CAUTI Prevention

Definition of CAUTI

• Urinary tract infection that occurs in a patient who had an indwelling urethral urinary catheter in place 48 hours prior to the UTI diagnosis and up to 30 days post removal or discharge

• Does not include straight in & out catheters or urinary catheters that are not placed in the urethra

Goals

• Decrease foley catheter use by 25%

• NorthCrest goal is to have a zero incidence of CAUTI

• Increase education on foley catheter use and CAUTI

Background

• Urinary Tract Infections (UTI’s) are the most common site of HAI’s

• Most UTI’s (80%) are associated with urinary catheterization instrumentation

• UTI’s lead to increased morbidity, mortality, LOS and cost

Background

• UTI’s account for approximately 36% of all HAI’s

Background

• According to the CDC, UTI’s are directly related to 5% of deaths associated with HAI’s

Eliminate CAUTI: One infection at a time

• Appropriate Indications: Does this patient need the catheter?• Ensure patient meets appropriate

indications for catheter use and document reason

• Consider alternatives to indwelling urethral catheterization

Hand Hygiene: It starts with the hands

• PRACTICE HAND HYGIENE and standard precautions• Sanitize hands thoroughly with an

alcohol-based hand rub or soap and water before and after catheter insertion and manipulation

Insertion Technique: Pay attention to detail• Use sterile equipment including, sterile

gloves, drape, sponges, and appropriate antiseptic solution

• Use aseptic technique to insert catheter. If aseptic technique is broken, replace catheter and collection system aseptically with sterile equipment

• Secure catheter to prevent movement and urethral traction

Catheter Maintenance: Keep it neat• Keep collection bag below level of the

bladder at all times• Check tubing frequently for kinking• Keep drainage bag/tubing off the floor• Empty the collection bag every four

hours or when ½ to 2/3 full• Maintain a closed-drainage system

Catheter Care: Keep it clean• Perform perineal care daily and after

each bowel movement• Soap and water or perineal cleansing

wipes will be utilized• Special care will be taken to remove

fecal soiling from around the catheter by cleaning fecal material away from the urinary meatus

Catheter removal: Get it Out!• Assess patient every shift for

catheter need• Take steps to remove catheter

when patient no longer meets indications

• Early removal of catheter using reminders or stop-order “stickers”

Indications for catheter use • Insert catheters only for

appropriate indications• Management of acute urinary

retention• Post-op bladder decompression for 48

hours• Surgery procedure• Monitoring urinary output in acutely ill

patient

Indications for catheter use

• Contamination of stage III or IV pressure ulcers with urine which has impeded healing, despite appropriate care for incontinence

• Terminal illness or severe impairment which makes positioning or clothing changes uncomfortable, or which is associated with intractable pain

• Other – MD clarification required

Alternatives

• Alternatives to indwelling catheter• Bladder ultrasound• Intermittent catheterization• Condom catheter

Organisms enter the bladder by 3 ways:

• At time of catheter insertion• Through the catheter lumen (from

a colonized drainage bag)• Along external surface of the

catheter (migrate along the catheter-mucosal interface)

Prevention

• Use general infection control practices• Aseptic insertion • Proper maintenance• Hand hygiene

• Nurse driven Catheter Removal Protocol

• Education

Implementation of Evidence-Based Prevention Strategies

• Make sure the catheter is indicated• Implement and promote alternatives to

indwelling urinary catheterization• Perform hand hygiene in compliance with CDC• Provide education on proper insertion and

maintenance• Limit insertion of catheters to trained

personnel• Insert catheters using aseptic technique and

sterile equipment

Implementation of Evidence-Based Prevention Strategies

• Secure catheter to prevent movement and urethral traction

• Maintain closed drainage system• Maintain unobstructed urine flow• Remove catheters with 48 hours

following surgical procedure or document reason for extended use

• Remove unnecessary catheters

Documentation

• Accurate documentation on the Urinary Catheter Assessment in HMS• Document medical indications for placement• Insertion documentation (size of catheter used,

patient response, amount & color or urine obtained, etc…)

• Assess patient every shift for foley catheter removal – includes scoring indications for maintenance of foley

• Discontinuation of urinary catheter documentation – includes Bladder scanner Clinical pathway documentation

• New alert sticker in physician orders to remind physicians to discontinue foley catheters

Lessons Learned

• Use evidenced-based, standardized, protocols and guidelines

• Build redundancy into the process – new alert sticker placed in physician orders

• Define and enforce accountability• Push accountability to the front line

staff

Conclusions

• CAUTI is a common and costly safety problem

• Several practices appear to decrease CAUTI

• Preventing CAUTI is a “team” effort