TAP into CAUTI and CLABSI Prevention: A Quality Improvement Framework

Infection preventionists (IPs) play a principal role in preventing hospital-acquired infections (HAIs). Now and then for IPs, it may seem as though we have read every article and tried every preventive measure to reduce catheter-associated urinary tract infection (CAUTIs) and central-line associated infections (CLABSIs), but they remain a persistent problem. If CLABSIs and CAUTIs continue to persist amongst your facilities and units, consider the Targeted Assessment for Prevention (TAP) Strategy developed by the Centers for Disease Control and Prevention (CDC).

The TAP Strategy is a framework for quality improvement that stands for Target, Assess, and Prevent. The program uses data reported by health care facilities to CDC’s National Health Care Safety Network (NHSN) to identify health care facilities and specific units with an excess burden of HAIs. Once these health care facilities and specific units have been identified, individuals can utilize the TAP Facility Assessment Tool to identify gaps in their infection prevention program. The identification of these gaps through the TAP Strategy brings new alertness to IPs on which areas need to be reviewed in the infection prevention and control program of their facility. Some of these gaps can include nurse and physician champions for prevention activities, training of proper central line and Foley insertions, routine audits of proper central line and Foley insertion practices, and documentation gaps. The TAP Strategy also provides IPs and other health care professionals with access to educational resources to address these gaps such as testimonials from other hospitals “How To” guides, and implementation guides.

“The TAP Strategy would be a great method of identifying where facilities have an above-average number of infections and ensuring that resources are available to aid those facilities in effectively setting prevention goals, in the private sector,” said Robbie Hilliard, MSN, RN, CIC, infection control coordinator, Carl Vinson Veterans’ Administration Medical Center (VAMC) in Dublin, Georgia, and a member of the Infection Control Today^®’s (ICT^®’s) editorial advisory board.

Another tool the VAMC has used is “the Strategic Analytics for Improvement and Learning (SAIL) metrics [from the US Department of Veterans Affairs] to look at VA hospital performance data by location since approximately 2012,” Hilliard told ICT^®. “It is similar to the TAP strategy as it looks at HAIs (ie CAUTI, CLABSI, ventilator-associated events [VAE], methicillin-resistant Staphylococcus aureus [MRSA], and Clostridioides difficile) as one of the metrics, and quarterly SAIL reports are publicly released and used as a learning tool and guide for performance improvement for VA facilities. In many ways, I think SAIL and the TAP Strategy resemble each other closely.”

The TAP Strategy also provides IPs and other health care professionals with access to educational resources to address these gaps such as testimonials from other hospitals “How To” guides, and implementation guides.

In January 2015, the TAP Reports became available within the NHSN application. In 2016, TAP Implementation guides were developed and are available for HAIs. IPs should run reports for their facilities on NHSN and determine which specific HAIs, such as CAUTI, CLABSI, MRSA, or CDI, and unit(s) would benefit from this program the most and where prevention efforts will be the most impactful. To start the program, I recommend 1 or 2 units at a time for prevention efforts. The TAP Strategy is a free resource to utilize to evaluate and improve any facility’s infection prevention and control program.

After using the TAP Strategy at my facility, Moffitt Cancer Center in Tampa, Florida, we were able to identify and address gaps in our infection prevention and control program. We identified one unit to target CLABSI efforts and one unit to target CAUTI efforts based on the findings from our report. The findings from the TAP Strategy were also beneficial for other departments such as nursing, quality, leadership, and more. My coworkers and I were able to present our findings to various committees within our health care facility, such as the CAUTI Committee, the CLABSI Committee, and the Infection Control Committee, to discuss gaps in our facilities and our upcoming improvement efforts.

If you feel as though you have exhausted every possible resource, consider the CDC’s Tap Strategy and the VA's SAIL as new methods for quality improvement efforts in your facility. The goal of the program is for HAI elimination through a customized approach.