Urinary Catheterization: Insertion, Maintenance, Catheter Care, & Removal September 2012

Why are we revising our process? Joint Commission requirements National Patient Safety Goal – 2013 Goal 7 Reduce the risk of health care-associated infections. Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI). CDC guidelines Catheter Associated Urinary Tract Infections (CAUTIs) Are the most common healthcare acquired infections UTI causes approximately 36% of all hospital infections per year 80% of those are catheter related Increases hospital stay Increases healthcare cost It is highly preventable You can make a difference by doing a few simple things!! APIC Guide 2008: Guide to Elimination of Catheter-Associated Urinary Tract Infections. Klevens RM, et al. 2002. Public Health Rep. 2007; 122:160–167

“Getting to Zero” Committee developed in 2012 to get to “O” CAUTIs CAUTIs recorded at Aultman 2010: 106 2011: 92 2012 YTD: 17 Our Goal NO CAUTIs from this point forward in 2012 Zero “O” CAUTIs in 2013! Mar 2012 – “O”

Prevention Strategies Eliminate unnecessary insertion of catheters Review physician orders to ensure a valid Foley catheter insertion order was entered Educate your patient about CAUTI (use FAQ sheet) prior to insertion Currently available on Policy Tech - type “SHEA CAUTI” Insert Foley catheter using sterile technique Secure the catheter as to prevent urethral trauma, migration of organisms, and kinking/bending of the catheter Keep catheter below the level of bladder Perform catheter care per policy Maintain a closed system Discuss daily with physician potential removal of unnecessary catheters Clinical Care Improvement Strategies: JCR Preventing Catheter Associated Urinary Tract Infections 2011

NEW catheter kits available to assist us to meet 2013 NPSG! Kits Include: Castile soap wipes Betadine swabs Pre-connected, sealed catheter tubing Securement Device Insertion labels for patient chart; apply to front of chart, and catheter tubing (from BARD ®) * Your unit director will communicate with you when the new kits are available on your unit

Insertion of Catheter: Policy Revisions Steps removed Steps added Testing urinary catheter balloon Already performed by manufacturer Use of cotton balls to cleanse urinary meatus Product changed to swab sticks Use of castile soap Use of betadine swab sticks Use green sheeting clip to secure catheter drainage tube to the sheet Apply insertion labels to the front of the chart and to the catheter drainage tube

Catheter 101 Proper Techniques for Urinary Catheter Insertion Perform hand hygiene immediately before and after insertion Remember: Wash hands after cleansing patient and before donning sterile gloves Insert urinary catheter using aseptic technique and sterile equipment Use the smallest Foley catheter possible, consistent with good drainage (18 French or larger not recommended for routine use) Document date and time of catheter insertion, individual who inserted catheter, size of catheter , and date and time of catheter removal along with who removed it in the patient record

Catheter 101 Proper Techniques for Urinary Catheter Maintenance Secure the Foley catheter Maintain a closed drainage system by utilizing pre-connected, sealed catheter-tubing junctions Maintain unobstructed urine flow and keep the catheter and collection tube free from kinking Keep the collection bag below the level of the bladder or hips at all times Empty the collection bag a minimum of every shift and prn or per physician’s order using a clean collection container Rinse the collection container after each use

Catheter Care http://medical-dictionary.thefreedictionary.com/Biofilms Revised process for catheter care Castile soap & water only Products must be thoroughly rinsed No emollients or residue producing products Bath-in-a bag Perineal cleansers Catheter Care is different than Perineal Care: Skin protectants & emollient products OK for perineum, but not at the insertion site of a catheter (urethral area) Skin protectants & emollient products intensify formation of biofilm* & provide a breeding ground for organisms *Biofilm is a very thin layer of microscopic organisms that covers the surface of an object. http://medical-dictionary.thefreedictionary.com/Biofilms

Catheter Care Product Update Why Castile Soap? Safe, very mild & effective cleanser Contains no emollients Why not just use the bath-in-a-bag or current perineal cleanser? Both contain emollients Should not be used on the catheter (urethral) area because it can increase biofilm formation

Product Update Continued… Why a closed drainage system? Using a pre-connected, sealed catheter tubing junction prevents CAUTIs Why StatLock ® securement device? Minimizes accidental catheter dislodgements Firmly holds catheter in place at the “Y” Allows complete freedom of movement Latex free StatLock ® Application and Care Use skin prep before application Apply with “click it before you stick it” method Initial and date securement device upon application Assess adherement and skin around device daily Move device every 7 days Remove with alcohol Pre-connected tubing & securement device

Catheter Care Procedure Cleanse, thoroughly rinse, and gently pat dry urethral meatus. (Pericare bottle may be used.) Remove gloves and discard. Perform hand hygiene. Resecure the catheter with securement device. Position the patient for comfort. Document activity in the medical record, including education provided to patient/family Perform at least every 24 hours and prn for soiling. Identify patient using two patient identifiers. Perform hand hygiene. Don clean gloves. Place the patient in supine position and expose the perineal area to easily visualize the meatus. Release the catheter from securement device to prevent urethral trauma. Remove gloves and perform hand hygiene.

Catheter Care Procedure Female: Using castile soap and water, cleanse the urethral area using circular motions moving outward with washcloth, thoroughly rinse with water, and then gently pat dry. Using a separate washcloth, cleanse the catheter beginning at the insertion site moving away from the body, using castile soap and water and then rinse and dry with clean towel.

Catheter Care Procedure Male: Circumcised Cleanse around the meatus using washcloth, castile soap and water. Rinse and then dry the area with a towel. Using a separate washcloth, cleanse the area between the scrotum and rectal area, rinse and dry. Using a separate washcloth, cleanse the catheter beginning at the insertion site moving away from the body, using castile soap and water and then rinse and dry with clean towel. Uncircumcised Retract the foreskin from the catheter. Cleanse around the meatus using a washcloth, castile soap and water. Rinse and dry with clean towel. Replace the foreskin around the catheter. Using a separate washcloth, cleanse the area between the scrotum and rectal area, rinse dry. Using a separate washcloth, cleanse the catheter beginning at the insertion site moving away from the body, using castile soap and water and then rinse and dry with clean towel.

Removal of Catheter: Policy Revisions Reminders Use of castile soap to cleanse urinary meatus prior to removal To prevent migration of organisms Cleanse urinary meatus prior to catheter removal - rinse, gently pat dry after cleansing Deflate catheter balloon prior to catheter removal Document catheter removal in medical record Liquid Castile Soap

Documentation – Urinary Catheter Document Patient Education task (fires BID) Select “Education Provided” from navigator bar Click box for “Infection Prevention”

Documentation Continued… Document education provided CAUTI/FAQ Hand Hygiene Catheter secure education Avoid twisting/kinking catheter Collection bag lower than bladder

Resources Smith, S., Duell, D., Martin, B. 2008. Clinical Nursing Skills: Basic to Advanced Skills. 7th EditionPrentice Hall. Clinical Care Improvement Strategies: Preventing Catheter-Associated Urinary Tract Infections. 2011. The Joint Commission Resources. Urinary Catheterization of a Male of Female Patient: Insertion, Care of Patient, and Removal of Catheter. 2012. Aultman Polices and Procedures. BARD ® Foley and Urethral Catheterization tray insert documents.

Online Education You have completed the Learning Module entitled Urinary Catheterization: Insertion, Maintenance, Catheter Care & Removal Please go to the quiz section in QUIA and complete the quiz Urinary Catheterization: Insertion, Maintenance, Catheter Care, & Removal Deadline for completion: October 15, 2012

Questions? Patty Russell, BSN, RN Ext. 35435 UD Main 5 (Chair – CAUTI Task Force) Kerri Samblanet, BSN, RN, CRRN Ext. 34243 Step-Down Staff Educator (Co-Chair CAUTI Task Force)