cause of secondary BSI with 10% mortality CAUTI CAUTI Urinary tract infections are the fourth most common type of health care associated infection with an estimated 93,300 UTIs in acute Care hospitals; UTIs additionally account for more than 12% of infections reported by acute care hospital. CAUTI The National health care safety network reported CAUTI rates to be from 3.1 to 7.5 per 1000 catheter days in acute care hospital IMPACT OF CAUTI Among UTIs acquired in the hospital, approximately 75% associated with a urinary catheter. Excess length of stay 2-4 days. Increased cost 0.4- 0.5 billion a year nationally
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- 10. 3,4, 5 URINARYRETENTION INCONTINENCE LOWERPROFESSIONAL TRAINING OF INSERTER. 1,2 AGE GENDER 7,8, 9 DISCONNECTION DRAINAGE SYSTEM DURATION OF CATHETERIZATION IMPAIRED IMMUNITY. 6,7 DIABETES ORTHOPEADIC /NEUROLOGY SERVICES. RISK FACTORS FOR CAUTI 10,11 MEATAL COLONIZATION. CREATININE(RENAL DYSFUNCTION.)
- 13. Fever Suprapubic tenderness CostoVertebral Angletenderness Altered mental status Dysuria,frequency,stranguria in the abscence of catheter. Flank tenderness Delirium. 13
- 15. Leukoesterase Nitrates Wbc in microscopy Bacteria Positive blood culture Positive urine culture At least1 matching uropathogenorganism.
- 16. Pediatric challenges Urine bagsshould not be used for culture catheter inserted >10 days new catheter specimen catheter inserted < 10 days use the collection port. DONT’S FOR INVESTIGATION
- 17. Non infectious complicationsincludes non bacterial urethral inflammation, urethral strictures, mechanical trauma and mobility impairment INFECTIOUS AND NON INFECTIOUS Infectious complications include urinary catheter obstruction, bladder urolithiasis, purulent urethritis ,gland abscesses and for males, prostatitis. COMPLICATIONS OF CAUTI
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- 19. CORE MEASURES FOR PREVENTION 1,2 1.placement only for appropriateindications. 2.Leave catheters in place only as long as needed. 3 4.Insert catheters using aseptic technique and sterile equipment. 3.Ensure that only properly trained persons insert and maintain catheters 4 5.Following aseptic insertion, maintain a closed drainage system. 5,6 7 6.Maintain unobstructed urine flow. 7.Hand hygiene and standard precautions.
- 20. SUPPLEMENTAL MEASURES TO PREVENT CAUTI 1 2 3 4 5,6 5.Electronic reminders 1..Alternativesto indwelling catheterization 6.Nurse based interventions 3.Intermittent catheterization 4.Use of anti microbial/ antiseptic catheters. 2.Portable bladder ultrasound scanner
- 21. Complex urinarydrainage systems.(eg.antiseptic-releasing cartridges in drain port.) Changing catheters or drainage bags at routine,fixed intervals(clinical indications include infection ,obstruction ,or compromise of closed system. Routine antimicrobial prophylaxis.
- 22. Cleaning ofperiurethral area with antiseptics while catheters is in place. Irrigation of bladder. Instillation of antiseptic or antimicrobial solutions into the drainage bags. Routine screening for asymptomatic bacteriuria.
- 23. Compliance withhand hygiene. Compliance with educational programme. Compliance with documentation of catheter insertion and removal. Compliance with documentation of indications for catheter placement.
- 24. Examples of metrics Numberof CAUTI per 1000 catheter days. Number of BSI secondary to CAUTI per 1000 catheter days. Catheter utilization ratio (urinary catheter- days/patient-days)*100. Use CDC/NHSN definitions for numerator data.
- 25.
- 26. 2.It is definedas a group of interventions related to a diseases process that when implemented individually CARE BUNDLE 1.A Care bundle is a group of evidence based practices that improve the quality of care when consistently applied to all participants CARE BUNDLE DEFINITION OF CARE BUNDLE
- 27. Urinary catheter carebundle are shown to be effective in reducing the rate of catheter Associated Urinary tract infections.
- 28. 28 Remove the catheters as soonas possible. To reduce the rate of catheter urinary tract infections. care for catheters individually .
- 29. CAUTI BUNDLE The implementationof care bundles can assist in enhancing compliance to evidence based quality process measures to improve patient care 01 USES CAUTI BUNDLE Care bundles include a set of evidence based measures that when implemented together have shown to produce better out comes and have a greater impact than that of the isolated implementation of individual measures 02 USES CAUTI BUNDLE Strong clinician engagement and endorsement 03 USES CAUTI BUNDLE Bundles also help to create reliable and consistent care systems in hospital settings . 04 USES USES OF CAUTI BUNDLE
- 30. Each element mustbe implemented collectively and be adapted to the local setting; appropriately followed. Health care providers are advised to follow each bundle element by all members of the health care team involved Develop and promote a positive habit forming behavior among providers and ultimately a reliable care processes CPRINCIPLE BPRINCIPLE APRINCIPLE GENERAL PRINCIPLES OF CAUTI BUNDLE
- 31. INSERTION OF CATHETER Thereare a multitude of varieties each with their own unique attributes for special situations. The ones you will most commonly see on this rotation are regular, coude tip, 3-way and whistle tip. UNIVERSAL PRECAUTIONS There is the potential for contact with a patient's blood/body fluids when working with catheters, this risk increases with the inexperience of the operator. This is a sterile procedure & should be treated as such.
- 34. INDICAT ION 1 Foley catheterinsertion allows us to drain, decompress, obtain a specimen, and irrigate the bladder. This will allow you to treat urinary retention, bladder outlet obstruction, evacuate clot, and monitor urine output INDICATI ON 2 In some cases, as in urethral stricture or prostatic hypertrophy, insertion will be difficult and may require consultation with urology
- 35. Sterile gloves -consider Universal Cleansing solution e.g. Betadine or aqueous Precautions Sterile drapes Cotton swabs Chlorhexidine Sterile water & syringe (usually 10 cc) Forceps Lubricant (water based jelly or xylocain Foley catheter (usually 16-18 French) EQUIPMENTS
- 36. STEP 03 STEP 01 Explain procedure to thepatient Open catheterization kit and catheter Gather Equipment STEP 02 Assist patient into supine position with legs spread for men (and patient truly flat) and in women feet together or frog leg STEP 04 PROCEDURE
- 37. c Generousl y coat the distal portion (2-5cm) of the catheter with lubricant STEP 8 Do not check balloon for patency, inflating alters the contour & can make insertion more difficult & uncomfortab le STEP 7 Put on sterile gloves STEP 6 If male patient retract foreskin STEP 5 c STEP 9 Remove the cap on the syringe containing sterile water. You can choose to attach to catheter now or after you have successfull y inserted
- 38. STEP 11b For men– until the hub of the catheter reaches the meatus, ie to the hilt STEP 11a For women - until 2 to 3 inches beyond where urine is noted STEP 11 Identify the urinary meatus and gently insert STEP 10 Discard all except two cotton swabs in the kit. You don’t need them and they soak up prep. Pour prep on the cotton swabs STEP 11c Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size)
- 39. Gently pull catheter sothat inflation balloon is snug against bladder neck Connect catheter to drainage system Secure catheter to thigh, with a bit of slack Remove gloves, dispose equipment appropriately, wash hands Document size of catheter inserted, amount of water in balloon STEP 12 STEP 13 STEP 14 STEP 15 STEP 16
- 40. Antimicrobial prophylaxis Urinary antiseptics (i.e., methanamine) Bladder irrigation Antiseptic instillation in the drainage bag Periurethral care Routine catheter or bag change Catheter lubricants
- 41. Securing devices Bacterial interference Catheter cleansing Catheter removal strategies (clamping vs. free drainage prior to removal, postoperative duration of catheterization) Assessment of urine volumes
- 42. Evaluate postvoid residual (PVR) using handheld ultrasound. High PVR is not equal to retention. Take into account voided volume and symptoms . If PVR over 300ml_ consider alternative drainage. If empty assess volume status. Catheter removal strategies
- 43. MAINTENANCE BUNDLE CHECKLISTYES NO Hand hygiene was performed before and after client contact? Gloves were used to manipulate the catheter and/or the drainage system? Catheter is anchored by a stabilization device (to the upper thigh in women – upper thigh or lower abdomen in men)? Catheter has been continuously connected to tubing and drainage system? If catheter was disconnected from the drainage tube, was the connection site disinfected again prior to reconnection of tubing?
- 44. Drainage bag isbelow level of the bladder and not in contact with the floor? . Drainage bag was emptied regularly into a separate clean container dedicated for client use only ? There was no contact between the non-sterile container and the drainage bag spout when emptied? Perineal area and catheter entry site were cleansed with soap and water (or an approved product) at least once daily and after each bowel movement Is there a planned date for catheter replacement based on the 12 week maximum or the client’s catheter change record?
- 45. CONCLUSION Catheter associated urinarytract infections were the most common health care associated infections. A Catheter associated urinary tract infection occurs when germs enter the urinary tract through the urinary catheter & cause infection. Urinary catheter care bundle are shown to be effective in reducing the rate of catheter Associated Urinary tract infections. Hand hygiene was performed before and after client contact, Gloves were used to manipulate the catheter and/or the drainage system, Catheter is anchored by a stabilization device . There was no contact between the non-sterile container. Drainage bag is below level of the bladder . Perineal area and catheter entry site were cleansed with soap and water. Catheter replacement to be done on based catheter change record.
- 46. 1.Leela Krishna.p ,karthikrao.p,”a study of risk factors for catheter associated urinary tract infection. International journal of advances in medicine, PISSN 2349-3925. 2.Mahesh ,kripa Angelina, Renuka ”effectiveness of nursing care bundle on catheter associated urinary tract infection (CAUTI) among patients with indwelling catheter in selected wards of MGMRI ”,volume 1, issue 2, 2018, ISSN- 2639-3629. 3.Eglal hassanein abdel “the effect of implementing urinary catheter care bundle on the prevention of CAUTI” IOSR journal of nursing and health science , vol.7, no.1,2018,pp.37-46.
- 47. 4.Linday ENicolle “catheter associated urinary tract infections” Anti microbial Resistance and infection control 2014,http://www.aricjournal.com. 5.Venkaram S, Rachmale S, Kanna.B”study of device use adjusted rates in health care associated infections after implementation of bundles in a closed model medical intensive care unit . journal crit care 2010 mar;25(1):174-8. 6.Helen S.Lee urinary tract infections PASP2018 Book1 7.Sean Wasserman,Angelika messina “guide to infection control in the hospital” Chapter 16,February 2018 8.http://www.nihms.com/er 9. www.ahqr.gov,pub no.15-0073-2-EF,September 2015. 10. http://www.ECRI.org/ signs and symptoms.