1. PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs)

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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)

9. 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

10. 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

11. 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

12. 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

13. 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)

14. 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

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

16. 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

17. 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