1. Goodbye UTI

2. Team Members: Ava J. Dobin, Epidemiologist/ Safety Officer
Dr. Mel Kohan, Chairman, ICC
Pam Kardys, ANM, Medical
Donna Bradford-Wilson, ANM, Critical Care
Kendall Pritchard, ANM, Progressive Care
Nicole Puleo, ANM, Orthopedics
Zeelena Calendar, ANM, Surgical
Mary Oulette, ANM, Pediatrics/PICU
Saray Diaz, CS, Medical Surgical

3. Catheter-Associated Urinary Tract Infections
About 80% of all HAI urinary tract infections are associated with indwelling catheters
10-15% of hospitalized patients are catheterized
Of catheterized patients, evidence for catheter-associated urinary tract infection (CA-NUTI) develops in 20% - 25%

4. About UTIs Have Become an Expected Outcome in Catheterized Patients
Most Frequent Cause of Sepsis
2%-4% of UTIs Progress to Bacteremia
Mortality of Patients with Bacteriuria is Nearly 3x Higher Than for Non-bacteriuric Patients
2%-3% of Acute Care Admissions will be Impacted by a UTI
Weinstein RA. Nosocomial Infection Update. Emerging Infectious Diseases. 1998; 4(3):

5. NUTI (nosocomial urinary tract infection) Rates
2% - 3% of acute care admissions will be impacted by an NUTI
Based on national averages*, a 15,000 admission hospital would experience
10.03 NUTI per month
NUTI per year
Information based on Churchill Economic Model

6. Consequences of NUTI’s
Pain / Discomfort
Acute Renal Failure
Surgical Site Infection
Death (<1%)
Prolonged Hospitalization
Pyelonephritis
Bacteremia
Additional Exposure to Antibiotics
Additional Hospital Expenditures

7. RISK OF INFECTION
Duration of catheterization is the most important risk factor for development of infection
Over first 10 days, 2-16% of will acquire infection each day
By 30 days, almost 100% will acquire infection
Garibaldi RA et al NEJM 1974;291:215-9
Burke et al. Infect Control 1986; 7(supp):96-99

8. Cost of UTIs
Average Cost of Each Uncomplicated UTI in 1992 was Reported at $680
Based on Total of 84 Patients
Average Cost Impact of Each UTI Reported in 1996 was $3,803
Based on 675 Cases, 5,337 Controls
Saint S and Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin N Am ; 17:
Public health focus: surveillance, prevention and control of nosocomial infections. MMWR Morb Mortal Wkly Rep ; 41:

9. How Fast do Organisms Travel?
Pseudomonas aeruginosa
2hrs on a 100% Silicone Foley Catheter
Pseudomonas aeruginosa
18hrs on a 100% Silicone Foley Catheter

11. UTIs and Antibiotics
Urinary tract infections are the largest breeding ground of antibiotic resistant organisms*
Bacteria exhibit remarkable adaptability in responding to the assault of antibiotics on their survival
APIC *Maki, DL

12. FOLEY RELATED URINARY TRACT INFECTIONS Cause and Effect Diagram
PATIENT RELATED FACTORS
CAREGIVER RELATED FACTORS
Primary Risks
Secondary Risks
No handwashing prior to
catheter manipulation
Poor insertion techniques
Female
Dehydration
Diabetes
Sickle-cell anemia
Inappropriate use of catheters
Breaks in closed system
Immobility
Urethral obstruction
Drainage bag spigot/tube
contaminated
Other methods to control
incontinence not used
Other sites of infection
Debilitated health
Previous UTI
Catheter not secured to body
Incomplete emptying of bladder
Colonization with resistant
organisms
Foley bag raised above level of bladder
Catheter left in place longer
than necessary
Fecal incontinence
Poor personal hygiene
Foley Catheter
Related UTI
Inappropriate antibiotic use
Indications for appropriate
catheter use not followed
Open drainage systems
Unsterile insertions
Standing columns of urine
Improper placement of
drainage bag during transport
Lack of supplies to
manage incontinence
No policy and procedures
Bacterial adherence to
catheter surface
Clustering of
catheterized patients
Routine catheter
changes
Lack of a closed system
Lack of preconnected urine meters
Multi-patient use of
measuring devices
No antiseptic coatings bonded to catheter
Breaks in closed system
No catheter
securing devices
No sample port
Limited variety of trays/Foley sizes available
SYSTEMS / HOSPITAL
SYSTEMS / EQUIPMENT
SYSTEMS / ENVIRONMENT 1

13. Solutions

14. Your patient has had a foley catheter in place for 72 hours (3 days).
Dear Doctor,
Your patient has had a foley
catheter in place for 72 hours (3 days).
Please discontinue this device or
document why it needs to be
continued.
Thank you,
Coral Springs Medical Center
Infection Control Committee
BROWARD HEALTH
Coral Springs Medical Center
3000 Coral Hills Drive, Coral Springs, FL (954)

15. Prevention of Catheter-Associated Urinary Tract Infections (CAUTI)
Data Collection Tool
Patient Name______________________________ MR #________________
Date urinary catheter inserted _________________Date D/C_____________
Where inserted ___________________________
Evidence Based Practice
Guidelines
Yes No
Date
Daily assessment for removal of urinary catheter
Sustained closed system
Securement device in place
Urine drainage bag below bladder
Documentation of catheter care (peri-care) with soap and water each shift.
Yellow sticker placed in chart for MD to D/C catheter
Documentation by MD to keep catheter in 1. 2. 3. 4. 5. 6. 7.

16. POLICY:
Indwelling catheter is assessed initially and daily by the registered nurse
Urinary catheter care is carried out at least every shift and more often if necessary.
The patient will be assessed daily to determine the need for removal of the urinary catheter.

18. Prevention
Reducing Infection Means:
Reducing Potential for Antibiotic-resistant Infection and Need for Isolation
Avoiding Diagnosis and Treatment Costs
Reducing Morbidity and Mortality
Projected savings are related to reducing an average of 4 UTI’s a month at CSMC x (times) 12 months = $192,000 a year!

20. Questions?