PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs)

History of CAUTI’s.... Preventing CAUTIs used to be relatively low priority in acute care hospitals. The CMS regulation that went into effect on October 1, 2008, ends reimbursement for CAUTIs CMC had 128 UTIs for 2008 Each event cost approximately $700.00 Increases patient length of stay Increases antibiotic use Increase patient discomfort

Nine risk factors have been identified for catheter associated UTIs Errors in catheter insertion Not doing pericare routinely Duration of catheterization Absence of use of a urimeter Microbial colonization of the drainage bag Female gender Use for reasons other than surgery or output measurement Diabetes

Prevention Strategy No single strategy used to prevent these infections have been found to help decrease CAUTI. A recent Compendium of Strategies to Prevent Healthcare Associated Infections in Acute Care Hospitals emphasized the importance of reducing CAUTIs by using the “bundle approach.” - This information was taken published by SHEA-IDSA

What is a bundle approach? The bundle is a collection of process needed to effectively and safely care for patients undergoing a particular treatment/procedure with inherent risk. Several interventions are “bundled” together and, when combined, significantly improve patient care outcomes. SHEA-IDSA: Society for Healthcare Epidemiology of America/Infectious Disease Society of America

What about CMC? Community Medical Center is implementing a bundle approach for Foley Catheter Insertion to reduce CAUTIs

The CAUTI Bundle: Hand Washing Avoid unnecessary urinary Catheters Insert urinary catheters using aseptic technique Maintain urinary catheters based on recommended guidelines Review urinary catheter necessity daily

CAUTI bundle in detail Hand Washing: First and most important preventative measure Avoid unnecessary urinary Catheters: No invasive device should ever be used unless absolutely necessary(placing catheters increase risk of infection, decreases mobility and increases urethral trauma)

CAUTI bundle in detail continued... Criteria for foley catheter has been meet Verification that these have been met are required prior to insertion. Assessing a patient for urinary retention, severely ill thus decreasing mobility , and lack of bladder control. Never place for convenience for staff

CAUTI bundle in detail continued... Insert urinary catheters using aseptic technique: Utilize appropriate hand hygiene practice Insert catheters using aseptic technique and use sterile equipment Use as small a catheter as possible that is consistent with proper drainage to minimize urethral trauma

CAUTI bundle in detail continued... Review urinary catheter necessity daily and remove promptly Keeping foley catheter in place greater than 48 hours puts patient at risk for infection

Recommendations from CDC, SHEA-IDSA are indications for placement: Perioperative use for selected surgical procedures Urine output monitoring in critical ill patients Management of acute urinary retention and urinary obstruction

Recommendations continued... Assistance in pressure ulcer healing for incontinent patients At patient request to improve comfort or for comfort during end of life care (CDC)

Maintain urinary catheters based on recommended guidelines: Assure that foley care occurs for every patient, every day, and every shift Do pericare for patients that don’t have a foley catheter everyday and every shift Maintain a closed drainage system Keep catheter properly secured to patient to prevent movement and urethral trauma

Maintain urinary catheters based on recommended guidelines: Keep collection bag below the level of the bladder at all times Maintain unobstructed urine flow

Maintain urinary catheters based on recommended guidelines: Empty collection bag at least every eight hours or as needed. Do not allow the drainage spigot to touch the collecting container, to avoid cross contamination when emptying foley Collection of specimen is done with aseptic technique Never take a sample from the urinary drainage bag. Take a urine sample from the sample port

In summary... CMC now looks at foley catheter placement in a “bundle approach.” When caring for and inserting foley catheters, be sure to: Wash your hands Avoid unnecessary catheters Always use aseptic technique Maintain catheters based on current recommended guidelines Review the necessity daily