PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs)

1. PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs)

2. History of CAUTI’s.... • Preventing CAUTIs used to be relatively low priority in acute care hospitals. • The CMS regulation that went into effect on October 1, 2008, ends reimbursement for CAUTIs • CMC had 128 UTIs for 2008 • Each event cost approximately $700.00 • Increases patient length of stay • Increases antibiotic use • Increase patient discomfort

3. Nine risk factors have been identified for catheter associated UTIs • Errors in catheter insertion • Not doing pericare routinely • Duration of catheterization • Absence of use of a urimeter • Microbial colonization of the drainage bag • Female gender • Use for reasons other than surgery or output measurement • Diabetes

4. Prevention Strategy • No single strategy used to prevent these infections have been found to help decrease CAUTI. • A recent Compendium of Strategies to Prevent Healthcare Associated Infections in Acute Care Hospitals emphasized the importance of reducing CAUTIs by using the “bundle approach.” - This information was taken published by SHEA-IDSA

5. What is a bundle approach? • The bundle is a collection of process needed to effectively and safely care for patients undergoing a particular treatment/procedure with inherent risk. Several interventions are “bundled” together and, when combined, significantly improve patient care outcomes. SHEA-IDSA: Society for Healthcare Epidemiology of America/Infectious Disease Society of America

6. What about CMC? • Community Medical Center is implementing a bundle approach for Foley Catheter Insertion to reduce CAUTIs

7. The CAUTI Bundle: • Hand Washing • Avoid unnecessary urinary Catheters • Insert urinary catheters using aseptic technique • Maintain urinary catheters based on recommended guidelines • Review urinary catheter necessity daily

8. CAUTI bundle in detail • Hand Washing: First and most important preventative measure • Avoid unnecessary urinary Catheters: No invasive device should ever be used unless absolutely necessary(placing catheters increase risk of infection, decreases mobility and increases urethral trauma)

9. CAUTI bundle in detail continued... • Criteria for foley catheter has been meet • Verification that these have been met are required prior to insertion. Assessing a patient for urinary retention, severely ill thus decreasing mobility , and lack of bladder control. Never place for convenience for staff

10. CAUTI bundle in detail continued... • Insert urinary catheters using aseptic technique: • Utilize appropriate hand hygiene practice • Insert catheters using aseptic technique and use sterile equipment • Use as small a catheter as possible that is consistent with proper drainage to minimize urethral trauma

11. CAUTI bundle in detail continued... • Review urinary catheter necessity daily and remove promptly • Keeping foley catheter in place greater than 48 hours puts patient at risk for infection

12. Recommendations from CDC, SHEA-IDSA are indications for placement: • Perioperative use for selected surgical procedures • Urine output monitoring in critical ill patients • Management of acute urinary retention and urinary obstruction

13. Recommendations continued... • Assistance in pressure ulcer healing for incontinent patients • At patient request to improve comfort or for comfort during end of life care (CDC)

14. Maintain urinary catheters based on recommended guidelines: • Assure that foley care occurs for every patient, every day, and every shift • Do pericare for patients that don’t have a foley catheter everyday and every shift • Maintain a closed drainage system • Keep catheter properly secured to patient to prevent movement and urethral trauma

15. Maintain urinary catheters based on recommended guidelines: • Keep collection bag below the level of the bladder at all times • Maintain unobstructed urine flow

16. Maintain urinary catheters based on recommended guidelines: • Empty collection bag at least every eight hours or as needed. • Do not allow the drainage spigot to touch the collecting container, to avoid cross contamination when emptying foley • Collection of specimen is done with aseptic technique • Never take a sample from the urinary drainage bag. Take a urine sample from the sample port

17. In summary... • CMC now looks at foley catheter placement in a “bundle approach.” • When caring for and inserting foley catheters, be sure to: • Wash your hands • Avoid unnecessary catheters • Always use aseptic technique • Maintain catheters based on current recommended guidelines • Review the necessity daily