Kaiser Permanente (South Bay, CA) was selected as a finalist for ECRI Institute's 7th Health Devices Achievement Award for driving the development and proper use of an "ideal" Foley catheter kit to help prevent catheter-associated urinary tract infections.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and five finalists for the 7th award in October 2012. Learn about the other submissions that achieved recognition.

ECRI Institute congratulates the Kaiser Permanente team: Reza Goharderakhshan, MD; Ronald Loo, MD; Paul Lee, MD; Kalvin Yu, MD; Stephen Parodi, MD; Jo Carol Hiatt, MD; Douglas Grey, MD; Robin Cisneros; Dana Trocino; Enid Eck; Sue Barnes; Jennifer Cox; Pancy Leung; Cathy Hevy; Brad Rhoa; Veda Bartlow; and Nestor Jarquin. 

The Concept

Historically, the procurement of catheter supplies for Kaiser Permanente facilities centered on securing the best pricing. But in 2011, Kaiser Permanente's urology procurement group employed a more innovative, quality-based approach. The group focused on product design and usage guidelines to drive the development and proper use of an "ideal" Foley catheter kit—one that met Kaiser Permanente's specifications geared toward preventing catheter-associated urinary tract infections (CAUTIs), facilitating insertion, and minimizing patient discomfort.

The urology procurement group had found that urinary tract infections accounted for a significant portion of hospital-acquired infections (HAIs) and that such infections were commonly associated with the use of a urinary Foley catheter. Further, the group learned that the urethral catheter trays that had been in use at the organization's facilities varied significantly from one location to the next. In addition, those trays did not foster incorporation of Kaiser Permanente's CAUTI prevention guidelines, and this best practice was not consistently being implemented. In response, a multidisciplinary team was formed to develop a new strategy; the team included representatives from urology, nursing, infection control, and infectious disease physician leadership.

The team discussed the limitations of the existing products and developed prototype specifications for an ideal Foley catheter kit. The specifications included the following:

• A catheter design that minimized urethral trauma during insertion, contributing to patient comfort and ease of use for the nursing staff.

• Complete alignment with the Kaiser Permanente CAUTI prevention guidelines, including the presence of a proper securement device, metered urinary drainage bag, and hand sanitizing agent in the kit.

• A latex-free kit with a silicone catheter to reduce bacterial adherence; specifying a latex-free kit would allow standardization on a single kit, rather than having to stock separate kits for latex-allergic patients.

Interested vendors were given the opportunity to compile Foley trays that met these specifications. The prototypes were then subjected to a program-wide clinical evaluation process. Once a kit was selected, an educational program was initiated focusing on proper Foley catheter use and care and reinforcing the organization's CAUTI prevention guidelines.

By convening a multidisciplinary team to optimize all components of the tray and to stress guidelines for proper use, the urology procurement group was able to achieve complete standardization in all Kaiser Permanente hospitals and across all venues, including emergency, med/surg, intensive care, and the OR. This in turn led to better pricing and $1.2 million in direct annual cost savings. The indirect cost savings associated with the reduction of catheter-associated infections will be monitored by the organization's infection surveillance program. Dr. Reza Goharderakhshan, chief of urologic surgery at Kaiser Permanente's South Bay Medical Center, notes that it is still too early to draw conclusions, but initial data from the facilities that first converted to the new trays suggests "significant reductions in CAUTI rates," as well as a reduction in urethral trauma. 

Best Practices

Not all healthcare facilities can harness sufficient buying power to dictate product design, as Kaiser Permanente was able to do, but the initiative nevertheless illustrates practices that other facilities can emulate. For example, rather than focusing narrowly on which catheter could be obtained at the best price, the Kaiser Permanente team took a broader view, defining the product characteristics that would lead to better care—and likely significant savings in the form of avoided infections.

In addition, the organization recognized a need to pursue an integrated, collaborative strategy throughout the process. For Dr. Goharderakhshan, a key to the success of the initiative was the willingness of the procurement team to work in a multidisciplinary fashion and to engage end users in the implementation process. He also noted that this project can serve as a model for effective collaboration as accountable care organizations begin to implement innovative ways of delivering efficient and affordable healthcare.