Catheter-associated urinary tract infections (CAUTI) are the most widely reported healthcare-associated infection (HAI). It is estimated that nearly 40% of HAI are CAUTI, leading central-line associated bloodstream infections, surgical site infections, and ventilator-associated pneumonia by wide margins. 75% of UTIs that are acquired in an acute care setting are attributed to indwelling urinary catheters (IUC). In today’s post, we will review some current evidence-based practice and patient-centered approaches aimed at reducing the incidence of CAUTI and protecting patients from preventable HAIs.
2009, exactly a decade ago, the Centers for Disease Control and Prevention (CDC) clearly defined what a catheter-associated urinary tract infection is and put a value to the number of patients affected — nearly 560,000 each year — and what impact it has — increasing readmissions and morbidity and causing longer hospital admissions, costing the healthcare industry more than 33 billion dollars a year. As a follow-up, the U.S. Department of Health and Human Services (HHS) introduced the HAI Action Plan the same year. The HAI Action Plan was a five-year plan to reduce HAI by 25%.
Strategies to Reduce CAUTI
The American Nurses Association (ANA) has partnered with the Centers for Medicare and Medicaid Services (CMS) to implement evidence-based practice procedures to help reduce preventable CAUTI by 40%. While these goals may seem lofty, they are important and perfectly attainable. But, how do we do it?
Reduce Unnecessary Urinary Catheter Use
It is estimated that during an inpatient hospital stay, between 15 and 30% of patients will receive an indwelling urinary catheter at some point. It is vital to assess the actual need versus the convenience of the catheter and reassess regularly for removal. For instance, if a patient has a Foley catheter placed in preparation for surgery or an epidural, it should be removed once the anesthesia has worn off and the patient can walk to the restroom again. For patients who are bed-bound, long-term use of a catheter is not indicated and other methods of elimination management should be practiced. Check your facility’s protocol for incontinence care. Keep in mind that the rate of CAUTI transmission increases by approximately 5% each day a catheter is left in place. If it is anticipated that the catheter will be long-term or permanent, consult a urologist for potential supra-pubic insertion.
CDC Criteria for Indwelling Urinary Catheter Insertion:
- Acute urinary retention — consider intermittent straight cath,
- To improve comfort for end-of-life care,
- For the critically ill patient when strict intake/output measurements are required,
- Selected surgical procedures,
- Aid in healing an open sacral or perineal wound in the incontinent,
- During intraoperative monitoring or when large volumes of fluids and/or diuretics are to be administered, or
- Prolonged immobilization.
Practice Strict Aseptic Technique and Follow-up Clean Procedures
During the insertion of the IUC, it is critical to maintain a strict aseptic technique and to intervene at any time it is compromised. Maintain a sterile field while performing the insertion, properly clean the area, and use sterile gloves and sterile, unused equipment. Sterile surgical lubricant should be used to prevent bacteria from being inserted along with the catheter. A bacteriostatic, water-based lubricant is preferred to maintain the integrity of the silicone tubing and prevent friction in the urethra during insertion.
Regular peri-care should be performed while the catheter is in place, using warm soap and water to clean the site and rubbing alcohol to clean eh exposed tubing. Assess the insertion site for leaking or irritation and continually asses the drainage bag to visualize the quality of the urine. The drainage bag should be emptied and cleaned regularly and should never be placed at, or above, the level of the bladder, to prevent backflow and reintroduction of urine to the bladder. The drainage spout should be covered and protected at all times to prevent contact with microbes.
Proper IUC Maintenance
- Secure tubing and drainage bag to prevent tugging on the tube or the drainage bag from resting on the floor.
- Empty and clean the drainage bag regularly — check your facility’s protocol for cleaning.
- Prevent obstruction or kinks in the tubing.
- Maintain a closed drainage system.
- Perform regular peri-care.
- Avoid fecal contamination.
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For more information, check out these online resources:
- Applying Mindful Evidence-Based Practice at the Bedside Using Catheter-Associated Urinary Tract Infection as a Model
- Strategies to Prevent Catheter-Associate Urinary Tract Infections in Acute Care Hospitals: 2014 Update
- Reducing Unnecessary Urinary Catheter Use and Other Strategies to Prevent Catheter-Associated Urinary Tract Infection: An Integrative Review
- Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections