Short Term Urinary Catheter Documentation & Care Bundle INFECTION PREVENTION & CONTROL AND CONTINENCE SERVICES JULIE FLOWER

Incidence of CAUTI The formation of a Working Group Assessment of Current Practice Evaluating Current Evidence Based Care Compiling a Short Term Urinary Catheter Care Bundle Implementation Recommendations for Future Practice

Incidence of CAUTI ‘Healthcare Associated Infections (HAI) continue to cause substantial patient morbidity and cost to the health service’ ‘7.4% of adult patients in acute hospital settings have a HAI’ ‘Catheter Associated Urinary Tract Infections (CAUTI) are the second largest group accounting for 16% of all HAI’ (WAG, 2004, Healthcare associated Infections – A strategy for hospitals in Wales) (DOH, 2006, National Prevalence Survey)

Incidence of CAUTI 3 - 6% risk / day of developing a UTI 50% of patients catheterised longer than 7-10 days contract bacteriuria 20 -30% of patients with catheter associated bacteriuria will develop symptoms (CAUTI), 1- 4% develop bacteraemia, 13 – 30 of these die Cost & loss of bed days (EPIC 2 Guidelines, 2004)

The Formation of a Working Group Consultant Urologist Consultant Microbiologist Infection Prevention & Control Continence Advisor Community Continence Advisor Surgical Nurse Practioner Urology Nurse Specialist Sister, Coronary Care Unit

Assessment of Current Practice – Clinical Audit 100% of devices were stored in appropriate areas Evidence that 32% of a patient’s clinical need for continuing catheterisation was reviewed and documented 100% of systems used were closed and sterile 83% of catheters were inserted using a single use anaesthetic lubricant 85% of catheter bags were positioned correctly 68% of circuits were not broken except for good clinical reason 58% of night bags were single use 53% of CSU’s were taken only when clinically indicated (Clinical audit of 55 patients in acute settings – ICNA audit tool)

Assessment of Current Practice – Snap Shot Audit 14 /55 (25%) of catheterised patients did not require a catheter. Reasons for catheterisation included: Reduced mobility (43%) Don’t know (14%) Acute retention post 48hours (14%) Urinary Tract Infection (14%) Frequency of micturition (7%) 1 week post surgery (7%)

Evidence Based Care Saving Lives, High Impact Intervention No 6, DOH (2007)

Short Term Urinary Catheter Care Bundle User friendly Patient documentation Care pathway Recommend practice Recommend selection of catheter product and size Record of CSU’s sent Record of patient education given

.…..…… mls of water used to inflate the balloon INSERTION Date / / (Day 1) 1. REASON FOR CATHETERISATION (please circle) Retention Residual Volume ………….mls Fluid Monitoring Post Operative Spinal / Epidural Other Please state: 2. CATHETER CHOICE (please circle) Does the patient have a confirmed latex allergy? NO / YES NO Latex allergy – use latex PTFE coated catheter Latex allergy – use silicone catheter Female 12Fg FSS949 female FSS588 standar Male 14Fg standard FSS589 16Fg standard FSS592 Haematuria Debris TURP State size: ……..Fg Paediatric ……...Fg FSS650 (F) FSS601 (M) 14Fg FSS602 3. INSERTION TECHNIQUE YES NO Catheter Sticker (found on catheter packaging) Hand hygiene Sterile gloves Facial protection (If risk of splashing) Urethral meatus cleaned prior to insertion (0.9% normal saline) Apron /Gown Instillagel used Sterile Field .…..…… mls of water used to inflate the balloon Signed …………………………… Print ……………………………….

Catheter Specimen Urine (CSU) CSU’s are ONLY to be taken if there is a clinical suspicion of Infection, with the exception of Critical Care patients. For further details please consult the Trusts’ policy. Date UTI suspected If YES please state symptoms Sample taken aseptically from catheter port Results Lab Specimen nos. Treated YES NO Patient Education Undertaken Patient details Assessors details Signature Name Signature Position

Date catheter removed / / Y DATE Is the catheter still needed? Drainage bag positioned below the bladder & off the floor Gloves worn - manipulate catheter preceded & followed by hand hygiene Urethral Meatal hygiene performed Catheter circuit not broken (except for good clinical reason) Overnight link system discarded (Leg bags only) SIGN & Designation YES NO 2 3 4 5 6 7 Catheter drainage bag changed? YES / NO 28 IF THE CATHETER IS STILL REQUIRED – CHANGE THE CATHETER, DRAINAGE BAG & COMMENCE NEW DOCUMENTATION Date catheter removed / /

Implementation Care Bundle piloted in acute areas, using PDSA cycle adjusted accordingly and introduced Weekly then monthly compliance audits Developed Short Term Urinary Catheter policy to support Care Bundle Liaised with procurement regarding issuing of catheters, developing central storage area for silicone and large gauge catheters at POW site Staff Training & Education Saving 1000 Lives campaign – Gained Clinical Governance support

Recommendations for future Practice Continue to roll out Implementation & audit of care bundle until Trust wide Develop the policy & documentation for long term catheters

EPIC 2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England (2007) NHS Quality Improvement Scotland, Urinary Catheterisation & Catheter Care (2004) Saving Lives, High Impact Intervention No 6, DOH (2007) ICNA Audit tools for monitoring Infection Control Standards