CAUTI Prevention
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
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
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
Background
• UTI’s account for
approximately 36%
of all HAI’s
Background
• According to the
CDC, UTI’s are
directly related to
5% of deaths
associated with
HAI’s
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
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
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
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
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
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”
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
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
Alternatives
• Alternatives to indwelling
catheter
• Bladder ultrasound
• Intermittent catheterization
• Condom catheter
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)
Prevention
• Use general infection control
practices
• Aseptic insertion
• Proper maintenance
• Hand hygiene
• Nurse driven Catheter Removal
Protocol
• Education
Implementation of EvidenceBased 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
Implementation of EvidenceBased 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
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
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
Conclusions
• CAUTI is a common and costly
safety problem
• Several practices appear to
decrease CAUTI
• Preventing CAUTI is a “team”
effort