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In the next 45 minutes...In the next 45 minutes...
What is a UTI?
The scale of the problem
Strategies to reduce risk
Is a catheter necessary?
ANTT catheter insertion
Ongoing education
Discussion
2
Problem Number 1Problem Number 1What is a UTI?What is a UTI?
Lots of conflicting definitions Google 753,000 (in 0.33 seconds!)
Bacteria in urine
Symptoms
3
Problem number 2Problem number 2What is a CAUTI?What is a CAUTI?
UTI associated with a urinary catheter! How long after insertion?
How long after removal?
Varying definitions = inconsistent findings
4
Acceptable definition?Acceptable definition?
Is it catheter related? The patient has an indwelling urinary
catheter OR has had a urinary catheter during the previous 7 days .
There is no evidence that a urinary tract infection was present or incubating before catheterisation.
The infection became evident 48 hours or more after catheterisation.
Third Prevalence Survey of Healthcare Associated Infections in Acute Hospitals5
SymptomsSymptoms Criterion 1:
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (>38oC), urgency, frequency, dysuria, or suprapubic tenderness
and
patient has a positive urine culture, that is, ≥105 microorganisms per cm3 of urine with no more than two species of microorganisms.
6
Or...criterion 2Or...criterion 2
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (>38oC), urgency, frequency, dysuria, or suprapubic tenderness
and...
7
at least at least one one of the followingof the following::
positive dipstick for leukocyte esterase and/or nitrate Pyuria (urine specimen with ≥10 WBC/mm3 or 3
WBC/high power field of unspun urine) Organisms seen on Gram stain of unspun urine At least two urine cultures with repeated isolation of the
same uropathogen (gram negative bacteria or S. saprophyticus) with 102 colonies / ml in nonvoided specimens
105 colonies/Ml or a single uropathogen (gram negative bacteria or S. saprophyticus) in a patient being treated with an effective antimicrobial agent for a urinary tract infection
Physician diagnosis of a urinary tract infection Physician institutes appropriate therapy for a urinary
tract infection8
How common?How common? 12.6% of acute patients are catheterised
20 - 30 % of acute catheterised patients will develop bacteruria
8-10% of acute catheterised patients will develop symptoms of urinary tract infection
A UTI increases the length of patient hospitalisation by 75% (8 to 14 days)
A single UTI costs £1327
Plowman et al 1999 9
HCAI Comparison 2000HCAI Comparison 2000
Socio-Economic Burden of Hospital Acquired Infection-PHLS report 2000
Incid
en
ce %
(n
ati
on
al
UK
)
UTI
LRTISWI
Skin BSI
Other
Multiple(may inc. UTI)
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Cost Estimate 2000Cost Estimate 2000
Socio-economic Burden of Hospital Acquired Infection-PHLS report 2000
UTI
LRTI
SWISkin
BSI
Other
£ m
illio
ns
11
NephritisNephritis
No studies in live patients
But
Evidence of nephritis in 33% of long-term catheterised patients at post mortem
Gomlin & McCue 2000
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EducationEducation
Need for catheter?
Early removal 5% risk per day
Correct products
Correct insertion
Correct care
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Catheter should be MDT decisionCatheter should be MDT decision No routine catheterizations
Individualized decision Discuss with patient
Alternative management Drugs Surgery
MITs CISC Sheath Pads
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Other toolsOther tools Standardize available products
Use national initiatives www.dh.gov.uk/publications HII Saving Lives
Top-down approach Management IC&P Team Urology
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ANTT Catheter InsertionANTT Catheter Insertion
Standardized insertion training using ANTT principles
ALL relevant clinical staff
Management engagement
Training
Assessment
Annual updates22
ANTT Catheter InsertionANTT Catheter Insertion Embedded with ANTT for other procedures
Vascular Access
IV therapy
Intubation
Blood cultures
Insertion using EAUN guidelines
www.uroweb.org/fileadmin/user_upload/EAUN/EAUN2.pdf
23
Manchester ANTT ImplementationManchester ANTT Implementation
ANTT included as a part of Trust IP&C strategy
Implementation process started September 2006
Education and training provided to all clinical staff
Individual assessment of staff
Weekly reporting of staff trained to director
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Audit Results – ANTT Compliance
72%
83%
65%68%
84%81%
77%
94%92%
95%
80%
97%
86%
91%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Children's MREH/Dental Surgery CSS St Mary's Medicine Total
Original Audit
Re-Audit
25
MRSA BacteraemiaMRSA Bacteraemia 12 Month Pre & Post ANTT
0
1
2
3
4
5
6
7
8
9
1 2 3 4 5 6 7 8 9 10 11 12
Month
Nu
mb
er Pre ANTT
Post ANTT
Pre ANTT Trend
Post ANTT Trend
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ANTT – Effect on UTIANTT – Effect on UTI
Not measured in isolation
Audit 2005 - 16%
Audit 2008 – 9.6%
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ConclusionsConclusions
Multifaceted catheter policy needed Insertion policy
ANTT
Product formulary
Education
Assessment
Audit
Much of the work has already been done EAUN
BAUNwww.baun.co.uk
HII
SIGN (Scotland)
www.sign.ac.uk
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