Presentation on theme: "UTI Prevention in Patients with Foley Catheters"— Presentation transcript:
1UTI Prevention in Patients with Foley Catheters Lourdes Health Network2011
2BackgroundUTIs account for over 6 million patient visits to physicians per year in the United States.UTIs are the most common hospital acquired (HA) infection80% of HA-UTI are attributable to indwelling urethral catheters.12-16% of hospitalized patients will get a Foley and half of them do NOT have a valid indication.Risk of UTI increases 3-7% for every day with Foley
3RelevanceUTIs increase a patient’s length of stay an average of dayThe estimated cost per Catheter Associated UTI (CAUTI) ranges $500- $3000If not documented upon admission (CAUTI), then hospital cannot code for higher reimbursement DRG for Medicare patients in some hospitals
4Urinary Tract Infections Definition of UTIa microbial infection (typically bacterial) of the urethra, bladder, ureters, or kidneys.Most common is Escheria coliCertain people are at a higher risk for kidney infections if they develop asymptomatic bacteriuria. The following increases your riskDiabetesInfected kidney stonesKidney transplantOlder agePregnancy -- up to 40% of pregnant women with untreated asymptomatic bacteriuria will develop a kidney infectionVesicoureteral reflux in young children
5UTI Definition continued… Symptomaticmore typical presentation (burning with urination, urinary frequency, low fever, cloudy urine (possibly), foul odor to urine, pressure or cramping in lower abdomenAsymptomatic bacteriuriaa significant number of bacteria in the urine that occurs without usual symptoms such as burning during urination or frequent urination. Those with urinary catheters will more likely have this condition.
63 Primary Routes of Infection Catheter-meatal junctionMore often in females (shorter urethra)Catheter manipulationExample: allowing drainage spout to touch the ground or contaminating the catheter tubing while placing a new drainage bag.Retrograde bacterial migrationExample: lifting bag above level of bladder during transport or repositioning
7More about indwelling catheters…. They are uncomfortable for patientsCan be unnecessary for patient treatment plan(41-58% in place found to be not indicated)Can be associated with negative outcomesUrethral inflammationUrethral stricturesMechanical trauma to urethra/bladderCan DECREASE mobility (because the patientdoes not have to get out of bed to urinate) whichmay impede recovery or contribute to complicationslike pressure ulcers, pneumonia, and/or DVT
8Appropriate Indications For Foley Catheters per LHN Protocol Criteria for Continuing Foley CatheterStrict I & O or aggressive treatment with diuretics or fluidsChronic urinary retention or bladder outlet obstructionCritically ill patient – hemodynamic instabilityRenal failureRecent renal/urology procedureAcute neurogenic bladderHistory of chronic, prolonged catherization or suprapubic catheterHematuriaChemical sedation or paralyzationTerminally ill or palliative care patientEpidural catheterPelvic or hip fractureStage 3 or greater pressure ulceration on coccyx or buttocksUrinary retention- prolonged period of no urinary output post-operatively
9Urinary Catheters are NOT Indicated for: Immobility or poor mobilityGeneral incontinenceSkin excoriationObtaining urine specimensPatient requestNurse convenience
10What is a Nurse Initiated Foley Removal? A policy developed in keeping with national best practice standards which ensures that Foley catheters are used appropriately.Facilitates nursing assessment for approved indications for the use of a Foley cathetersNurses are empowered to remove unnecessary catheters (those not meeting an approved criteria) without a doctors order.Enables catheters to be removed earlier!Decreases potential for hospital acquired UTIs in our patients!!!DOCUMENT- sometimes MDs do not know the patient has a foley, thus they do not address the need to take it out)
11This policy has been supported and approved by MEC!
12Foley Removal Assessment & Documentation on Meditech
13Foley Removal Assessment & Documentation on Meditech continued . . . . Look up forcontinuing Foley
14If the patient does not meet any of the criteria for continuing the Foley catheter, REMOVE THE CATHETER!
15Post catheter removalEducate patient about what to expect (e.g. to notify nursing with the first voided specimen, measuring urine, getting help if needed to go to the BR, etc.)Document due to void time(5 – 8 hours post catheter removal) and communicate this with the oncoming shift!Scan patients bladder and notify physician of inability to void if the patient is unable to void post removal.
16Documentation of removal & due to void time (DTV)
18If Urinary Catheterization continues to be appropriate. . . . Use aseptic technique during subsequent catheter insertion and careProperly manage the system and componentsKeep closed drainage systemKeep bag below level of the bladderPrevent excessive manipulation of the catheterKeep bag off of the floorSecure catheter to legProvide catheter care daily and after bowel movementsContinue to educate and advocate for the prompt removal of the Foley catheter
19References Institute for Healthcare Improvement-Preventing CAUTI Lo, E., Nicolle, L, Classen, D., et al. (2008). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infection control and hospital epidimiology. October, Vol 29, Supplement 1. (Supplement article: SHEA/IDSA practice recommendations)Nazarko, Linda (2008). Reducing the risk of catheter-related urinary tract infection. British Journal of Nursing, Vol 17, No 16.Gotelli, J., Merryman, P., Carr, C., McElveen, Epperson, C., & Bynum, D. (2008). A quality improvement project to reduce the complications associated with indwelling urinary catheters. (Society of Urologic Nurses and Associates) Urologic Nursing. ppVieira, Fabricia (2009). Nursing actions to prevent urinary tract infection associated with long-standing bladder catheter. A Literature Review. Einstein; 7 (3 part 1):
20References continuedCenters for Disease Control and PreventionNational Healthcare Safety Network (NHSN)Association for Professional Infection Control and Epidimiology (APIC)Busuttil Leaver, Rachel (2007).The evidence for urethral meatal cleansing. Nursing Standard. June, vol 21, no 41.2009 NACNS National Conference Abstracts (March 5-7, 2009), St. Louis, Missouri.Creating a foley free zone by preventing and removing unnecessary urinary catheters.Clinical Nurses finding evidence for practice: reducing catheter-associated urinary tract infections. Critical Care Nurse. April, 29 (2)