Abstract :
ISSUE: The Infection Control Department is responsible for an annual review and update of the surveillance plan. Surveillance is extremely important in the context of continuous quality improvement because it makes use of objective data to improve organizational performance. Catheter-associated urinary tract infection (CA-UTI) rates were compared to data from the National Nosocomial Infection Surveillance System (NNIS). It was noted that infection rates in the intensive care unit (ICU) from October 2001 to September 2002 were consistently greater than the 90th percentile when compared to NNIS.
PROJECT: An action plan was devised through a root-cause analysis identifying issues in practice, patient demographics, and human characteristics. The action plan included lecture and demonstration in handwashing techniques with a program that included the use of fluorescent lotion to help the staff with visualization of residue left on the hands after hand hygiene, encouraging the use of a waterless hand sanitizer (already available in all the ICU rooms), anonymous culturing of the hands of the ICU staff (for educational purposes), environmental culturing, trialing a new catheter securement device, and reviewing the CDC recommendations for prevention and/or reduction of CA-UTIs.
RESULTS: The action plan was implemented from July through September 2002. The data collected from September 2002 to the present shows a consistent decline in the incidence of CA-UTIs in the ICU, with a rate of 2.8 infections per 1000 urinary catheter days, which falls between the 25th and 50th percentile when compared to NNIS. Annual statistics show a total of 13 infections per 1000 urinary catheter days from October 2001 to August 2002, and a total of 4 infections per 1000 urinary catheter days from September 2002 to September 2003, a decrease of 70%.
LESSONS LEARNED: It is extremely important to continue to monitor and give feedback to the staff on all of the actions taken. Several monitoring systems were also put into place, one for the usage of the alcohol hand sanitizer and one for the use of the new catheter securement device.
