SAVAHCS

NURSING VALOR
PROGRAM 2017
 THE USE OF SILVER GEL
COATED FOLEY CATHETERS
TO DECREASE THE
OCCURRENCE OF CAUTIS
Daniel Hermosillo, John Fernandez,
Christian Salazar, Anna Bourget MSN,
Gale Bradford, MSN
 THE CURRENT ISSUE
According to the CDC, CAUTIs account
for 75% of hospital acquired infections.
In addition, the average ratio of patients
with Foley catheters is 1 to 5
Possible causes:
Break in sterility during insertion
Lack of catheter care
Delayed emptying of urine
Extended period of urinary catheter
days
 CURRENT STATE OF CAUTIS IN THE VA

Fiscal year 10/16 09/17

Critical Care CAUTI & Urinary catheter day* ratio = 3:2030
- Infection rate per 1,000 urinary catheter days = 1.48

Acute Care CAUTI & Urinary catheter day ratio = 1:749

- Infection rate per 1,000 urinary catheter days = 1.34

*urinary catheter day = each day a pt. has an indwelling foley

 CURRENT SAVAHCS PRACTICES

Daily CHG baths for patients with

indwelling Foley catheters & suprapubic
catheters
CAUTI Bundle
CAUTI audits (managers/CNLs)
RN Foley insertion/DC Notes
Per protocol nurses are required to:
Maintain sterility during insertion, aseptic
technique with sterile equipment, and
catheter care every shift

CHG wipes oven on 3E, SAVAHCS

 IMPLEMENTATION OF PROPOSED
SOLUTION
Ideal/target state: decrease CAUTI rates
to 0 infections per 1000 urinary catheter
days
Start by decreasing infection rates to
1:1000
Coordinate with SPD
Coordinate with Infection Control
Coordinate with education department
ie. Implementing in-service teaching on
how to use new type of Foley (review of
standard of care for indwelling Foleys)
 COST ANALYSIS

Cost of CAUTI? How often are they used?

Hospital acquired infection
Nationally 1 in 5 patients
Monetary cost can vary but research has shown
that it can range from $700-4,500 (medication, Average urinary catheter days for 2017
staff, and hospital length)
fiscal year in SAVAHCS
Physical and emotional cost on patient
- Critical Care = 225.6 days
Cost of Traditional Foley vs Silver-gel coated
Foley Catheter - Acute Care = 83.2 days
Normal Foley Catheter $ 1.22-1.55 (BARDIA
Silicone-Coated Latex 2-way Foley Catheter
with 5cc Balloon)
Silver-gel coated $ 13.22-14.99 (Bardex I.C.
Silver-Coated Latex Foley Catheters - 2-way,
5cc)
 COST ANALYSIS
Additional costs to implement?
Staff education
Cost for one RN educator for one day
5 min presentation to each unit
Flyer/instruction sheet
Cost for someone to create flyer and cost
to make copies
How much money would SAVAHCS save if
we invested in Silver-gel Coated Foleys?
What we can expect right away:
Slow change of culture RNs may not use
Silver-hydrogel Foleys despite availability
Then we expect (future state):
Significant decrease in the amount of
CAUTIs occurring at SAVAHCS
Decrease in hospital expenses
Increased Veteran satisfaction & patient
outcomes
EVIDENCE FROM LITERATURE
 Study 1: The efficacy of noble metal alloy urinary
catheters in reducing catheter-associated urinary tract
infection.

Evaluated CAUTI reducing effects of noble Results

metal alloy catheters in sixty patients in an ICU
at KING FAHAD Hospital in Saudi Arabia
Single-blinded, randomized, single-centered,
prospective study
Two randomized groups: standard latex foleys
and noble metal alloy catheter (60 randomized
pts who needed indwelling Foleys: closed
system, no UTI in ICU setting)
90% decrease in rate of CAUTI vs the standard
catheter
83% decrease in catheter associated
asymptomatic bacteriuria and CAUTI
100% decrease in risk of secondary
bacteremia vs standard catheter
Conclusion - CAUTI rates and secondary
outcomes [ie. bacteremia] are decreased with
use of Foleys coated with silver-infused hydrogel
 Study 2: A prospective interventional study to examine
the effect of a silver alloy and hydrogel-coated catheter
on the incidence of catheter-associated urinary tract
infection..

- Analyzed effect of silver alloy and Results

hydrogel coated catheters on CAUTI Control group had 4352 catheter days, silver alloy
hydrogel had 7474 (All the pts in each group had
rates in Hong Kong their catheter days added)
- One year study, subgroup analysis Control had 28 CAUTI episodes, SAH had 70 =
31% reduction in CAUTI incidences vs the control
group. For every 1000 catheter days there were
6.4 CAUTI instances/1000 control and 9.4 CAUTI
instances/1000 SAH which equates to 31%)
Conclusion - CAUTI rates are decreased by almost
1/3rd compared to standard use of latex Foley
 Study 3: Multicenter cohort study to assess the impact of a
silver-alloy and hydrogel-coated urinary catheter on
symptomatic catheter-associated urinary tract infections.

Determine effects of silver hydrogel
coated Foley catheters on CAUTIs
Multicenter before-after non-randomized
cohort study
Seven acute care hospitals partook in
study
Each hospital conducted CAUTI
surveillance for 3 months with standard
Foleys and 3 months with silver-hydrogel
Foleys
Results
National Healthcare Safety Network and clinical definitions of
CAUTIs (CAUTIs defined by National Healthcare Safety
Network (NHSN) and CAUTIs that met the clinical definition
were used to aid in calculation of results)
47% reduction in CAUTI was when accounting for both NHSN
and clinical definitions of CAUTI
58% reduction in CAUTI when accounting solely for NHSN
definition
Antimicrobial Tx days for CAUTI decreased from 1165 to 406
(when using standard Foleys, days spent treating CAUTI with
antibiotics went from 1165 to 406 when SAH were used)
Conclusion - In real-life hospital application, SAH Foleys
decrease CAUTI
 What is the potential impact of the
change?
The potential impact is to reduce
the amount of catheter associated
infections within the hospital thus
reducing length of stay and reducing the
amount of money spent on HAIs.
How could the impact be measured?
- Looking through charts to count urinary
catheter days and lab cultures indicating
urinary infections
- Comparing information from charts to National
VA infection control definition for CAUTI
- Comparing CAUTI rates per fiscal year by
measuring CAUTIs vs. urinary catheter days in
Critical Care and Acute Care settings
 Recommendations for future
review/action:
Recommendation for future
review should consist of collecting more
information on the adherence of catheter
care implemented by the staff as well as
sterile technique implementation during
insertion and other predisposing factors
that lead to a CAUTI.
 The efficacy of noble metal alloy urinary catheters in reducing catheter-associated
urinary tract infection.
- https://www.ncbi.nlm.nih.gov/pubmed/28057985

A prospective interventional study to examine the effect of a silver alloy and

hydrogel-coated catheter on the incidence of catheter-associated urinary tract
infection.
- https://www.ncbi.nlm.nih.gov/pubmed/28211358

Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated

urinary catheter on symptomatic catheter-associated urinary tract infections.
- https://www.ncbi.nlm.nih.gov/pubmed/24922561