UTI Prevention in
Patients with Foley
Catheters
Lourdes Health Network
2011
Background
UTIs account for over 6 million patient
visits to physicians per year in the United
States.
 UTIs are the most common hospital
acquired (HA) infection
 80% of HA-UTI are attributable to
indwelling urethral catheters.
 12-16% of hospitalized patients will get a
Foley and half of them do NOT have a
valid indication.
 Risk of UTI increases 3-7% for every day
with Foley

Relevance
UTIs increase a patient’s length of stay an
average of 0.5 -1 day
 The estimated cost per Catheter
Associated UTI (CAUTI) ranges $500$3000
 If not documented upon admission
(CAUTI), then hospital cannot code for
higher reimbursement DRG for Medicare
patients in some hospitals

Urinary Tract Infections

Definition of UTI
a microbial
infection (typically
bacterial) of the
urethra, bladder,
ureters, or kidneys.
 Most common is
Escheria coli

UTI Definition continued…
Symptomatic

more typical presentation (burning with
urination, urinary frequency, low fever, cloudy
urine (possibly), foul odor to urine, pressure or
cramping in lower abdomen
Asymptomatic bacteriuria

a significant number of bacteria in the urine
that occurs without usual symptoms such as
burning during urination or frequent
urination. Those with urinary catheters will
more likely have this condition.
3 Primary Routes of Infection
1.
Catheter-meatal junction

2.
Catheter manipulation

3.
More often in females (shorter urethra)
Example: allowing drainage spout to touch the
ground or contaminating the catheter tubing
while placing a new drainage bag.
Retrograde bacterial migration

Example: lifting bag above level of bladder during
transport or repositioning
More about indwelling catheters….

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They are uncomfortable for patients
Can be unnecessary for patient treatment plan
(41-58% in place found to be not indicated)
Can be associated with negative outcomes
Urethral inflammation
 Urethral strictures
 Mechanical trauma to urethra/bladder

Can DECREASE mobility (because the patient
does not have to get out of bed to urinate) which
may impede recovery or contribute to complications
like pressure ulcers, pneumonia, and/or DVT
Appropriate Indications For Foley
Catheters per LHN Protocol
Criteria for Continuing Foley Catheter
Strict I & O or aggressive treatment with
diuretics or fluids
Chronic urinary retention or bladder outlet
obstruction
Critically ill patient – hemodynamic
instability
Renal failure
Recent renal/urology procedure
Acute neurogenic bladder
History of chronic, prolonged catherization
or suprapubic catheter
Hematuria
Chemical sedation or paralyzation
Terminally ill or palliative care patient
Epidural catheter
Pelvic or hip fracture
Stage 3 or greater pressure ulceration on
coccyx or buttocks
Urinary Catheters are NOT
Indicated for:
Immobility or poor mobility
 General incontinence
 Skin excoriation
 Obtaining urine specimens
 Patient request
 Nurse convenience

What is a Nurse Initiated Foley
Removal?

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
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A policy developed in keeping with national best
practice standards which ensures that Foley catheters
are used appropriately.
Facilitates nursing assessment for approved indications
for the use of a Foley catheters
Nurses are empowered to remove unnecessary
catheters (those not meeting an approved criteria)
without a doctors order.
Enables catheters to be removed earlier!
Decreases potential for hospital acquired UTIs in our
patients!!!
This policy has been
supported and approved by
MEC!
Foley Removal Assessment &
Documentation on Meditech
Foley Removal Assessment &
Documentation on Meditech
continued . . . .
Look up for
continuing Foley

If the patient does not meet any of the
criteria for continuing the Foley catheter,
REMOVE THE CATHETER!
Post catheter removal
Educate patient about what to expect (e.g.
to notify nursing with the first voided
specimen, measuring urine, getting help if
needed to go to the BR, etc.)
 Document due to void time(5 – 8 hours
post catheter removal) and communicate
this with the oncoming shift!
 Scan patients bladder and notify physician
of inability to void if the patient is unable to
void post removal.

Documentation of removal &
due to void time (DTV)
Document Output - Post
Catheter Removal
If Urinary Catheterization
continues to be appropriate. . . .


Use aseptic technique during subsequent catheter
insertion and care
Properly manage the system and components

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
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Keep closed drainage system
Keep bag below level of the bladder
Prevent excessive manipulation of the catheter
Keep bag off of the floor
Secure catheter to leg
Provide catheter care daily and after bowel
movements
Continue to educate and advocate for the prompt
removal of the Foley catheter
References
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Institute for Healthcare Improvement-Preventing CAUTI
http://www.ihi.org/IHI/Programs/ImprovementMap/PreventCatheterAssoc
iatedUrinaryTractInfections.htm
Lo, E., Nicolle, L, Classen, D., et al. (2008). Strategies to prevent catheterassociated urinary tract infections in acute care hospitals. Infection control and
hospital epidimiology. October, Vol 29, Supplement 1. (Supplement article:
SHEA/IDSA practice recommendations)
Nazarko, Linda (2008). Reducing the risk of catheter-related urinary tract
infection. British Journal of Nursing, Vol 17, No 16.
Gotelli, J., Merryman, P., Carr, C., McElveen, Epperson, C., & Bynum, D.
(2008). A quality improvement project to reduce the complications associated
with indwelling urinary catheters. (Society of Urologic Nurses and
Associates) Urologic Nursing. pp.465-473.
Vieira, Fabricia (2009). Nursing actions to prevent urinary tract infection
associated with long-standing bladder catheter. A Literature Review. Einstein;
7 (3 part 1): 372-5.
References continued . . . .
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Centers for Disease Control and Prevention
National Healthcare Safety Network (NHSN)
Association for Professional Infection Control and Epidimiology (APIC)
Busuttil Leaver, Rachel (2007).The evidence for urethral meatal cleansing.
Nursing Standard. June, vol 21, no 41.
2009 NACNS National Conference Abstracts (March 5-7, 2009), St. Louis,
Missouri.Creating a foley free zone by preventing and removing unnecessary
urinary catheters.
www.cconline.org. Clinical Nurses finding evidence for practice: reducing
catheter-associated urinary tract infections. Critical Care Nurse. April, 29 (2)