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

2. 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

3. 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)

4. 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)

5. 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

6. 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)

7. 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%)

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

9. 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

10. .…..…… 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 ……………………………….

11. 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

12. 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 / /

13. 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

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

15. 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