Aseptic Catheter Insertion Practices in the ED: A Focus on Engagement

Slide Presentation

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Aseptic Catheter Insertion Practices in the ED: A Focus on Engagement

Milisa Manojlovich PhD, RN, CCRN
Associate Professor
University of Michigan, School of Nursing

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Learning Objectives

  • Discuss barriers to ED staff engagement
  • Describe strategies to engage ED staff in aseptic insertion technique

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The Scope of the Problem

  • Guidelines for preventing CAUTI have always recommended aseptic insertion techniques.
  • Healthcare providers who insert catheters say they use aseptic technique.
  • In multiple observation studies, at least half of the time there are significant breaks in aseptic technique.

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Lack of Knowledge

  • Healthcare providers may not have the skills to maintain aseptic technique given work environment constraints.
  • They may observe peers inserting catheters and notice that aseptic technique is not used.

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Lack of Knowledge: Strategies to Overcome

  • First, always make sure that there is an appropriate indication for catheterization.
  • Review catheter insertion technique during annual competency testing.
  • Require that there be oversight for catheter insertion by a licensed provider.
  • Develop a policy on catheter insertion techniques if none is in place.
  • Use a variety of checklists.

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Lack of Importance

  • Activities strictly within the nursing domain may not perceived as being important or of much value, compared to activities that cross disciplinary boundaries.
  • Catheter insertion may be perceived as one of many “tasks” rather than as a component of evidence-based practice.

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Lack of Importance: Strategies to Overcome

  • Aseptic insertion of indwelling urinary catheters is a component of evidence-based practice, no matter what the discipline.
  • Develop a culture where evidence-based practice is recognized and rewarded.
  • Think in terms of nursing practice components rather than a set of tasks to be completed.

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Lack of Feedback & Strategy to Overcome

  • Patients move from the ED to other units, and there is no systematic process to let ED staff know of patient outcomes.

Organizational level strategies:

  • Post CAUTI rates for all units, so that comparisons can be seen.

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Lack of Resources

  • Time, financial, space, equipment constraints can all contribute to situations where aseptic insertion techniques are not used.
  • Variation in staffing resources contributes as well:
    • High turnover
    • Understaffing

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Lack of Resources: Strategies to Minimize

  • Adequate supplies:
    • Over-the-bed tables
    • Hand sanitizers
    • Sterile gloves
    • Best type of kit to stock for your patient population
  • Would individual supplies be better than a kit?
  • Adequate facilities for hand hygiene

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Components of Aseptic Insertion

  • Set up a sterile field.
  • Perform hand hygiene immediately before and after insertion.
  • Use sterile gloves, drapes, sponges.
  • Use appropriate antiseptic or sterile solution for peri-urethral cleaning, and a single-use packet of lubricant jelly for catheter tip.
  • If catheter is accidentally contaminated, it is discarded, and a new sterile catheter is obtained.

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Tips for Success

  • A non-punitive culture
  • Visible and supportive leadership
  • Identify system-wide barriers to aseptic insertion:
    • Lack of adequate supplies
    • Lack of space for sterile field set-ups
    • Lack of manpower
  • Allocate resources to overcome as many barriers as possible.

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More Tips for Success!

  • Transition to an evidence-based practice approach for patient care delivery:
    • Several evidence-based practice models are available to choose from;
    • They all provide guidelines for enlisting staff support and buy-in.
  • Enable collaborative and decentralized decision-making.
  • Allow nurses to make decisions that affect their practice.

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Thank you!

Questions?

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Funding

Prepared by the Health Research & Educational Trust of the American Hospital Association with contract funding provided by the Agency for Healthcare Research and Quality through the contract, “National Implementation of Comprehensive Unit-based Safety Program (CUSP) to Reduce Catheter-Associated Urinary Tract Infection (CAUTI), project number HHSA290201000025I/HHSA29032001T, Task Order #1.”

Return to CAUTI Toolkit Information for Specialty Audiences Page

 

Page last reviewed December 2017
Page originally created November 2015
Internet Citation: Aseptic Catheter Insertion Practices in the ED: A Focus on Engagement. Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/aseptic-catheter-insertion-practices-ed-slides.html