Authors (including presenting author) :
Chan TC(1), Lam HY(2), Wong I (2), Lin OYF(1), Luk KHJ(1), Chan HWF (1)
Affiliation :
(1)Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital
(2)Department of Nursing, TWGHs Fung Yiu King Hospital
Introduction :
The nosocomial CAUTI of FYKH was high, with point prevalence of 2.6% in Aug 2018. It was the highest among 30 hospitals in Hong Kong. Major contributing factors for the high CAUTI rate were (1) lack of planned urinary catheter removal, which make some urinary catheter remain connected to patient after many days of insertion, (2) lack of reminder system to remind doctor to review indication of urinary and the need of weaning urinary catheter, (3) inadequate frontline education for inserting, caring and weaning urinary catheter. (4) Lack of regular surveillance for nosocomial CAUTI. Through bi-directional communication between FYKH infection control team and frontline staff (doctors, nurses and patient care assistant), a new urinary catheter care program has been launched in Sep 2019.
Objectives :
To minimize nosocomial CAUTI, target zero
Methodology :
A series of preparatory works have been done from Jul 2019 to Aug 2019. (1) Use of an infection control team designed yellow label to serve as a reminder for reviewing urinary catheter indication, for any patients with urinary catheter. Every urinary catheter (except long term foley) has a fixed pre-set planned removal date, which is day 3 after insertion. On day 3 of insertion, nurse will remind doctor to review indication and confirm removal of urinary catheter. If doctor feel it is not suitable to remove urinary catheter yet, he could write down a planned removal date and nurse will remind him that day. Doctor could also decide removal date on first day of urinary catheter insertion with documentation on the yellow label. Nurse will remind the doctor on that day (2) Frontline knowledge updates for urinary catheter through multiple identical forums. (3) Implementation of regular surveillance for nosocomial CAUTI.
After implementation of the new program. Prevalence of nosocomial CAUTI was calculated in two ways. (1) Point prevalence which is number of CAUTI of 3 randomly selected days in Sep 2019. (2) Monthly prevalence which is the number of CAUTI in Sep 2019 with the unit number per 1000 catheter days.
Point prevalence and monthly prevalence of patient having urinary catheter were also calculated.
Compliance to new urinary catheter care program was calculated.
Result & Outcome :
The new program is started on 1st Sep 2019. After implementation of new urinary catheter care program, 3 surveillance studies were performed in 3 different days of Sep 2019. Point prevalence of patient having urinary catheter reduced by 40% (from 12.5% to 8.0%). Compliance to new urinary catheter care program was 100%. Point prevalence of nosocomial CAUTI was 0% in 3 surveillance studies. Monthly prevalence of nosocomial CAUTI was 0 per 1000 catheter days.
The new urinary catheter care program in FYKH successfully minimize nosocomial CAUTI.
