Running head: CATHETER UTI’S
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Catheter-Associated Urinary Tract Infections
Abigail R. Fish
Ferris State University
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Catheter-Associated Urinary Tract Infections
A urinary tract infection is simply that, an infection of the urinary tract. Typically, the
urinary tract consists of two kidneys, the ureters, the bladder and the urethra. The kidneys are
responsible for removing waste from the blood, where it is stored in the bladder as urine.
Leaving the bladder, the sphincters relax and urine is able to travel down the urethra and out of
the body. A urinary tract infection (UTI) is caused by bacteria that migrate into the urinary tract.
Women have a tendency to get UTI’s more often than men, however they are not uncommon in
men. This is due to the fact that women have a shorter urethra, making it easier for bacteria to
enter. Possible UTI symptoms include: a burning sensation while voiding, voiding more often
than usual, spotting urine, a strong urge to void but not being able to, as well as darker and
smelly urine.
It is apparent that many patients who require indwelling catheters during their hospital
stay can easily obtain a UTI. While these infections can be very painful, they can also cause
further damage to any part of the urinary tract if left untreated. By following aseptic techniques
and providing proper and timely catheter care using evidence based practices, nurses can provide
comfort to their patients and keep them free of catheter-associated UTI’s.
Urinary tract infections account for nearly 40 percent of all hospital-acquired infections,
of which 80 percent are catheter-associated UTI’s (Salamon, 2009). The best way to prevent
catheter- associated UTI’s (CAUTI) is to not insert urinary catheters at all, which is not feasible,
or to remove them promptly after they are no longer needed (Fakih, Rey, Pena, 2013).
Methods
A study was performed in central Italy at a teaching hospital, Ospedali Riuniti. This
hospital contains 900 beds and the units included in the study were nephrology, neurology,
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orthopedics, urology, plastic surgery, reconstructive surgery and vascular surgery. A pilot study
was done, where catheter-associated infections were collected from each of these units and filed
for the hospital’s records. After one year, 12 monthly reviews of CAUTI incidences, the facility
conducted a 2 day educational in service for all of the nurses and doctors employed at the
hospital. The interventions that were covered focused on the importance of prompt catheter
removal, maintaining catheter care while still inserted in the patient, catheterization
contraindications and finally, approved catheter techniques from the CDC (Marigliano,
Barbadora, 2012). After two days of instruction and education, the actual data collection began.
It was done by surveillance of each ward included in the study. A nurse from each unit was to
complete a surveillance record for every patient who required catheterization. The information to
be gathered were the sex of the patient, their date of birth, date of admission, date of catheter
insertion, onset of CAUTI symptoms, date of catheter removal and their date of discharge
(2012).
From a questionnaire study obtained from nurses from an unknown hospital, it was
apparent that most of the nurses (97.8%) working at this hospital thought it was their
responsibility to evaluate catheter placement and maintain proper catheter care and maintain
sterile practice. The nurses stated that their unit makes checks every shift for the presence of
catheters and their need for continued use. Ninety seven percent of these nurses voiced their
confidence in knowledge regarding catheter indications (Fakih, Rey, Pena, 2013).
At a facility in southern California, nurses were asked for a common use of catheters
within their facility. While nearly half of them stated a 24-hour urine collection, none of the
patients had their catheter removed by the 24 hour time period (Romito, Beaudoin, Stein, 2012).
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Another study about CAUTIs was conducted in a 38-bed medical-surgical intensive care
unit in Sao Paula, Brazil. In the first phase of the experiment the ICU nurses inserted catheters
only using aseptic technique and chlorhexidine. The catheters were not routinely removed during
the patient’s stay; in most cases they were kept in until the patient was discharged. A year later
the second phase of the study began after the hospital implemented a zero tolerance policy of
CAUTIs. They introduced what they call the bladder bundle. This consisted of providing urinary
catheter carts to the floors, performing religious hand hygiene, use of chlorhexidine for skin and
meatal antisepsis, a proper sterile field and use of sterile gloves, a new catheter for each failed
attempt, sufficient balloon inflation, daily inspection and immediate removal if the catheter is no
longer beneficial. During this second phase of the experiment, the nurses’ bedside routine was
monitored. Once a month, feedback was supplied to the nurses about the progress of the bladder
bundle use and their improvements. Posters were also placed for nurses to see, providing
information about implementation of the appropriate procedure techniques and evaluations of
CAUTIs. A shift check was also put into action, requiring a nurse to check all of the patients
with urinary catheters and check with the physician to make sure they were still necessary
(Marra, Andrea, Rosa, 2011).
Correlation
Recall the study done at the teaching hospital in central Italy, their study showed
significant reduction in catheter-associated urinary tract infections. The study conducted in
Brazil also showed a positive correlation between reduced CAUTIs and the diligent use of
evidence-based sterile practice when performing insertion, care or removal of a urinary catheter.
The results gathered from the hospital in Italy showed that due to the 2-day educational
training and then the immediate surveillance, caused the rate of CAUTIs to drop from their prior
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year review of catheter infections. After these steps became protocol, CATUI incidences dropped
by 50%. Not only did infection rates drop, but the number of days a patient was using a catheter
also decreased (Marigliano, Barbadora, 2012). This proves the nurses who made their catheter
inspection rounds diligently stressed the importance of shorter urinary catheter days to the
physicians.
The results of the Brazilian study also show a positive correlation rate. Twelve percent of
the patients studied were determined to have a UTI and 80% of those were catheter related. The
period of active surveillance along with the education and implementation of the bladder bundle
showed a significant reduction in CAUTI rates (Marra, Andrea, Rosa, 2011). The positive
feedback from the hospital about the nurses’ compliance as well as the posters, which provided
visuals about their work, helped the nurses realize the importance of reducing catheter infections
by using evidence-based practices.
Conclusion
Nurses play a vital role in decreasing CAUTIs, because a nurse’s knowledge about
urinary tract infection rates can reflect CAUTI incidence. They can take simple precautions such
as performing proper sterile technique during insertion, practicing strict hand hygiene,
maintaining a clean environment near the patient’s urinary meatus, using correct asepsis
technique when removing the catheter and making sure the patient is receiving an adequate
amount of water during their stay. These simple steps can add up to big results that are needed to
keep patients safe and free from infection. Contracting a CAUTI is not only painful and
uncomfortable for the patient, but it may also require a longer hospital stay, which does not
benefit the patient or the nurse. As displayed by evidence based practice techniques, nurses can
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really cut down on CAUTIs by being mindful and knowledgeable about urinary catheter
indications.
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References
Fakih, M. G., Rey, J. E., Pena, M. E. (2013). Sustained Reductions in Urinary Catheter Use Over
5 Years: Bedside Nurses View Themselves Responsible for Evaluation of Catheter
Necessity. American Journal of Infection Control, 41(3),236-239. doi:http://0dx.doi.org.libcat.ferris.edu/10.1016/j.ajic.2012.04.328. Retrieved April 11, 2013, from
CINAHL.
Marigliano, A., Barbadora, P., Pennacchietti, L., D'Errico, M. M., & Prospero, E. (2012). Active
Training and Surveillance: 2 Good Friends to Reduce Urinary Catheterization Rate.
American Journal of Infection Control, 692-695. Retrieved April 17, 2013, from
CINAHL.
Marra, R., Andrea, C., & Rosa, A. (2011). Preventing Catheter-Associated Urinary Tract
Infection in the Zero-tolerance Era. AJIC Major Articles, 817-822. Retrieved April 8,
2013, from CINAHL.
Salamon, L. (2009). Catheter-Associated Urinary Tract Infections: A Nurse-Sensitive Indicator
in an Inpatient Rehabilitation Program. Rehabilitation Nursing, 34(6), 237-241. Retrieved
April 11, 2013, from CINAHL.
Romito, D., Beaudoin, J., & Stein, P. (2012). Urinary Tract Infections in Patients Admitted to
Rehabilitation from Acute Care Settings: A Descriptive Research Study. Rehabilitation
Nursing, 36(5), 216-221. Retrieved April 9, 2013, from CINAHL.
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