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IndicatorWorksheet-JulianJalomo.docx

List the steps or key pieces that your clinical practice guideline or systematic review suggest that should be in place to improve outcomes (these become your measurements):

	Indicator	What data will be collected
1.	Type of catheter used or duration of catheter placement	1. Orders for use of indwelling or intermittent bladder catheter 2. Order for duration and frequency 3. Weekly audits to document types and frequency used
2.	Administer prophylactic antibiotics	1. Obtain orders to administer antibiotics, if deemed appropriate 2. Scan antibiotics in EMAR for documentation 3. Ensure duration given is appropriate 4. Weekly audits to ensure compliance
3.	Maintain sterile, clean techniques for catheter placement/care and perineal care	1. Maintain sterile technique when placing catheters 2. proper handwashing 3. catheter and perineal care with water and soap or appropriate cleanser per protocol or doctors’ orders.

Indicator#1: Type of catheter used – Indwelling VS Intermittent

This is key to improving outcomes because the choice of indwelling catheter versus intermittent catheters can yield varying results on the occurrence of acquiring MRSA or a MDRO. In fact, “intermittent urinary catheterization reduces the risk of bacteriuria and UTI” (Chenoweth & Saint, 2013).

Operational definition: Reduction in MDROs is measured by the auditing process on patients with a need of bladder catheterization in a hospital setting once an appropriate catheterization type is chosen by a doctor.

Numerator: Type of catheter chosen

Denominator: all catheter types

Data collection methods:

Who	Nurses caring for patients with a need for bladder catheterization
What	Type of catheter, including how long it is in place or frequency of its use
Where	In the hospital setting
Why	The aim is to determine which type of bladder catheter would benefit the patient in reducing the occurrence of MRSA and other MDRO infection.
When	A weekly audit will yield 100% compliance with thorough documentation of all aspects of catheter placement and care by the end of the month.
How	An audit will be conducted on all patients with either type of bladder catheter. The audit will include the duration or frequency of catheterization, the type of catheter used, and occurrence or lack of an occurrence of MDRO. The data will be used to assess correlation with MRSA and MDRO occurrences for patients who had indwelling versus intermittent catheters in the last 30 days who were discharged from the hospital.

Goal for this indicator: To reduce and ultimately eliminate MRSA and MDRO infections in bladder catharized patients in the hospital setting

Benchmark: 100% free from MRSA and MDRO occurrences in bladder catheterized patients in the hospital setting

Indicator#2: Administer prophylactic antibiotics, when appropriate

This is key to improving outcomes because it can prevent infections including MRSA and MDRO in preprocedural instances when patients are more susceptible to infection because urinary tracts of hospitalized patients represent a significant reservoir for MDROs. (Chenoweth & Saint, 2013)

Numerator: Bladder catheterized patients receiving antibiotics

Denominator: All bladder catheterized patients

Data collection methods:

Who	Nurses caring for patients with a need for bladder catheterization and administering antibiotics
What	Administration of antibiotics
Where	In the hospital setting
Why	The aim is to determine if antibiotics would benefit the patient in reducing the occurrence of MRSA and other MDRO infection.
When	A weekly audit will yield 100% compliance with thorough documentation of antibiotic administration by the end of the month.
How	An audit will be conducted on all patients with some type bladder catheter, both receiving antibiotics and not receiving antibiotics. The data will be used to assess correlation with MRSA and MDRO occurrences for catheterized patients in the last 30 days who were discharged from the hospital.

Goal for this indicator: To reduce and ultimately eliminate MRSA and MDRO infections in bladder catharized patients in the hospital setting

Benchmark: 100% free from MRSA and MDRO occurrences in bladder catheterized patients in the hospital setting

Indicator #3: Maintain sterile and clean techniques for catheter placement/care and perineal care

This is key to improving outcomes because adherence to sterile and clean technique, handwashing, catheter placement/care and perineal care will all for the reduction of infections including MRSA and MDRO. In fact, adhering to handwashing is important because, “Most of these hospital-based outbreaks have been associated with improper hand hygiene of healthcare personnel” (Chenoweth & Saint, 2013).

Operational definition: Adherence to sterile and clean technique, handwashing, catheter care and perineal care is measured by the auditing process on patients with a need of bladder catheterization in a hospital setting when the staff practices, adheres to and documents practices.

Numerator: Staff that is maintaining sterile and clean techniques

Denominator: All staff involved in care

Data collection methods:

Who	Nurses caring for patients with a need for bladder catheterization
What	Adherence to sterile and clean techniques for catheter placement/care and perineal care
Where	In the hospital setting
Why	The aim is to determine if antibiotics would benefit the patient in reducing the occurrence of MRSA and other MDRO infection.
When	A weekly audit will yield 100% compliance with thorough practice and documentation of sterile and clean technique by the end of the month.
How	An audit will be conducted on all staff caring for patients with some type bladder catheter. The data will be used to assess correlation with MRSA and MDRO occurrences for catheterized patients in the last 30 days who were discharged from the hospital.

Goal for this indicator: To reduce and ultimately eliminate MRSA and MDRO infections in bladder catharized patients in the hospital setting

Benchmark: 100% free from MRSA and MDRO occurrences in bladder catheterized patients in the hospital setting

Chenoweth & Saint, 2013- found at:

https://www.criticalcare.theclinics.com/article/S0749-0704(12)00082-6/fulltext#relatedArticles