CAUTI Prevention

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