Catheter Associated UTI
Remove That Foley!
Objectives
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Review evidence that foley catheters cause
infection
Employ algorithm to determine if foley
catheter is appropriate
Apply guidelines for when to remove foley
catheter
Foley Catheters Cause
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 Infections
 Length of stay
 Cost $$$
 Patient Discomfort 
 Antibiotic Usage
 Risk of falls (tethered to bed/1 point
restraint)
 Risk of skin breakdown, DVT and
pneumonia due to immobility
Urinary Tract Infection (UTI) and
Indwelling Catheters
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UTIs: THE most common Hospital Acquired
Infection (HAI) and are directly associated
with the use of indwelling foley catheters
40% of all HAI are caused by UTI
80% are secondary to foley catheters
Risk of infection

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 5% each day
 25% at 1 week
100% at one month
Duration
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SCIP INF-9* recommends that post-operative
foley catheters are removed by the end of
post op day 2
Use urinary catheter in operative patients
only as long as necessary
SCIP INF-9 requires physician
documentation for foley catheter continuation
*SCIP = SURGICAL CARE IMPROVEMENT PROJECT
*INF-9 = Infection Module # 9
When to Discontinue
Foley Catheters?
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Decreasing the duration of an indwelling
urinary catheter will reduce the risk of a
catheter-associated UTI
The time frame for foley catheter removal is
dependant on clinical judgment and findings
Indwelling catheters should not be changed
at arbitrary intervals
Is there a
Foley Catheter
in place?
NO
YES
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Does the
patient meet
criteria for
a Foley?
YES
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
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Foley Indicators
Obstruction relief
Neurogenic bladder
Strict I&O
GU related Surgery/Procedure
Stage III/IV decubitus
Diuresis / Mass hydration
Comfort Care/Palliative Care
Other__________________
YES
NO
Obtain
Remove Foley
order
Foley Catheter Decision-Making Algorithm
Foley Catheter Checklist*
Date
Post Op Day #_____________
Foley Day #_______________
Room #
Does your patient have a foley catheter?
Y
N
Is there an order for the catheter?
Y
N
Which service is your patient on?
Medical
Surgical
Trauma
Which criteria for appropriate use of foley catheter does your patient meet:

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Obstruction relief
Neurogenic bladder
Strict I&O
GU related Surgery/Procedure
Stage III/IV decubitus
Diuresis / Mass hydration
Comfort Care
Other
If none of the above criteria are met, was a D/C foley order obtained?
Y
N
*Used in ICUs that do not document nursing assessment in IDX/GECE
Foley Catheter Sticker*: Doctor’s Order
Documentation of catheter criteria
FOLEY CATHETER ORDER
Date/Time
Doctor__________
This patient has a Foley Catheter, inserted __________(date)
Please indicate criteria for continuation of foley catheter:
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Obstruction relief
Neurogenic bladder
Strict I&O
GU related Surgery/Procedure
Stage III/IV decubitus
 Diuresis / Mass hydration
 Comfort Care/Palliative Care
 Other__________________
___________________________
IF NO CRITERIA APPLY PLEASE CONSIDER
DISCONTINUATION OF FOLEY CATHETER
□ Continue Foley Catheter
□ D/C Foley Catheter
Physician/NP/PA Signature __________________#________Date/Time__________
Cat # 86604
*Place dated sticker on physician order sheet
Sticker for Chart Front to Alert MD
Place on front of chart
Foley Catheter in place…… See Doctor’s Order Sheet
Date__________
Cat # 86605
Date and place this sticker on the front of the chart to alert
MD that the foley catheter order sticker has been
placed on the physician order sheet.
Unit Flyer
How does this apply to nursing?
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Nurses must advocate for the removal
of unnecessary indwelling catheters.
Use the criteria-based guidelines to
determine need for foley catheter.
Document foley criteria, insertion date,
and discontinuation date.
Nursing Guidelines
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Use the decision-making algorithm
Use the Criteria-Based Foley Catheter Checklist
daily for areas that do not chart in GECE/IDX
If no criteria on the checklist are met, obtain a
physician’s order to discontinue the foley catheter
Foley Catheter Days will be collected on each unit,
every day
There is no evidence to support a set time of day
that foley catheters are to be discontinued.
GECE Screenshot
2 Documentation Changes as of January 1, 2010:
#1 Discontinue date of foley
#2 Foley Catheter Criteria IF patient has a foley
Maintain catheters based on recommended
guidelines
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Maintain a sterile, continuously closed drainage system.
Keep catheter properly secured to prevent movement
and urethral traction.
Keep collection bag below the level of the bladder at all
times (even during transport).
Maintain unobstructed urine flow.
Empty collection bag regularly, using a separate
collecting container for each patient, and avoid allowing
the draining spigot to touch the collecting container.
Maintain meatal care with routine hygiene (bathing)
using soap and water.
Questions
Foley Catheters cause:
A.
B.
C.
D.
E.
Increased infections
Increased length of stay
Increased risk of falls
Increased cost
All of the above
Criteria for Foley Catheter includes:
A.
B.
C.
D.
E.
F.
Neurogenic bladder
Strict I&O
GU related Surgery/Procedure
Stage III/IV decubitus
Comfort Care/ Palliative Care
All of the above
Discontinuation of foley catheters is based
on all of the below except:
A.
B.
C.
D.
E.
Physician Order-sets
Research based criteria
Gut feeling
Pathways
MD/PA/NP order
Maintaining foley catheters includes all of
the following except:
A. Maintain a sterile, continuously closed drainage
system.
B. Keep catheter properly secured to prevent movement
and urethral traction.
C. Keep collection bag on top of the bed covers at all
times.
D. Maintain unobstructed urine flow.
E. Maintain meatal care with routine hygiene (bathing)
using soap and water.