Novel Tray Design Aims to Tackle Infection

Medline Industries Inc.’s (Mundelein, IL) novel Foley catheter management system is a revolutionary approach to managing catheters and reducing catheter-associated urinary tract infections (CAUTI). The shift from a two-layer tray to a one-layered tray to support the sequence of events during catheterization represents a major change for clinicians within the hospital setting. The product launched alongside a comprehensive professional awareness campaign, ERASE CAUTI, using packaging that includes patient and family education components.

Developed by Deborah Adler and Medline’s urological product division and marketing division, the one-layer tray design encourages aseptic technique. According to Sue MacInnes, chief marketing officer for Medline, the marketer conducted intense research on catheter-associated urinary tract infections, which is reportedly the number-one hospital infection. The project, however, brought about a unique set of challenges: evaluating a procedure that had not been looked at for a long time, working with clinicians who have developed their own individual techniques, and dealing with the day-to-day challenges of job requirements.

“The tray is a no brainer,” says Melinda Hill, ER staff educator at Trinity Mother Frances Hospital and Clinics (Tyler, TX). “It’s laid out in perfect order for the staff member to go from A–Z without fumbling around and creating opportunity for cross contamination. It has made placing a Foley in a busy ECC setting faster and more efficient.”

Medline’s research coincided with the timing of studies and guidelines released by industry experts on ways to prevent CAUTI, including limiting the duration of the catheter, identifying alternatives to catheterization or not catheterizing at all if possible, compliance with regulatory bodies, and patient satisfaction. According to the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Committee, clinicians are advised to insert catheters only for appropriate indications, to leave them in place only as long as needed, and to consider using alternatives to indwelling urethral catheterization in selected patients when appropriate. Examples of appropriate indications for indwelling urethral catheter use include acute urinary retention or bladder outlet obstruction; the need to accurately measure urinary output in critically ill patients; perioperative use for selected surgical procedures; assisting the healing of open sacral or perineal wounds in incontinent patients; prolonged immobilization; and improving comfort for end-of-life care if needed.

“When we examined the current state of the industry, we realized that the current trays did not support the recommended guidelines,” MacInnes says. “We expanded our research to the bedside nurse, visiting hospitals to observe nurses and interview them on the procedure. After digesting our learnings, Deborah approached us with several different design concepts.”

At first, Medline’s goal was to reduce variance in practice by sequencing the components to mirror the appropriate steps in catheterization. Then the goal was to bring to the clinicians’ attention to proper indications for using silver versus non-silver catheters, which would reduce cost and support appropriate use of silver. Many facilities were using silver catheters and questioning whether the added expense had any effect on the number of infections they were experiencing in their facilities, while industry guidelines actually supported the concept of not catheterizing.

“We looked at the recommended processes and incorporated each step of the CDC guidelines into the tray constructions,” MacInnes says. “We now had a tray that used trigger tools to identify whether or not there was a clinically acceptable reason to catheterize.”
While this was alarming for the Medline sales force, ultimately the right thing was to support the correct clinical practice.
“Medline is winning ten-fold, and so are our customers,” MacInnes says.

The new tray design follows intuitive flow of the procedure to reduce variance in care process and promotes efficiency. Trigger tools promote recommended CDC guidelines with an outer sticker that includes reasons for catheterization, a catheter placement checklist, and an area for clinician to sign and date. A removeable sticker can then be placed in the patient’s chart. There is also a tag to put on the catheter to alert staff as to when it was placed. The tray’s product label includes a schematic of the tray components to ease viewing of tray contents, and instructions are attached to the label with step-by-step illustrations.

“This is a clear departure from the industry norm where instructions are obscure, in small typeface and hidden,” MacInnes says.
A product booklet is included in every tray. The brochure shows a pictorial image of the kit components on the outside cover. Inside the booklet is a clear, step-by-step guide to catheter insertion.

Patient and family education is provided as a perforated addition to the instruction sheet to ensure the clinician is prompted to give support and education to the patient on signs and symptoms of a urinary tract infection. This can potentially reduce hospital readmissions and emergency room visits and improve patient satisfaction scores for patients and families that want information and answers on how to care for themselves once they leave the hospital.

“As educators at our facility, we were really impressed with the new Medline catheter tray design to help prevent CAUTI,” says Becky Schlabach RN, CNOR, Perioperative Educator, Goshen General Hospital (Goshen, IN). “Medline has really done their homework on what nurses need and how to render great patient care. The tray is very intuitive, and our colleagues were pleased with and sold on the product from the first use. Medline has also developed a competency-based learning model that is available free of charge that helps drive home the important learning aspects of catheter care and CAUTI prevention. This is a great product from a great company.”

The kit’s components include PVP swabsticks to cleanse the peritoneal area prior to catheterization; a securement device in every tray; and a packet of hand sanitizer. The swabsticks reduce the number of steps to cleanse the patient, which is important because the nurse and the patient are anxious about the procedure. Anything that can be done to combine steps to make the process more efficient is appreciated by both participants.

The securement device keeps the catheter from moving, which is a recommended guideline. The hand sanitizer explicitly follows recommended guidelines and is a step that many times is overlooked.

Although clinicians on Medline’s staff worked on the education components, the company needed to simplify it to ensure that it was simple enough for a patient or family member to understand. All education materials were reviewed extensively by Medline’s board and subsequently tested for reading grade level and consumer acceptability.

Medline.com/erase is the Web link for the ERASE CAUTI tray and was designed under the direction of Jignesh Thakkar, director of marketing/ebusiness at Medline. The Web site consolidates all of the materials in one location, such as product information, industry expert commentary, educational offerings on CAUTI, prevention techniques, instructions on proper use of the tray, news, and an awareness campaign that encourages nurses to join the “Race to ERASE CAUTI.”

Highlighted at Medline’s ERASE CAUTI Web site is the introduction of new and innovative packaging for three of its existing catheters. The new tray design and arrangement, instructions, and labeling components are designed to help the healthcare worker be more efficacious.
Medline’s Silvertouch 100% Silicone Foley Catheter Management System Tray comprises latex-free catheters, which incorporate the power of silver through a patented process that binds silver ions to the catheter’s lubricious coating. The hydrophilic coating is covalently bonded to the catheter surface, hydrating quickly and maintaining its lubricity for at least seven days, helping to reduce friction and irritation.

The company’s Silicone-Elastomer Coated Latex Foley Catheter Management System Tray incorporates an innovative manufacturing process to provide the maximum amount of silicone coating available. Silicone-elastomer coating resists encrustation.

With the 100% Silicone Foley Catheter Management System Tray, 100% Silicone Foley Catheters are completely inert to minimize tissue irritation during extended periods of indwelling use. A pliable catheter with a firm tip eases insertion. This catheter features large smooth eyes for maximum comfort and drainage and a symmetrical balloon for added reliability. 0