Does the use of Foley Catheters Increase the Occurrence of Urinary Tract Infection? Presented are four evidence based nursing studies showing the risks of UTI’s and catheter use. Ways to decrease patients risks. Medicare and Medicaid involvement with CAUTI’s And supporting data

Catheter-associated urinary tract infections and the Medicare rule change was written by Jennifer A. Meddings, Sanjay Saint, David Calfee, Christine P. Kowalski, and Sarah L. Krein in June of The article discusses the risks and percentage of catheter associated urinary tract infections and why Medicare and medicaide have chosen to eliminate additional payments.

The Facts multidisciplinary approaches can prevent between 25% and 75% of CAUTI. CMS believes that if payment is halted for improper care, then the quality of hospital care would improve.

Medicare and Medicaid Medicare and Medicaid have chosen to eliminate additional payment if infections occur due to the use of catheters the new CMS rule change would increase focus on CAUTI’s, and increase focus on catheter care and early removal. The downside would be more expenses to the patient as a urinalysis may be ordered on admit to rule out any infections prior to being admitted to the hospital.

Medicare/Medicaid and cost The CMS rule change was brought on by “linking payment with health care out-comes by paying more for better health care and less for inferior care”(Saint, 2009, pg. 878) CMS believes that if payment is halted for improper care, then the quality of hospital care would improve. CMS uses a system call present-on-admission

“Engineering Out the Risk of Infection with Urinary Catheters” was written by Dennis G. Maki from the University of Wisconsin Medical School, Madison Wisconsin and Paul A. Tambyah from the National University of Singapore Medical School, Singapore in 2001.

The Facts “Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection” (p.1). With the cause of bacteremia and candiduria causing more than 25% of the infections for those with a catheter for a week or more and at a rate of 5% daily risk on average (Maki, 2001,p.1).

What can we do to decrease our patients risks ? First and foremost avoid the use of catheters if and when possible, use alternatives to bladder catheterization (such as suprapubic catheterization or condom catheters), practice sterile technique, maintain a closed dependent drainage system, and use as little handling of the device as possible (Maki and Tambyah 2001, p.4).

What can we do to decrease patients risks? Catheters impregnated with anti-infective solutions have been studied in randomized trials, one impregnated with the urinary antiseptic nitrofurazone and the other with a new broad spectrum antimicrobial-drug combination minocycline and rifampin. Both catheters showed a significant reduction in bacterial CAUTIs Use of a silver hydrogel coated catheter not only showed that its use decreased CAUTI but dropped it by 26% (Maki and Tambyah, 2001, p.5).

Systematic Review and Meta-Analysis: Reminder Systems to Reduce Catheter-Associated Urinary Tract Infections and Urinary Catheter Use in hospitalized Patients was written by Jennifer Meddings, Mary A. M. Rogers, Michele Macy, and Sanjay Saint in The article focuses on statistical analysis related to catheter-associated urinary tract infections (CAUTI).

The Facts The greatest risk factor for CAUTI is prolonged catheterization (Meddings et al. pp.550)” Catheters not only cause infection but promote other challenges such as patient discomfort, and difficulty in mobility.

Interventions Two interventions that the article focused on included a reminder system and a stop order system – The reminder system is simply to remind either a physician or a nurse that the catheter was still in place and that removal was recommended if no longer necessary – a stop order is a prompt to the physician to remove the catheter by default after either a certain time period or a set of clinical conditions occurred

The article Preventing Catheter-Related Bacteriuria was written by Sanjay Saint and Benjamin Lipsky in The article focuses on clinical definitions of catheter- related infection and rate of occurrence. This article also examines risk factors associated with catheter use and methods of prevention and interventions.

Facts Clinical definition of catheter-related infection (UTI) “growth of 10CFU/mL or greater of a predominant pathogen from a catheterized urine specimen, especially when associated with pyuria, represents catheter-related UTI” (Saint, 1999, p. 801). Risk Factors included length of foley catheter use, female gender, older than 50 years old, lack of systemic antibiotics, and underlying illness Prevention focused on abstaining from foley catheter use when not necessary, use of alternative devices such as condom catheters, suprapubic catheters, and intermittent catheterizations when necessary to meet patient needs Interventions included systemic antibiotic use but not prophylactic, closed drainage system, and silver coated catheters

Data “The available data suggest that urinary catheter-associated bacteriuria may be preventable for the short term (less than a few weeks) but is only postponed at best if the device is needed long term. Furthermore, the complications of catheter-associated bacteriuria, including symptomatic UTI and bacteriuria, may be largely not preventable” (Saint, 1999, p. 806)

Conclusion Is there a direct correlation between using foley catheters and occurrence of urinary tract infection, the answer is yes The available data suggest that catheter- associated urinary tract infections can be preventable. RN’s need to be aware of foley catheter use, prevention strategies, alternative devices, and reason to avoid use of foley catheters in the hospitalized patient if possible.