1. CAUTI Prevention

2. Definition of CAUTI
Urinary tract infection that occurs in a patient who had an indwelling urethral urinary catheter in place 48 hours prior to the UTI diagnosis and up to 30 days post removal or discharge
Does not include straight in & out catheters or urinary catheters that are not placed in the urethra

3. Goals Decrease foley catheter use by 25%
NorthCrest goal is to have a zero incidence of CAUTI
Increase education on foley catheter use and CAUTI

4. Background
Urinary Tract Infections (UTI’s) are the most common site of HAI’s
Most UTI’s (80%) are associated with urinary catheterization instrumentation
UTI’s lead to increased morbidity, mortality, LOS and cost

5. Background
UTI’s account for approximately 36% of all HAI’s

6. Background
According to the CDC, UTI’s are directly related to 5% of deaths associated with HAI’s

7. Eliminate CAUTI: One infection at a time
Appropriate Indications: Does this patient need the catheter?
Ensure patient meets appropriate indications for catheter use and document reason
Consider alternatives to indwelling urethral catheterization

8. Hand Hygiene: It starts with the hands
PRACTICE HAND HYGIENE and standard precautions
Sanitize hands thoroughly with an alcohol-based hand rub or soap and water before and after catheter insertion and manipulation

9. Insertion Technique: Pay attention to detail
Use sterile equipment including, sterile gloves, drape, sponges, and appropriate antiseptic solution
Use aseptic technique to insert catheter. If aseptic technique is broken, replace catheter and collection system aseptically with sterile equipment
Secure catheter to prevent movement and urethral traction

10. Catheter Maintenance: Keep it neat
Keep collection bag below level of the bladder at all times
Check tubing frequently for kinking
Keep drainage bag/tubing off the floor
Empty the collection bag every four hours or when ½ to 2/3 full
Maintain a closed-drainage system

11. Catheter Care: Keep it clean
Perform perineal care daily and after each bowel movement
Soap and water or perineal cleansing wipes will be utilized
Special care will be taken to remove fecal soiling from around the catheter by cleaning fecal material away from the urinary meatus

12. Catheter removal: Get it Out!
Assess patient every shift for catheter need
Take steps to remove catheter when patient no longer meets indications
Early removal of catheter using reminders or stop-order “stickers”

13. Indications for catheter use
Insert catheters only for appropriate indications
Management of acute urinary retention
Post-op bladder decompression for 48 hours
Surgery procedure
Monitoring urinary output in acutely ill patient

14. Indications for catheter use
Contamination of stage III or IV pressure ulcers with urine which has impeded healing, despite appropriate care for incontinence
Terminal illness or severe impairment which makes positioning or clothing changes uncomfortable, or which is associated with intractable pain
Other – MD clarification required

15. Alternatives Alternatives to indwelling catheter Bladder ultrasound
Intermittent catheterization
Condom catheter

16. Organisms enter the bladder by 3 ways:
At time of catheter insertion
Through the catheter lumen (from a colonized drainage bag)
Along external surface of the catheter (migrate along the catheter-mucosal interface)

17. Prevention Use general infection control practices
Aseptic insertion
Proper maintenance
Hand hygiene
Nurse driven Catheter Removal Protocol
Education

18. Implementation of Evidence-Based Prevention Strategies
Make sure the catheter is indicated
Implement and promote alternatives to indwelling urinary catheterization
Perform hand hygiene in compliance with CDC
Provide education on proper insertion and maintenance
Limit insertion of catheters to trained personnel
Insert catheters using aseptic technique and sterile equipment

19. Implementation of Evidence-Based Prevention Strategies
Secure catheter to prevent movement and urethral traction
Maintain closed drainage system
Maintain unobstructed urine flow
Remove catheters with 48 hours following surgical procedure or document reason for extended use
Remove unnecessary catheters

20. Documentation
Accurate documentation on the Urinary Catheter Assessment in HMS
Document medical indications for placement
Insertion documentation (size of catheter used, patient response, amount & color or urine obtained, etc…)
Assess patient every shift for foley catheter removal – includes scoring indications for maintenance of foley
Discontinuation of urinary catheter documentation – includes Bladder scanner Clinical pathway documentation
New alert sticker in physician orders to remind physicians to discontinue foley catheters

21. Lessons Learned
Use evidenced-based, standardized, protocols and guidelines
Build redundancy into the process – new alert sticker placed in physician orders
Define and enforce accountability
Push accountability to the front line staff

22. Conclusions CAUTI is a common and costly safety problem
Several practices appear to decrease CAUTI
Preventing CAUTI is a “team” effort