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

2. 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 Public Health Rep. 2007; 122:160–167

3. “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”

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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.

13. 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.

14. 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.

15. 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

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

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

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

19. 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

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