1. REDUCING CATHETER ASSOCIATED URINARY TRACT INFECTIONS CLINICAL EXCELLENCE COMMISSION 2014 ACUTE CATHETERISATION INDICATIONS AND INSERTION OPTIONS

2. What’s a CAUTI? 2  Catheter Associated Urinary Tract Infection (CAUTI)  Most common healthcare associated infection (HAI)  80% patients have a urinary tract infection (UTI) during a hospital admission * *Lo, E., L. Nicolle, S. Coffin, et al. (2014). "Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update." Infection Control and Hospital Epidemiology 35(5): 464-479.

3. Why do patients get CAUTIs? 3  Breaches in infection prevention and control  Hand hygiene  Aseptic technique  Poor insertion technique  Unnecessary catheterisation and unnecessary prolonged dwell time  High number of commensal and transient bacteria in urethral orifice area  Biofilms grow on the internal walls of the catheter within 48 hours post insertion* *Jacobsen, S. M., D. J. Stickler, H. L. T. Mobley, et al. (2008). "Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis." Clinical Microbiology Reviews 21(1): 26-59. Photo: Janice Carr, CDC (Public Health Image Library)

4. How can we prevent CAUTIs in our patients? 4  Only catheterise a patient if clinically indicated  Reduce the dwell time of catheterisation  Maintain asepsis when handling catheter and drainage device  effective hand hygiene practices  aseptic technique

5. 5 Use the decision support tool !!! ‘How am I supposed to know all the indications for catheterisation?’

7. 7 STEP 1: Check for an appropriate indication for catheterisation Assess the patient and determine the reason for catheterisation.

8. 8 Confirm urinary retention or obstruction via pre-insertion bladder scanning STEP 1: Check for an appropriate indication for catheterisation

9. 9 STEP 2: Choose the most appropriate catheter option  Suitable catheterisation options have been identified for each of the indications categories  Some categories have more than 1 catheterisation option.  First consider the suitability of the ‘  ’ option √√√ BEST CHOICE √√SECOND CHOICE √THIRD CHOICE

10. 10 STEP 3: Confirm choice using additional guidance

11. 11 STEP 3: Return to Step 1 if option is contraindicated

12. 12 Documentation for insertion  How consent was gained and who  Indication for catheterisation  Catheter option  Size and type of catheter  Time and date of insertion  Balloon volume in  Total volume drained on insertion  Clinical misadventures/abnormalities on insertion  Presence of UTI signs and symptoms  Colour of urine, sediment or abnormality  Whether urine culture was ordered  Post procedure tests  Follow up actions Documenting indications  ‘Catheter inserted to relieve retention’  ‘In/out catheter inserted to relieve neurogenic retention’  ‘Catheter inserted post surgery’  ‘Short term IDC inserted for post surgery management of repaired NOF surgery and to ensure patient remains immobile’.

13. Thank you 13 For further information: hai@cec.health.nsw.gov.au www.cec.health.nsw.gov.au