1. Catheter associated Urinary Tract Infection
SCFT Infection Prevention and Control Team 2018

2. Learning Outcomes
To have a clinical appreciation of a CAUTI and its impact
To be able to critically discuss contributory factors and Prevention strategies
To Understand Gram Negative Bloodstream Infections (BSIs) and how to prevent and detect them

3. Urinary Tract Infection
UTI is the most common HCAI
Up to 13% of Community patients will have a catheter, making it the most common indwelling device in use (HPSC 2012)
Large numbers of bacteria occur within days of catheterisation
The duration of catheterisation greatly increases the risk of developing a CAUTI (Nicolle 2014)
Safety Thermometer
• The NHS Safety Thermometer is a local
improvement tool for measuring,
monitoring and analysing patient harms
and 'harm free' care.
• Focused audits for areas with high CAUTI
• Care planning

4. Indwelling Urinary Catheters
Long-term catheters common in both hospital and community care settings but are they always needed?
They carry a significant risk of symptomatic of serious complications - sepsis and death
They increase the use of antibiotics leading to antimicrobial resistance and C.diff

5. Entry points for bacteria
Needle and syringe method for taking specimens no longer used , needless port (discuss careers options )
Clean gloves for any manipulation
Sterile gloves for sample
Aseptic non touch technique for changing catheter
Bacteria introduced into the drainage bag take only a few days to reach the bladder via the tubing.
Wilson (2006)

6. CAUTI contributory factors
Perineal colonisation -  with age and in females
The bladder is incompetent when there is a foreign body in it
Abnormal bladder emptying
Poor fluid intake
Duration of catheterisation
Risk ↑ 3-6% for each day of catheterisation

7. NHS Improvement: Plans to reduce GNBSI
Ambition to halve GNBSI by 2021(10% per year)
Improve Antimicrobial prescribing for UTIs
Gram negative blood stream infections account for deaths per year

8. Reduction in Gram Negative Bloodstream Infections (BSIs)
Ecoli is the main target at this time .

9. New Trends: CPE – Carbapenemase producing Enterobacteriaceae
ESBLs – Extended Spectrum Beta-lactamases
Gram negative bloodstream infections
Contact the Infection control team with these and any multi Drug resistant infections.
nclude what to do if a specimen result returns MDR (multi-drug resistance) as a reminder to check the sample and let us know.

10. SCFT Gram neg. Learning to date
Lack of documented reason for catheter
Lack of catheter passport
Missed opportunities for antibiotic cover
Haematuria/ blood clots common factor
Dip sticking CSU
Inappropriate treatment for blocked catheters
Specimen labelling - MSU/ CSU
Lack of education – Residential homes/ carers

11. Weekly Urinary Catheter Care Plan (including Supra Pubic)
June 2018

12. Weekly Catheter Care Plan
State reason for ongoing catheter
Does the patient have a Catheter Passport?
Catheter entry site washed?
Drainage bag secured to patients leg?
Urine draining well and clear?
Drainage bag changed weekly- Date of change
Catheter tap with sterit (alcohol) when emptying .
If samples needed take via needless port and label CSU. (Never distick CSU)

13. Biofilm
Dangers of catheter maintenance solutions – toxic effects, resistant organisms and break the closed system. Use for specific reasons only ie Urologist advice, Suby G recommended in Epic 2 for crystallisation. If a catheter blocks first line should be to remove it.

14. Prophylaxis - Learning from Blood Stream infections
When changing catheters, antibiotics should not be used routinely but be considered for the following patients:
History of CAUTI
Trauma to the urethra
History of Gram Negative Bloodstream infections
(STAT Gentamicin IM. Usual dose 80mg to 120mg)
Findings from our gram neg work

15. Catheter specimens urine
Do not dipstick CSU
Only send if patient symptomatic- eg. confusion, temp ↑, abdo pain
Use aseptic technique and sampling port
Microbiology form - clearly state details Specify MSU/CSU
Transport container – rigid UN5573
It must be clear to staff that using near patient testing such as “dip stick” is not the process to
confirm CAUTI
Dipstick non-catheterised patients only for leucocytes, esterase and nitrite. CSU have different criteria as organisms will be present after 72hours
S&S often missing with catheterised patients, consider other causes of pyrexia if present

16. Maintenance of Drainage System
Maintain sterile closed system
Avoid unnecessary breaches e.g. disconnection of bag
Hang to allow free-flow of urine into bag
Bag should not touch the floor
Ensure catheter tubing secured

17. Standard Infection Control Principles
Hand washing
Personal Protective Equipment [PPE]
Patient information and education
Compliant sinks

18. Preventing cross infection
Decontaminate hands and wear CLEAN gloves to empty/handle
Decontaminate hands after ANY contact with drainage system
Use CLEAN container

19. QUIZ How can you prevent CAUTI
QUIZ How can you prevent CAUTI? How many people per year die due to Gram negative infections?

20. Q Which Gram Negative Organism causes the most Blood Stream Infection.
A (Klebsiella Pneumonia)
B (Escherichia Coli )
C ( Pseudomonas aeruginosa )

21. Q Contributory Factors for CAUTI
A (Insertion of urinary catheter)
B (Poor fluid intake)
C (Underlying uropathology)

22. Q What action can you take to prevent cross infection
A (Keep the patient well hydrated)
B (Decontaminate hands and wear CLEAN gloves to empty/handle)
C (Avoid disconnecting system)
Although A cannot prevent cross contamination is it important for reducing UTIs

23. References
EPIC3 2014: ‘National evidence-based guidelines for preventing healthcare associated infections in NHS hospitals in England’ Loveday et al 2014
NICE 2014 ‘Infection Prevention and Control Quality Standard 61’
SIGN 2012 Management of suspected bacterial UTI in adults. Chapter 5
HPSC Health Protection Surveillance centre 2012
Nicolle 2014 Journal of Infection Prevention 2018
SIGN is Scottish Intercollegiate Guidelines which our local Microbiologist believes is the most evidence based work on urinary catheters available