Running head: CATHETER ASSOCIATED URINARY TRACT INFECTIONS
Catheter Associated Urinary Tract Infection
Jaya Lingam
Ferris State University
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CATHETHER ASSOCIATED URINARY TRACT INFECTION
Abstract
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CATHETHER ASSOCIATED URINARY TRACT INFECTION
Catheter Associated Urinary Tract Infection
Urinary tract infections are the most common type of healthcare-associated
infections; accounting for more than 30% of healthcare-associated infections reported by
acute care hospitals. Almost all healthcare-associated urinary-tract infections (UTIs) are
caused by instrumentation of the urinary tract for example insertion of catheters. Catheter
associated urinary tract infection (CAUTI) has been associated with increased morbidity,
mortality, hospital cost, and length of stay (CDC, 2011).
The diagnosis of CAUTI is based on elevated white blood cell count (WBC) and
finding bacteriuria in the urinalysis examination. Some of the following signs and
symptoms may be present:
 Pain or burning in the region of the bladder, urethra, or flank
 Fever (greater than 100.4○ F or 38○ C) or chills
 Malaise
 Offensive urine odor
 Change in color or character of urine, including cloudy urine or increased sediment
 Hematuria
 Bladder spasms or leakage
 Catheter obstruction
 Increased weakness or spasticity, especially, in those with neurological disease or
injury
 Change in mental status, particularly in older adults, such as confusion, lethargy,
agitation, delirium, or subtle changes in behavior (Catheter, 2008).
Giving importance to the prevention of CAUTIs, the researchers have attempted
various methods to prevent this common, costly, and morbid patient safety problem. In July
2010 the Society for Healthcare Epidemiology of America (SHEA), the Centers for Disease
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CATHETHER ASSOCIATED URINARY TRACT INFECTION
Control and Prevention (CDC), the Association for Professionals in Infection Control
(APIC), and the Infectious Diseases Society of America (IDSA) published guidelines to
prevent CAUTI. The members of Ann Arbor Veterans Administration Medical Center and
University of Michigan Patient Safety Research group also have been involved in the
development of most of these guidelines and also have recommended a memory aid
“ABCDE” to prevent CAUTI. The following are the ABCDE:

“Adherence to general infection control principles (e.g., hand hygiene, surveillance
and feedback, aseptic insertion, proper maintenance, education) is important

Bladder ultrasound may avoid indwelling catheterization

Condom catheters or other alternatives to an indwelling catheter such as intermittent
catheterization should be considered in appropriate patients

Do not use the indwelling catheter unless you must!

Early removal of the catheter using a reminder, stop-order, or nurse-initiated
removal protocol is warranted” (General 2010).
There were many research conducted over the years on CAUTI. A collaborative
project between nursing and infect control was designated to collect baseline data on
catheter associated urinary tract infection in a non-intensive care unit impatient setting.
Method
The method used in preparation in collecting the data was paper generated tool and
computer generated lab reports, and patients’ temperature. Two inpatient rehabilitation
units were used for the initial data collection. The first unit (A) had 45 beds and the
second unit (B) had 8 beds. The initial data collection on the 45-bed unit was over 4
months period and on the 8-bed unit for 6 months to determine baseline CAUTI rates. The
data was collected by the nurses in all the shifts (Salamon 2009).
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CATHETHER ASSOCIATED URINARY TRACT INFECTION
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Results
The table below shows the result of the data collection over the period of time
Table 1
Unit A Average Untilization Rate 2007-2008
70
#
62.5
60
60
C
A
U
I
T
/
1
0
0
0
i
n
d
w
e
l
l
i
n
g
49.6
50
51.5
40
35.5
30
c
a
t
h
e
r
e
s
20
14.6
10
0
0
0
Note. CAUTI = Catheter-associated urinary tract infection (Salamon2009).
Table 2
Unit A Symptomatic versus Asymptomatic Bacteriuria 2007-2008
14
12
9
#
10
o
f
C
A
U
I
T
4
8
3
6
6
2
6
4
4
4
3
2
2
0
Jan-
Feb-07
Mar-07
Apr-
Sep-
Jan-
Apr-
Note. CAUTI = Catheter-associated urinary tract infection; SUTI = symptomatic urinary tract
infection; ASB = asymptomatic bacteriuria (Salamon 2009)
CATHETHER ASSOCIATED URINARY TRACT INFECTION
The baseline data for Unit A for January–April 2007, total of 35 patients developed
CAUTI during that time period. They included 21 females and 14 males, with an average
age of 71 years. The ongoing data collection for Unit A through April 2008 no CAUTI
were reported. And also in August and September 2007 no CAUTIs were reported. In
January 2008, six patients developed CAUTI and all were asymptomatic. In April 2008
only two patients developed CAUTI. The baseline data for Unit B for January–May 2007
three patients developed CAUTI. All three patients were female with an average age of 81
years (Salamon2009).
The criteria for table 1 and 2 were adapted from Centers for Disease Control and
Prevention. (2009). Catheter-associated urinary tract infection (CAUTI).
Table 1
Criteria 1
Must meet at least one of the following signs and symptoms with no other recognized
cause:
• Fever (>38 ºC), urgency, frequency, dysuria, or suprapubic tenderness AND
• Positive urine culture that is ≥105 microorganisms per cc of urine with no more than two
species of microorganisms.
Criteria 2
Patient has at least two of the following S&S with no other recognized cause:
• Fever (>38 ºC), urgency frequency, dysuria, or suprapubic tenderness AND
• At least one of the following:
a) positive dipstick for leukocyte esterase and/or nitrite
b) pyuria (urine specimen with >10 wbc/mm3 or > 3 wbc/high power field of unspun urine
c) organisms seen on Gram stain of unspun urine
d) at least two urine cultures with repeated isolation of the same uropathogen (gram
negative bacteria or S. saprophyticus) with >102 colonies/ml in nonvoided specimens
e) less than 105 colonies/ml of a single uropathogen (gram-negative or S. saprophyticus) in
a patient being treated with an effective antimicrobial agent for a urinary tract infection
f) physician diagnosis of urinary tract infection
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Table 2
Must meet one of the following criteria:
• Patient has had an indwelling urinary catheter within 7 days before the culture and
patient has a positive urine culture that is ≥105 microorganisms per cc of urine with no
more than two species of microorganisms AND
• Patient has no fever (>38 ºC), urgency, frequency, dysuria, or
suprapubic tenderness.
(Salamon 2009)
Conclusion
The increased incidence of CAUTI is not only an individual patient safety issue, but a
financial concern for hospitals as well. Urinary tract infections are the most common cause of
hospital-acquired infections and 80% of these UTIs are associated with the catheter use. As
we see the rates of UTI in table 1 has a very high incidence of UTI, because the care for
patients with indwelling catheters where assigned to unlicensed health care workers. Here the
main focus was on the basics—what are hospital-acquired conditions, what happens when
CAUTI occurs, what to report to the nurse, and the ABCs of care—Always check the entire
system; Bag below the bladder; use Clean technique when handling the catheter; Secure the
catheter. In table 2 the incidences of UTI were lower because the care was assigned to nurses
who inserted and monitored indwelling catheters. These nurses where provided with
educational materials skill videos and literature on inserting the catheter. The nurses learned
the CAUTIs were caused by microorganisms during insertion of the catheter. In addition, the
entire nursing staff licensed and unlicensed were provide with additional demonstration and
education on CAUTIs. The additional education provided to nursing staff indicated a very
low or no incidence of CAUTI in the hospital. However, during the project the only options
CATHETHER ASSOCIATED URINARY TRACT INFECTION
for securing catheters to reduce urethral trauma was a leg strap. The obstacles in using the
strap, it was moving too easily on the leg and physicians felt the straps could potentially be
constricting. It was very important to find a suitable alternative to secure the catheter
(Salamon, 2009).
Nurses have a major role in implementing evidence-based practice. Practice can
change be challenging. Clear communication regarding the patient care is very necessary
especially when working with a team of healthcare workers. The most important benefit from
the project was improved patient outcomes and improved satisfaction of nurses who gained
the ability to control the outcomes through evidence-based practice changes. And also
changed practice to save healthcare dollars, increase nurse satisfaction, and increase the
incidence of positive patient outcomes.
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CATHETHER ASSOCIATED URINARY TRACT INFECTION
References
Buchmann, B., & Stinnett, G. (2011). Reducing rates of catheter-associated urinary tract
infection. Alabama Nurse, 38(2), 5. CINAHL, EBSCOhost (accessed November
25, 2012).
Catheter Associated Urinary Tract Infections (CAUTI): Fact Sheet (2008). Wound
Ostomy and Continence Nurses Society. Retrieved from
http://c.ymcdn.com/sites/www.wocn.org/resource/collection/6D79B935-1AA04791-886F
E361D29F152D/Catheter_Associated_Urinary_Tract_Infections_(CAUTI)__FS_(2008).pdf
CAUTI Guideline Fast Facts (2009). Centers for Disease Control and Prevention.
Retrieved from http://www.cdc.gov/hicpac/CAUTI_fastFacts.html
General catheter-associated urinary tract infection (CAUTI) prevention practices (2010
July). News @ Catheterout. Retrieved from
http://www.catheterout.org/?q=general-prevention-practices.html
Salamon, L. (2009). Catheter-associated urinary tract infections: a nurse-sensitive
indicator in an inpatient rehabilitation program. Rehabilitation Nursing, 34(6),
237-241. CINAHL, EBSCOhost (accessed November 25, 2012).
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