1. CAUTI Prevention Policy Recommendations Clinical Implications
By: Haley Psareas, University of New Hampshire Senior Practicum Student
In hospitalized patients with indwelling urinary catheters, does implementing evidence-based catheter care, assessment, and documentation reduce the incidence of CAUTIs compared to current hospital policy?
Practice Recommendations
Catheters must be assessed daily and removed as soon as no longer indicated.
Follow aseptic insertion of the urinary catheter, using a closed drainage system.
Keep the catheter and collecting tube free from kinking with no dependent loops.
Keep the collection bag below the level of the bladder, but never on the floor.
Empty the bag using a separate, clean container and prevent contact with the spigot.
Only change catheter and drainage bags when indicated such as infection, obstruction, or the closed system has been compromised.
Complete routine hygiene such as cleansing the meatal surface, but do not cleanse the area with antiseptics to prevent CAUTI.
Do not instill antiseptic or antimicrobial solutions into urinary drainage bags (CDC, 2018)
(Tampa General Hospital, 2016)
(Fairview, 2018)
Policy Recommendations
Include catheter necessity in the daily nursing assessments at the start of every shift, with the requirement to contact physician if criteria are not met.
Develop nursing protocols that allow for removal of urinary catheters if criteria for necessity are not met and there are no contraindications for removal (as defined in protocol).
Implement automatic stop orders for 48 to 72 hours after insertion, with continuation only when indication is documented in renewal order (CDC, 2018)
(Danlee Medical Products, 2015)
Clinical Implications
Urinary tract infections (UTI) are common healthcare-associated infections.
Approximately 70%-80% are attributed to the use of an indwelling urinary catheter.
CAUTIs contribute to increased morbidity, mortality, hospital cost, and length of stay (Brigham and Women’s Hospital, 2016).
Alternatives to indwelling urinary catheters…
Research Implications
Although the CDC recommends changes in policy be implicated such as daily assessments, nursing protocols, and stop orders, there is a lack in current evidence its effectiveness in practice. A controlled clinical trial needs to be completed to determine the effectiveness of the recommendations in preventing CAUTIs.
(Sage Products, 2019)
(Hospice of Cincinnati, 2017)