1. Catheter-Associated Urinary Tract Infection (CAUTI)
National Patient Safety Goal
Preventing Catheter-Associated Urinary Tract Infections
(CAUTI)
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2. OBJECTIVES Describe appropriate screening for UTI
Describe appropriate treatment of asymptomatic bacteriuria
Describe the criteria for diagnosing a CAUTI
List the appropriate versus inappropriate use of indwelling urinary catheters
Identify the risk factors that contribute to CAUTI
List the bundles involved in prevention of CAUTI
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3. The pathway of pathogens to the urinary tract
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4. Clinician Practice
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5. Clinician Practice Screening Urine
The practice: “screening culture on admission”, “standing orders” or “reflex orders” for urine cultures based on urinalysis results:
May increase utilization of unnecessary antibiotics, testing, consults
May adversely affect patients exposing them to inappropriate testing and treatments.
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6. Clinician Practice
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7. Clinician Practice
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8. Clinician Practice
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9. Clinician Practice
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10. Clinician Practice
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11. Clinician Practice
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12. Urine Specimen
If a urinary tract infection is suspected indwelling urinary catheter should be replaced before urine collection obtained.
It is important to identify a true UTI.
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13. Catheter-Associated Urinary Tract Infection (CAUTI)
UTI causes ~ 35% of hospital-acquired infections
Most due to urinary catheters
~20% of inpatients are catheterized
Leads to increased morbidity and healthcare costs
CMS does not reimburse for the additional costs of hospital-acquired CAUTI
Urinary tract infection causes over 40% of hospital-acquired infections, making it the most common nosocomial infection.
Most of these infections are due to urinary catheters.
25% of inpatients are catheterized at some time during their hospital stay.
Nosocomial UTI leads to increased morbidity and increased costs.

14. What is CAUTI (CDC defined)
UTI: Patient has at least one of the following signs or symptoms:
fever (>38.0°C), suprapubic tenderness, costovertebral angle pain or tenderness, urinary urgency, urinary frequency, dysuria
Patient has a urine culture with no more than two species of organisms identified, at least one of which is a bacterium of ≥10˄5 CFU/ml
Catheter-associated UTI (CAUTI): A UTI where an indwelling urinary catheter was in place for >2 calendar days on the date of event, with day of device placement being
Day 1,
AND
an indwelling urinary catheter was in place on the date of event or the day before. If an indwelling urinary catheter was in place for > 2 calendar days and then removed, the date of event for the UTI must be the day of discontinuation or the next day for the UTI to be catheter-associated.
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15. Clinician Practice
Signs and symptoms “new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause; flank pain, costovertebral angle tenderness; acute hematuria; pelvic discomfort”
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16. Clinician Practice
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17. Risk Factors for CAUTI Extended use of foley
Microbial colonization of the drainage bag
Female gender
Diabetes
Errors in catheter insertion
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18. Indwelling Urinary Catheters
Studies have shown that initial catheterization was inappropriate 21% to 50% of the time, and that continued catheter use was inappropriate almost half of the days that patients are catheterized.
A common reason for inappropriate continued catheter use is that physician is not aware that catheter is in place.
Physicians should assess daily whether or not their catheterized patient still requires the catheter.
References
Am J Med 2000 Oct 15;109(6): Are physicians aware of which of their patients have indwelling urinary catheters? Saint S, Wiese J, Amory JK, Bernstein ML, Patel UD, Zemencuk JK, Lipsky BA, Hofer TP.
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19. Expert Consensus of Appropriate Versus Inappropriate Use of Urinary Catheters
Annals of Internal Medicine, 2015, Website:
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20. Patients perspective
Satisfaction survey of 100 catheterized VA patients:
42% found the indwelling catheter to be uncomfortable
48% stated that it was painful
61% noted that it restricted their ADLs
2 patients provided unsolicited comments that their catheter “hurt like hell”
(Saint et al. JAGS 1999)

21. Latex and Urinary Catheters
Most urinary catheters do contain latex
This provides the pliable soft consistency.
EIRMC does have latex free catheters if needed.
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22. Post Removal Orders
Interventions should be employed to encourage spontaneous voiding:
Early mobilization
Toilet or bedside commode to allow for upright position
Bladder scan for:
Bladder discomfort
Urge to void but is unable to do so
Incontinent
Lippincott Procedures for Bladder ultrasonography, and urinary incontinence care.
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23. Reduce the Risk of CAUTI
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24. Reduce the Risk of CAUTI
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25. Nurses Role/CAUTI Bundles
Hand Washing
Aseptic technique during insertion
Daily peri-care/bathing
Bag below the bladder
Secure in place
Closed system
Avoid contamination when emptying
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26. No Dependent Loop. Go with the Flow
Nurses Role/CAUTI Bundles
No Dependent Loop. Go with the Flow
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27. How does CAUTI compare?
Despite the small increase in the CAUTI rate, initial evidence from 2014 indicates this rate could be declining.
Despite the marked decreases in most HAI categories, the U.S. did not meet 2013 goals.
Source: CDC, "Healthcare-associated Infections (HAI) Progress Report,” January 13, 2015
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28. Clinician Practice
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29. Summary Avoid placing urinary catheter not indicated
Order removal when not clinically indicated
Consider alternatives: External catheters, frequent toileting, and briefs
Avoid ordering urine cultures unless clinical signs of UTI present or other reasons prevail
Don’t treat aseptic bacteriuria except for selected conditions
If catheter is necessary, educate patient about risk of UTI
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30. Criteria for a Continuous Foley Catheter
Summary
Criteria for a Continuous Foley Catheter
Acute urinary retention
Perioperative use in selected surgeries
Assist in skin healing for incontinent patient
Palliative care
Gross hematuria/irrigation
Prolonged immobilization for trauma or surgery
Hourly I/O in the setting of critically ill patient
Why
need that catheter?
does your patient
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31. References Lippincott; care of patient with indwelling foley catheter
Carolyn V. Gould, MD, MSCR ; Craig A. Umscheid, MD, MSCE ; Rajender K. Agarwal, MD, MPH; Gretchen Kuntz, MSW, MSLIS ; David A. Pegues, MD and the Healthcare Infection Control Practices Advisory Committee (HICPAC)
The Joint Commission. (2014). Standard NPSG Comprehensive accreditation manual for hospitals: The official handbook. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
Healthcare Infection Control Practices Advisory Committee. (2010). "Guideline for prevention of catheter-associated urinary tract infections, 2009" [Online]. Accessed September 2014 via the Web at (Level I)
Institute for Healthcare Improvement. (2012). How-to guide: Prevent catheter-associated urinary tract infection. Cambridge, MA: Institute for Healthcare Improvement. (Level VII)
Association of Professionals in Infection Control and Epidemiology (APIC). (2014). "APIC implementation guide: Guide to preventing catheter-associated urinary tract infections" [Online]. Accessed September 2014 via the Web at (Level IV)
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