CAUTI Catheter associated - UTI

1. CAUTICatheter associated - UTI CIP Consulting LLC Michele Barr, RN, BSN, CIC Jennifer Perry, RN, BSN, CIC

2. Question • When determining the strength of recommendations a HICPAC category ll has stronger evidence than a lC • True • False

3. Questions • What are the appropriate indications for an indwelling catheter? • To Improve comfort at end of life • Anticipated prolonged duration of surgery • Assist with healing of an open sacral wound • All of the above • None of the above

4. Questions • Indwelling Urinary Catheters should be used in • The elderly • For patients undergoing surgery to protect the surgical site • To obtain specimens from those who cannot voluntarily void • All of the above • None of the above

5. Questions • In a non-acute care setting, it is acceptable to use a clean (non-sterile) technique for intermittent catheterization • True • False

6. Question • To prevent a CAUTI, you should routinely apply lubricants to the catheter to prevent friction. • True • False

7. Question • When should you change a urinary catheter? • When the closed system has been compromised • Patient has an obstruction • Every 2 weeks • All of the above • A and B • A and C

8. Question • The Periurethral area should be cleaned with antiseptics daily while the catheter is in place to prevent an infection. • True • False

9. Questions • CAUTI rates are calculated as • Number of CAUTI per 1000 Patient days • Number of CAUTI per 1000 Catheter days • Number of CAUTI per 100 FTE

10. CA-UTI Surveillance • What do you need in order to do CA-UTI surveillance? • # of foley days • Urine culture results • Correct CDC Definition for CA-UTI

11. Collecting Foley catheter daysThis is collection of your denominator data Educate the people who collect this for you 

12. Urine culture results Do you just get the organism that grew and the Antibiogram? You also need the colony forming units (CFU’s) – it is part of the surveillance definition

13. CDC CA-UTI definition • Link to CDC HAI Definitions http://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf • Print them and use them when doing surveillance • Be careful with the UTI definitions, only use the ones that pertain to “foley in place” at time of culture or “Foley removed” within 48 hours of culture when doing CA-UTI surveillance.

14. Review of the definition

15. Review of the definition

16. Review of the definition (2a continued)

17. Review of the definition when the patient is asymptomatic Asymptomatic Bacteremic Urinary Tract Infection (ABUTI) Patient with or without an indwelling urinary catheter has no signs or symptoms (i.e., for any age patient, no fever (>38°C), urgency, frequency, dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness, OR for a patient ≤1 year of age, no fever (>38°C core), hypothermia (<36°C core), apnea, bradycardia, dysuria, lethargy, or vomiting) And a positive urine culture of >105 CFU/ml with no more than 2 species of uropathogen microorganisms* And a positive blood culture with at least 1 matching uropathogen microorganism to the urine culture, or at least 2 matching blood cultures drawn on separate occasions if the matching pathogen is a common skin contaminant. * For ABUTI, report only isolate(s) in both blood and urine specimens. * Uropathogen microorganisms are: Gram-negative bacilli, Staphylococcus spp., yeasts, betahemolytic Streptococcus spp., Enterococcus spp., G. vaginalis, Aerococcus urinae,and Corynebacterium (urease positive).

18. Practice calculating CA-UTI rate • You found 3 CA-UTI’s in November. • The ICU reports that they had 326 foley catheter days. • How do you calculate the CA-UTI rate for November in ICU? • 3/326 X 1000 = 9.2 CA-UTI per 1000 foley catheter days for the month of November.

19. CA-UTI case review

20. According to the SUTI definition – No…