Catheter-associated Urinary Tract Infection (CAUTI) Skilled Nursing Facility Pre-assessment

 
Note: This assessment will be used only to identify current practices used or not used in your facility. This document does not necessarily represent best practice and should not be used as a guide for best practice.
1. Facility Information
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2. What is the total number of staff currently working in infection prevention and control at your facility? Please describe using full-time equivalents of people working directly in infection control, do not include support staff (for example, if a facility had one full-time person and one half-time person, this would equal 1.5 staff members).
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3. How many of the staff working in hospital infection prevention and control are certified in infection control?
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4. Currently, how many post-acute care (i.e., rehabilitation or assisted living) beds does your facility have?
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5. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedures on appropriate indications for urinary catheter use
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6. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedures on proper techniques for urinary catheter insertion
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7. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedures on proper techniques for urinary catheter maintenance
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8. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedure for documenting each urinary catheter insertion
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9. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedure for documenting each urinary catheter removal
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10. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedure for documenting indication for urinary catheter placement
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11. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Procedure for assessing each catheterized patient daily for appropriate indications for catheter use
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12. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Regular in-service training for appropriate healthcare personnel on techniques and procedures for urinary catheter insertion, maintenance, and removal
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13. Please indicate whether your facility provides the following with respect to urinary catheters:
Yes, facility-wideYes, service or unit-specificNo
Readily available supplies necessary for aseptic urinary catheter insertion
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