Education and best practices cut infection rates
Make sure caregivers know early symptoms of UTI
[Editor's note: This is the first article of a two-part series on how to reduce the risk of infection for patients with indwelling bladder catheters. This month we take a look at the factors that increase the risk of infection, patient and staff education, and identification of best practices. Next month, the "sacred cows," or practices that are not based on scientific evidence, will be identified along with the proper practices for catheter care.]
The number of bladder catheter infections per 1,000 device days reported by participants in the Infection Surveillance Project of the Missouri Alliance for Home Care (MAHC) dropped from 3.35 infections in the first quarter of 2005 to 2.68 in the fourth quarter of 2007.
While the decrease in infections is good, it does not present a true picture of what happens at individual agencies, points out Cyndee Howell, project manager for MAHC. "Because participating agencies typically drop out of the project when their infection rate reaches 1%, and new agencies typically come into the project with higher rates, we don't see a dramatic decrease in the overall project results," she explains. "We do know that participation in the project increases awareness of the risk of infection and helps agency staff members identify ways to reduce risk through communication with other participants," she adds.
In addition to collecting the surveillance data submitted by the participating agencies, MAHC hosts quarterly conference calls for participants to raise issues for which they need ideas and suggestions, and MAHC produces a participant newsletter that includes peer-to-peer advice, says Mary Schantz, executive director of MAHC. "We are trying to improve communications between participants so that we can share the knowledge gained through each agency's efforts to reduce infection," she explains.
When you have a group of people from different agencies talking together, you do get different perspectives, says Howell. "People will think outside the box and come up with ideas they might not have had on their own," she adds. An example of a problem raised in a conference call was one agency nurse who described a patient with sediment in the urine on a constant basis. The suggestion was made that dieticians work with the patient to develop a diet that might prevent infection. "The nurse discovered that the patient was drinking two liters of carbonated cola each day," she says. Once the patient decreased intake of the cola and increased clear fluids, the problem was resolved, she adds.
Participants in the surveillance project not only have the opportunity to identify best practices, but they also have the opportunity to discover practices that are based on myth and "we've always done it this way" thinking rather than scientific evidence, says Schantz. As the nurses in the project learn more from other agencies, they go back to their own agencies to educate staff, physicians, and patients, she adds.
"I have been able to change some of the long-term habits of nurses because I can present data and experience from the surveillance project and other participants," says Rita Sansoucie, RN, BSN, staff development director of Phelps Regional Homecare in Rolla, MO. While Sansoucie's agency has seen a decrease in the infection rate for patients with bladder catheters, she believes that participation in the surveillance project and ongoing discussion in staff education and team meetings about the agency's results and lessons learned from others has had the most positive effect on the infection rate. "I think when people are thinking about a specific issue, they pay close attention to activities that can affect an infection rate," she explains.
In addition to ongoing education, Sansoucie's agency also has made bladder catheter care a part of the employee evaluation process. "We've incorporated it into our competency assessments," she says.
Symptoms can be patient-specific
Because the goal of a home health agency is to help the patient be as independent as possible, patient and family education about the care of an indwelling catheter is critical, says Gayle Lovato, RN, MS, infection control practitioner at Inova Loudoun Hospital in Leesburg, VA, and a member of the Association of Infection Control Professional's communications committee. Make sure that patients know the symptoms of an infection, she suggests. A burning sensation; a change in the appearance or smell of the urine; redness, swelling, or drainage at the insertion site; increased confusion; pain in the flank; or nausea or vomiting are all potential symptoms. "Fever is also a symptom, but not all patients have a fever," she explains.
Because symptoms can vary from patient to patient, it is important to determine the pattern of symptoms for each patient, suggests Lisa Gorski MS, APRN, BC, CRNI, FAAN, clinical nurse specialist at Wheaton Franciscan Home Health & Hospice in Milwaukee, WI. "Teach nurses to look back in the chart to see what symptoms led to treatment of a previous urinary tract infection," she recommends. Then use that pattern of symptoms to teach the family how to recognize the early stages of an infection, she says. This gives the family members a chance to contact the nurse at a point where the patient won't require a trip to the hospital and can be treated at home, she adds. Stress the importance of calling immediately, she says. "Some patients and families are reluctant to call the home health nurse and believe it is easier to go to the emergency room," she explains.
Keep patient and family education simple and emphasize good hygiene, recommends Lovato. "Make sure they use soap and water only to clean the area twice a day and pat dry with a towel after cleaning," she says. "The bag should be changed when it becomes one-half to two-thirds full," she says. Have family members wear gloves if they change the bag in case there is splash, she adds.
In addition to stressing the importance of washing hands before catheter care, be sure to tell family members and patients that they must wash hands afterwards, even if they wore gloves, says Lovato. "We have healthcare personnel who believe that gloves eliminate the need for handwashing, so we have to make sure we teach everyone to wash hands regardless of the use of gloves," she adds.
When teaching, the nurse must watch a return demonstration by the patient or family caregiver, points out Lovato. "Don't rely upon verbalization or a repetition of the information," she says.
"There's a lot of information about bladder catheter care, so there's no need to reinvent the wheel when developing protocols," says Schantz. "Home care is a unique health care setting, so it's important to look to other home health agencies for ideas and tools."
Sources
- Cyndee Howell, Project Manager, Missouri Alliance for Home Care, 2420 Hyde Park, Suite A, Jefferson City, MO 65109-4731. Telephone: (573) 634-7772. Fax: (573) 634-4374. E-mail: [email protected]. Website: www.homecaremissouri.org.
- Rita Sansoucie, RN, BSN, Staff Development Director, Phelps Regional Homecare 1202 Homelife Drive, Rolla, Mo. 65401. Telephone: (573) 364-2425. Fax Number: (573) 364-3993. E-mail: [email protected].
- Gayle Lovato, MS, RN, Infection Control Practitioner, Inova Loudoun Hospital, 44045 Riverside Parkway, Leesburg, VA 20176-5101. Telephone: (703) 858-6630. Fax: (703) 858-8933. E-mail: [email protected].
- Lisa Gorski, MS, APRN, BC, CRNI, FAAN, Clinical Nurse Specialist at Wheaton Franciscan Home Health & Hospice, 9688 W. Appleton Avenue, Milwaukee, WI 53225. Telephone: (414) 535-6922. E-mail: [email protected].
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