Reducing catheter-associated UTIs - the abstract

"Feedback to Nursing Staff as an Intervention to Reduce Catheter-associated Urinary Tract Infections," by Goetz AM, Kedzuf S, Wagener M, and Muder RR. In American Journal Of Infection Control [Am J Infect Control] 1999 Oct; Vol. 27 (5), pp. 402-4.

Abstract:
Because of high incidence of catheter-related urinary tract infections (UTIs) in our Veterans Affairs medical center, we began providing nursing staff with unit-specific UTI rates. In our preintervention period, the first quarter of 1995, 38 infections occurred in 1186 catheter-patient-days or 32/1000 catheter-patient-days (95% CI, 22.9-43.7). Thereafter, nursing staff members were provided with a quarterly report with catheter-related UTI rates depicted graphically by unit. In the 18 months after this intervention, the mean UTI rate decreased to 17.4/1000 catheter-patient-days (95% CI, 14.6-20.6, P =.002). We estimated a cost savings of $403,000. We conclude that unit-specific feedback of nosocomial UTI rates to nursing staff is a highly effective method of reducing infection rates and reducing costs associated with nosocomial UTI.

Wound care -- Irrigation and dry dressing

>BEFORE REMOVING BANDAGE:
1. Medicate for pain
2. Gather supplies
3. Wash hands
4. Ask patient/check chart and id bracelet for

--name
--medical record #
--date of birth
--allergies

5. Don clean gloves; wipe down table & rails w/disinfectant
6. Put supplies IN ORDER OF USE on table
7. Cut tape; write Date, Time, Initials

>REMOVE THE BANDAGE; TOSS IT, ALONG WITH YOUR GLOVES. DON'T FORGET:

--use sterile saline to loosen, if it sticks
--don't make patient see wound
--check for exudate

>DON CLEAN GLOVES; MEASURE WOUND; CHUCK GLOVES AGAIN

>GET READY TO IRRIGATE THE WOUND:
1. Cover the wound temporarily with a gauze pad or ABD
2. Get all your sterile stuff organized:

--open syringe box; use ring to lift up bottle; take out the syringe
--open saline, lip off & pour into syringe bottle
--don clean gloves
--open a gauze sponge or 2

>IRRIGATE THE WOUND:
1. only touch ring & top collar of syringe
2. cleanest to dirty
3. dry w/gauze
4. REMOVE GLOVES

>BANDAGE THE WOUND:
1. Open gauze (1), cover sponges (1), ABD (1)
2. Lastly, open sterile gloves and don
3. Put gauze, then cover sponges, then ABD on wound
4. Tape all 4 sides; make sure date, time and initials are easy to see

documenting refusal of treatment in a nutshell

(my thoughts after reading "Documenting Refusal of Treatment," by Linda Smith, in Nursing, Apr 2004, pg 79)

so as I see it, if a person refuses some treatment or other, you tell 'em:

1. what's wrong with 'em
2. what you want to do about it
3. how wonderful it might be for them if they let you (give 'em a pamphlet!)
4. how terrible it might be for them if they don't

also: ask 'em: why the hell they're saying no (maybe they're nuts?)

also you gotta:

1. make sure they're not nuts

2. write it all down

3. get 'em to sign it. you sign it. hell, get the doctor to sign it
4. if the patient won't sign it,
write that down too! sign it!