UTI Bundle
Yes No Does the patient meet criteria to continue use of an indwelling urinary catheter?
Yes No Has the length of time the patient is likely to need the catheter been determined?
Yes No If yes, has the catheter been changed to one recommended for long-term use?
Yes No N/A Was the catheter removed today?
Yes No N/A Did MD/NP/PA give verbal/written order to remove the catheter?
If no, please explain_________________________________
Yes No Does the patient have any signs or symptoms of possible UTI?
Yes No N/A If symptomatic for infection, were U/A and C&S sent?
If not, explain reason_________________________________
Yes No N/A Was aseptic technique used when accessing ports to collect urine specimens?
Yes No
Was urinary drainage bag kept below patient’s bladder level at all times?
Yes No N/A Is catheter secured to leg and is tubing kink free?
Yes No N/A Was thorough perineal/meatal care with soap and water provided daily and PRN?
Yes No N/A Has the patient’s catheter been removed and a new catheter reinserted?
If yes, please explain_______________________________
Indwelling urinary catheters should be continued if criteria are met.
Nursing will review appropriateness of indwelling urinary catheters on a daily basis, using these criteria:
1.
2.
Relief of urinary tract obstruction/urinary retention not manageable by other means.
Drainage in patients with neurogenic bladder when intermittent catheterization is not possible.
3.
For accurate intake and output if medically indicated, such as in critically ill/unstable patients.
4.
In patients with surgery in contiguous structures such as GYN or GU system procedures.
5.
6.
7.
Management of incontinence in patients with stage III or IV pressure ulcers or wounds.
Patients with diuresis and/or massive hydration.
Patients with epidural management.

8.
Patients requiring comfort care measures in palliative care situations.
9.
Physician/NP/PA ordered catheter for other reasons.
Please state__________________________________
Indwelling urinary catheters should be removed if none of the above criteria are met.
APIC Text of Infection Control and Epidemiology II edition
January 2005; Chapter 25: UTI
Date: ______________
Signature: _____________________________
References
Robinson, S., et al. (2007). “Development of an evidence-based protocol for reduction of indwelling urinary catheter usage.”
MEDSURG Nursing 16(3): 157-161.
Adapted with permission from University Hospitals Case Medical Center, Cleveland, OH, 2006
(unpublished protocol).
_______________________________________________________________________
Source: Preventing Catheter-Associated Urinary Tract Infections: Build an Evidence-Based
Program to Improve Patient Outcomes . By Mikel L. Gray, PhD, CUNP, CCCN, FAANP, FAAN;
June Marshall, RN, MS, NEA-BC; Lucy Bird, RN; Laura Maverick; Laura J. Weber, RN, MSN,
MBA/HCM. Published by HCPro, Inc.