Patients at Shepherd Center Benefit from First-of-Its-Kind Urinary Management System
The new system, coupled with other practices to support urinary health, delivers lower infection rates and reduces cost.
Shepherd Center is stepping up efforts to reduce catheter-associated urinary tract infections (CAUTIs), and the initiative seems to be paying off thanks to good clinical practice coupled with an innovative new urinary management system called BioFlo. The result is a dramatic drop in the number of infections and related costs.
Spinal cord injury often leads to altered bladder elimination and harmful urinary retention. On any given day, one in three patients at Shepherd Center typically uses an indwelling catheter to drain urine from their bladder.
CAUTI happens when germs or bacteria enter the urinary tract through the catheter and cause infection. Acquiring this infection during an inpatient stay negatively impacts patients, requiring antibiotic use and, at Shepherd Center, potentially limiting their ability to participate in therapy, said Susan Bowen, RN, CPHQ, Shepherd Center’s director of Quality, Outcomes and Patient Safety.
“When we use traditional urinary catheter systems, every time there is a break in the urinary system, it introduces microorganisms into the bladder and can lead to a urinary tract infection,” Bowen explained.
In rehabilitation, it is a daily necessity to disconnect patients from a nighttime bedside drainage system, which has a larger receptacle for urine collection, and change to a smaller, less conspicuous leg bag for daytime therapy. This practice constitutes an inevitable “break in the system,” Bowen added. In fact, this practice among Shepherd patients – who use may use Foley catheters for three or more weeks – puts them significantly at risk of infection. CDC statistics show the risk increases to almost 100 percent after 30 days of catheter use, explained Sarah Culberson, RN, CIC, infection preventionist at Shepherd Center.
Given this situation, three factors contributed to Shepherd Center’s interest in using BioFlo, as well as adopting other measures to lower infection rates.
First and foremost was ensuring the safest care for Shepherd Center patients and avoiding harm to them from CAUTI, Bowen said. Second, emerging scientific evidence demonstrates that patients needing an indwelling catheter who used an unbroken urinary system also had better outcomes. Third, the hospital is complying with a new national patient safety standard instated on Jan. 1, 2013, requiring hospitals to maintain a closed (unbroken) system 100 percent of the time a patient has an indwelling catheter.
“To maintain a closed system 100 percent of the time, the only option we had to protect our patients prior to BioFlo was to not convert patients to a leg bag, thus negatively impacting their self-esteem and therapy potential,” Bowen said.
“The impact of this technology for patients in rehabilitation is quite significant,” she added. “BioFlo is the only device like it on the market.”
The BioFlo device mimics a closed system by using a secure magnetic design that serves as an anti-reflux valve, preventing the potential for urine from the bag and bacteria to flow up the catheter and into the bladder. BioFlo enables clinicians to safely change from a bed bag to leg bag while protecting the patient, Bowen explained.
“Its benefits go beyond the ability to maintain a closed system,” explained Tammy King, RN, MSN, chief nurse executive at Shepherd Center. “It also minimizes obstacles in transferring patients from a bed to a wheelchair.”
When patients need to be moved into a wheelchair or take part in therapy, therapists can temporarily and safely disconnect the patient, avoiding any accidental tugging on the tubing, which can cause trauma to the bladder, King explained.
BioFlo provides a quick disconnect design that maintains a closed system even when urine bags are detached, making it easier to change bags and collect sterile urine samples, said Kevin Spolski, creator of BioFlo, which is made in the United States by Insert Molding Solutions Inc. in Atlanta.
“It’s quick and easy, there is less mess, and it is improving patients’ quality of life and functionality,” Spolski added.
Bowen noted: “Not only has this product benefited our patients by giving them added protection against costly and burdensome infections, it has also helped them maintain their independence and dignity.”
Former Shepherd Center patient Justin Lake, 34, of Fayetteville, Ga., who sustained a C-6 incomplete spinal cord injury and used BioFlo, agrees.
“The system is genius,” Lake said, explaining the bags are designed to be discretely hidden under shorts or pants. “It sped up the time it takes me to get ready, is easier to maintain and allowed me to focus on therapy.”
Justin sustained his injury while on vacation in 2012. He had just finished a morning scuba dive with friends off the coast of Trinidad when a drunk driver slammed into their car. Although he uses an indwelling catheter and leg bag more often, he is excited to have the option of gaining even more freedom through intermittent catheterization, he said. This practice allows users to go without a collection bag for up to four hours and manually release urine when needed.
Another important piece of the puzzle, Justin noted, is the education Shepherd Center provides patients about how they can best manage their urinary health and avoid a UTI post-injury. This information includes tips on staying well-hydrated, frequent hand washing, hygiene and possible dietary changes that can help.
Altogether, Shepherd Center has reduced the number of CAUTIs by half since October 2013, expecting 25 fewer cases at the end of the year. “Not only does this outcome carry significant benefits for patients, it is also expected to translate to nearly $170,000 in cost avoidance for the hospital,” said Kristin Goin, BSIE, a senior improvement advisor in Quality, Outcomes and Patient Safety.
“Use of the BioFlo system – coupled with adequate hydration and effective clinical practice – seems to be reducing CaUTIs and can be the recipe to successfully impact patient outcomes in both rehabilitation and acute-care settings,” Bowen said.
BioFlo has been very receptive to feedback from Shepherd Center clinicians regarding potential enhancements to the product to better meet patients’ needs, Bowen noted. “We are thrilled to be working with Shepherd Center,” Spolski said. “These patients face an uphill battle in their recovery, but they are so positive, and we are happy to know this device is helping.”
The results of this collaboration are a significant breakthrough, Bowen added, especially as the Centers for Medicaid & Medicare Services (CMS) requires all hospitals to report CAUTI rates quarterly for all inpatients. CMS will soon base hospital reimbursements on quality measures such as this one.
Written by Amanda Crowe, MA, MPH
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 740 inpatients, nearly 280 day program patients and more than 7,100 outpatients each year in more than 46,000 visits.