Catheter associated urinary tract infection (CAUTI) in the ICU
A urinary tract infection (UTI) is where an indwelling urinary catheter was in place for more than two calendar days and the catheter was in place on the date of infection or the day before. We measure this rate per 1,000 catheter days.
Approximately 75 percent of all hospital-acquired UTIs are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Around 1 in 4 hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a CAUTI is prolonged use of the urinary catheter. We work to reduce the number of CAUTIs by:
Pressure ulcers are the breakdown of skin tissue, not present on admission, caused by sitting or lying in the same position for a long period of time. They are typically the most reported adverse health event. According to the Agency for Healthcare Research and Quality, each year more than 2.5 million people in the U.S. develop pressure ulcers. The injuries to the skin and underlying tissue are painful and increase risk for infection or other complications. Here are ways we are working to reduce the incidence of pressure ulcers:
- Three NICU staff members were recruited as their unit “skin champions.” As a result, they began using a skin integrity risk assessment, added skin assessment documentation and began quarterly pressure ulcer prevalence and incidence studies.
- Intensive care nursing staff and respiratory therapy staff are working together to improve skin assessment under respiratory equipment
- We are exploring community practice related to “standard” off-loading mattress for the intensive care patient.
- We are developing staff education related to thorough skin assessment under and around medical devices and accuracy of pressure ulcer risk assessment to ensure we identify all patients at risk for development of pressure ulcers
We report the number of stage 3, 4 or unstageable pressure ulcer events to the State of Minnesota.
Falls Resulting in an Injury Severity of Moderate or Greater Harm
Falls are the most common adverse event in hospitals. Each year, somewhere between 700,000 and 1 million people in the United States fall in the hospital. A fall may result in fractures, lacerations or internal bleeding, leading to increased health care utilization. University of Minnesota Health makes reducing and eventually eliminating falls that result in injury a top priority. Some of our efforts include:
- Implementing the Minnesota Hospital Association (MHA) Falls Tool - a new risk assessment and intervention to prevent falls and falls with injury
- Aligning interventions with the specific risks identified in the risk assessment
- Purchasing new beds equipped with bed alarms and pressure reduction mattresses, among other innovations
- Reviewing and improving processes to promote awareness of fall prevention responsibilities and interventions
We measure and report the number of inpatient falls associated with an injury severity of moderate or greater that we report to the State of Minnesota.
University of Minnesota Masonic Children’s Hospital has reported zero falls since 2013.
Surgical Site Infections
Surgical site infection (SSI) is the most common and costly health care-acquired infection (HAI), occurring in up to 5 percent of patients undergoing inpatient surgery. Annual costs are estimated at $3.5 billion to $10 billion, and the emotional and physical costs to patients are staggering, including lengthened hospital stays, readmission and death. Experts estimate that up to 60 percent of SSIs are preventable.
We are doing the following to reduce the incidence of surgical site infections:
- Ensuring that the appropriate antibiotics are chosen and given at the right time
- Building processes and a checklist to ensure pre-surgical preparations are made, like patients taking an antibacterial bath or shower the day before surgery
- Participation in Minnesota Hospital Association’s Slashing SSI project. Some of the recommendations being implemented include:
- Post-operative wound care
- Maintaining blood glucose levels before, during and after surgery
- Maintaining normal body temperatures before, during and after surgery
Definitions provided by the National Healthcare Safety Network.