1. Catheter-Associated Urinary Tract Infections
Kaleida Health
Infection Control and Prevention
Suzanne Bradley, RN, BSN

2. Healthcare-Associated Infections
Healthcare-associated infections account for an estimated 1.7 million infections each year.
32 % are urinary tract infections
The estimated deaths associated with HAIs in U.S. hospitals were 98,987.
13,088 for urinary tract infections
Estimating Healthcare-Associated Infections and Deaths in U.S. Hospitals, 2002, Public Health Reports / March–April 2007 / Volume 122

3. Healthcare-Associated Infections
Transmission of pathogens most commonly occurs on contaminated hands of HCWs
Compliance with recommended hand hygiene practices is less than 50%

4. Catheter-Associated Urinary Tract Infections
10%–20% of CAUTIs are caused by the introduction of microorganisms during catheter insertion.
30%–45% are due to migration of microorganisms on the external surface of the catheter along the catheter–urethra interface to the bladder.

5. Catheter-Associated Urinary Tract Infections
Reflux of microorganisms up the catheter lumen to the bladder from contaminated drainage tubing or collecting bags accounts for approximately 25%–40% of infections.
When catheters are left in place greater than 5 days, UTIs occur in approximately half of patients.

6. CDC Definition of Catheter-Associated Urinary Tract Infection
CA (catheter associated) infection refers to infection occurring in a person whose urinary tract is currently catheterized or has been catheterized within the previous 48 hours.
UTI (urinary tract infection) refers to significant bacteriuria in a patient with symptoms or signs attributable to the urinary tract and no alternate source.
ASB (asymptomatic bacteruria) refers to significant bacteriuria in a patient without symptoms or signs attributable to the urinary tract.

7. CA-UTI
Patient had an indwelling urinary catheter in place at the time of or within 48 hours prior to specimen collection
and
at least 1 of the following signs or symptoms with no other recognized cause:
fever (>38°C),
suprapubic tenderness,
or costovertebral angle pain or tenderness
a positive urine culture of ≥105 colony-forming units (CFU)/ml with no more than 2 species of microorganisms.

8. Asymptomatic Bacteriuria
Patient had an indwelling urinary catheter in place at the time of or within 48 hours prior to specimen collection
and
a positive urine culture of ≥103 and <105 CFU/ml with no more than 2 species of microorganisms.
patient has no fever (>38 C), urgency, frequency or suprapubic tenderness.

9. Catheter-Associated Urinary Tract Infections
The duration of catheterization is the most important risk factor for development of infection!
The duration of catheterization is the most important risk factor for development of infection!!
The duration of catheterization is the most important risk factor for development of infection!!!

10. Prevention of CAUTIs
Use indwelling catheter only when medically necessary:
Urinary obstruction or acute urinary retention
Assistance in pressure ulcer healing in some patients
Hospice or palliative care, when requested by patient
Critical care monitoring
Some surgical procedures
Physician order is required for insertion of indwelling catheter. Include indication for catheterization.

11. Prevention of CAUTIs
These are not indications for indwelling catheter:
Incontinence
Immobility
Patient request or convenience
Obtaining urine specimens

12. Prevention of CAUTIs Consider alternatives to indwelling catheters
Bladder scanner to measure residual
Intermittent catheterization
External (condom style, Texas catheter, Urosan)
Reviews of silver-coated and other antibacterial urinary catheters consistently conclude that evidence does not support a recommendation for the uniform use of such devices.

13. Prevention of CAUTIs Insertion of indwelling catheters
Only when necessary and only left in place as long as indications persist
Only trained healthcare providers should insert catheter
Aseptic technique for insertion with appropriate hand hygiene and gloves
Hand hygiene immediately before insertion of catheter and before and after any manipulation of catheter site or apparatus

14. Prevention of CAUTIs Maintain sterile continuously closed system.
Maintain drainage bag below level of bladder AT ALL TIMES.
Properly secure catheter after insertion to prevent movement, friction.
Clean periurethral and perianal areas two times per day and as needed with soap and water.

15. Prevention of CAUTIs
Hand hygiene and gloves when emptying drainage bag
DO NOT share containers between patients when emptying drainage bag
DO NOT allow drainage bag port to touch measuring container

16. Documentation Document the following on the patient record:
Date/time of catheter insertion
Indications for insertion
Name of individual who inserted catheter
Date/time of catheter removal

17. “Urinary Catheterization Insertion and Maintenance for the Acute Adult and Pediatric Patient” Kaleida Policy TX.GU.6
A physician order must be obtained prior to inserting a urinary catheter.
A physician order to maintain an indwelling urinary catheter must be re-written every 24 hours. “Re-order indwelling urinary catheter for 24 hours” is appropriate. Otherwise the catheter will be removed on the day shift following the 24-hour period. The nurse will be responsible to either discontinue the urinary catheter or contact the physician for a reorder based on clinical necessity.

18. HAI Prevention
Healthcare providers can prevent healthcare-associated infections by adhering to recommended infection control practices including standard, contact, droplet, and airborne precautions. To learn more about infection control precautions, see Guideline for Isolation Precautions in Hospitals.
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
Implementing what we know for prevention can lead to up to a 70% or more reduction in HAIs