Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH

by maggiejrn

21,826 Views | 29 Comments
  1. 32
    While working as the Quality Manager for a LTACH (Long Term Acute Care Hospital) one of my responsibilities was Infection Control. As with most facilities our highest number of infections were FRUTI (Foley Related Urinary Tract Infections). There were a number of factors to consider. The biggest was NOT getting catheters out as soon as possible. If the doctor doesn't address it then the nurse should ask if there are any reasons the patient still needs the catheter. If not ask for an order to remove it. However, if the foley is needed then it is of the utmost importance that foley care is done at least once per shift.

    Our policy was revised to include clear guidelines for care. Along with q shift peri care, staff was educated on importance of having a leg strap in place below the Y port to prevent tension on it, proper placement of the bag, never opening the closed sterile system and close observation of patient for any symptoms of a UTI. One of the most difficult issues was that many of out patients were placed into Low Boy beds due to high risk for falls. These beds had no place to hang the bag that did not have it touching the floor. To keep it off the floor it ended up being higher than the bladder. I called the manufacturer of the beds and the catheters to see if they had any suggestions. They were both completely baffled. I realized it was going to be up to me to figure this one out. I considered blue pads but felt this would be a fall risk and would easily be kicked aside. I came up with a temporary plan until we could come up with something more permanent. The foley bag was placed into the small plastic disposable bath tubs. They were less than 50 cents each, much less than the cost to treat an infection. I then set out on my quest to find a fluid impermeable cover for the bags. Since they would touch the floor no matter where it was placed, the only solution was to protect it from allowing any contamination from the floors. It took a great deal of searching but I finally found just what we needed. The last step was that after each time the bag was emptied the spout was to be cleansed with alcohol wipe then placed back into the holder.

    With a clear plan it was now time to not only educate but to get staff "buy in". I asked for volunteers and since the CNA's performed most of the foley care the majority of the team was made up of them with a few LPN's and RN's. We decided that staff along with myself would police eachother. To keep it positive, we decided that when one of the staff observed another correctly performing foley care they were given "tickets" to issue to the person "caught" doing a good job. Once a staff member acquired a predetermined amount of tickets they were able to turn them in for a small "prize". From start to finish it took about 6 months for our infection rate to drop. We had a Pizza Party to celebrate our accomplishment. Even after we discontinued the prizes staff continued to be vigilent about the foley care and in the end it was the patients who were the real "WINNERS".
    Last edit by NRSKarenRN on Sep 10, '09
    nitenite, 4_Sq, xtian0143rn, and 29 others like this.
  2. Read more articles from maggiejrn

  3. Get our hottest nursing topics delivered to your inbox.

  4. About maggiejrn

    maggiejrn joined Aug '09. Age: 55 Posts: 8 Likes: 50; Learn more about maggiejrn by visiting their allnursesPage


    Find Similar Topics

    29 Comments so far...

  5. 0
    Hi maggiejrn
    Thanks for sharing your experience, you came up with some great ideas. Since you made a number of changes, I am curious which variable influenced the decrease in UTIs. Did duration of the indwelling catheter decrease at the same time as the infection rate decreased? How were the infections measured?
    regards
    dishes
  6. 6
    FRUTI is a poor acronym.

    Why not this one: Catheter Related Urine Stream Tract Infection
    canigraduate, Mary C, Norwaynurse, and 3 others like this.
  7. 1
    Quote from maggiejrn
    While working as the Quality Manager for a LTACH (Long Term Acute Care Hospital)



    With a clear plan it was now time to not only educate but to get staff "buy in". I asked for volunteers and since the CNA's performed most of the foley care the majority of the team was made up of them with a few LPN's and RN's. We decided that staff along with myself would police eachother. To keep it positive, we decided that when one of the staff observed another correctly performing foley care they were given "tickets" to issue to the person "caught" doing a good job. Once a staff member acquired a predetermined amount of tickets they were able to turn them in for a small "prize". From start to finish it took about 6 months for our infection rate to drop. We had a Pizza Party to celebrate our accomplishment. Even after we discontinued the prizes staff continued to be vigilent about the foley care and in the end it was the patients who were the real "WINNERS".
    this is why i will never advance to management, i find this whole concept highly insulting!!!!!!!
    pussycat66 likes this.
  8. 2
    Where I worked we got balloons with a ribbon and a happy face sign. Ohhh wheeeee! Then they progressed to little plastic pins in bronze color. IF you got TEN you could trade them in for ONE silver color plastic pins. I liked the balloon better.

    The best way to avoid indwelling catheter infection is to take the darn thing out. Intermittent in and out, fastitdious peri care, frequent skin assessment and WATCH the patient.
    dishes and
  9. 5
    After reading all the comments I realized again just how difficult it is to work in a female dominated profession. Yes, I am a woman so it pains me to say this but instead of either pulling out any information that you might have found usefull or just skip it entirely 3 out of the 4 posted replies were negative and petty.
    P-RN: My very first paragraph addressed the need to get the foleys out asap. Unfortuneatly this actually ends up falling to the nurse admitting the patient. When you call to give report ask if the foley can be removed. It is everyone's job to ensure what is best for the pt. The "prize" was meant to show positive reinforcement since all too often we only hear the NEGATIVE.

    Morte: I am sorry if you were offended by the "rewards". This was my first stab at management and trust me I was lower than low on the totem pole. When you can not get management buy in I am not wasting my time on them. They are not the ones out there on the front line" performing the care. If you remember this was a TEAM effort led by CNA's with a few LPN's and RN's. If this upsets you how do you think a patient who is already extremely ill feels when they unnecessarily end up with a UTI?

    hypocaffienemia: What difference does it make what acronym you use as long as the staff understand it. You do realize your suggestion sounds like CRUSTI? As a pt if I heard staff using the word CRUSTI around me I would be offended. The information offered really had nothing to do with the acronym. It was about team work and coming up with a successful plan to decrease infections.
    deskbarn, TomLM, RNGrad2006, and 2 others like this.
  10. 5
    DISHES: Thank you for the questions and understanding this was more than an opportunity to critique my experience. I believe it was the foley care being done q shift along with all the other hard work by staff that brought our infection rate down. Too many doctors just don't think about things such as foley related infections. There are a lot of nurses out there that would prefer to keep them in just for convenience of less bed changes. If no one is out there advocating for the patient the foley is not going to come out. CDC guidelines were used to determine an active vs colonized infection and at the time we used PHC4 guidelines to determine who "owned" the infection since most of our patients came from acute care hospitals.
    deskbarn, +one, NRSKarenRN, and 2 others like this.
  11. 1
    maggiejrn
    Thanks for answering my questions. Your suggestion to put the drainage bag in a disposable plastic basin was new to me. My tips for patients who have urine drainage bags and are at home sleeping on regular beds, is to slip the urine bag inside a pillowcase and tuck the ends of the pillowcase in between the matress and the boxspring. Another suggestion is to make a hook by bending a coat hanger and wrapping it with tape and slipping it between the matress and boxspring.
    In the future I am also going to suggest your tip to patients as a third option because it may be easier for some patients to manage. Again, thanks for sharing your tips on what you do to help prevent foley related UTIs.
    kindest regards
    dishes
    deskbarn likes this.
  12. 5
    Could you tell us more about the fluid impenetrable cover that you found?

    BTW, good job trying to find positive ways to motivate people. Most places just use fear of getting in trouble. Random positive reinforcement is the most effective method according to psychological studies.
    deskbarn, suzi-Q, dishes, and 2 others like this.
  13. 8
    Quote from maggiejrn
    hypocaffienemia: What difference does it make what acronym you use as long as the staff understand it. You do realize your suggestion sounds like CRUSTI? As a pt if I heard staff using the word CRUSTI around me I would be offended. The information offered really had nothing to do with the acronym. It was about team work and coming up with a successful plan to decrease infections.
    Your discussion is very interesting and enlightening, but I think you'll find that hypocaffienemia knew exactly what he was writing, and I doubt that it was a serious suggestion, just an amusing little side note that was supposed to make people chuckle (well it made me chuckle anyway).
    I have found that serious stuff works well when there is laughter as it makes people think.
    sazola, Patchouli, Norwaynurse, and 5 others like this.


Top