Preventing Catheter-Associated Urinary Tract Infections

[Virtual Presenter] Preventing catheter associated urinary tract infections..

[Audio] At the conclusion of this module the learner will be able to: Identify what CAUTI is Identify the three steps to reduce CAUTI Identify CAUTI prevention measures.

[Audio] CAUTI is a catheter associated urinary tract infection. A CAUTI is a urinary tract infection which occurs is a patient who had an indwelling urethral urinary catheter in place forty-eight hours prior to the urinary tract infection diagnosis and up to thirty days post removal or discontinuation of the catheter..

[Audio] The majority of catheter associated urinary tract infections are caused by instrumentation of the urinary tract. CAUTI is the leading cause of secondary hospital associated bloodstream infections. Studies show that U T I 's make up the highest number of infections compared to other hospital acquired infections. An estimated 17%-69% of CAUTI may be preventable with applying evidence-based practices in caring for our patients.

[Audio] The source of microorganisms causing CAUTI can be endogenous, meatal, rectal, or vaginal colonization; or exogenous, equipment, contaminated hands. The catheter provides a portal of entry into the urinary tract. Organisms can enter the bladder at the time of catheter insertion, through the catheter lumen from a colonized drainage bag, or along an external surface of the catheter. Bacteria can establish colonization of a patient's bladder within three days. This introduction of bacteria is often associated with catheter related biofilms. Biofilms are structures that include bacteria, host cells, and cellular by products; this formation is considered as a primary mechanism in the development of certain diseases as well as CAUTI ..

[Audio] Biofilm is bacteria and fungi that adhere to a surface. It can grow on living and non-living surfaces. Biofilm attaches within minutes and forms colonies within two to four hours..

[Audio] Please observe these pictures to see what biofilm looks like and what it does to a urinary catheter..

[Audio] Prevention of CAUTI focuses on three parts; Appropriate catheterization, proper catheter insertion and maintenance and prompt removal..

[Audio] Only insert an indwelling urinary catheter if the patient meets the criteria. Indwelling urinary catheters are used to treat Critical care patient requiring strict I&O AND hemodynamically unstable Urinary Retention/ Obstruction – not relieved by intermittent straight catheterization Prolonged immobilization due to unstable thoracic or lumbar spine until surgically repaired Promote healing incontinent patients with stage III-IV sacral wound if urine cannot be contained by an external catheter Unstable fractures until surgically repaired Urological Conditions Urinary Retention due to neurogenic bladder Relieve urinary/ bladder outlet obstruction Hematuria Requires order by genitourinary surgeon to discontinue indwelling catheter End of Life care for patient comfort.

[Audio] A patient cannot get a CAUTI if they do not have an indwelling urinary catheter. Utilize the bladder scanners when assessing a patient or when considering the need for a catheter. This will help you determine the volume of urine the patient is retaining. Indwelling catheters do not always need to be used, intermittent catheterization is also an option. Condon catheters, and external urinary catheter devices like purewick and primafit , are available as well. Toileting every two hours helps get the patient on a routine and encourages urinary removal..

[Audio] Huddles are short and patient focused for information sharing. The focus is to heighten awareness of a situation or to enhance prevention efforts. Identify who has a Foley, whether the Foley is still necessary (based on CAUTI algorithm) and if it is no longer necessary, discontinue usage (Foley catheter). As nurses we need to keep the foley days and indications foremost in hand off and during interdisciplinary rounds, ensuring we promote early removal so no CAUTI occurs..

[Audio] Before inserting an indwelling urinary catheter refer to the CAUTI Algorithm. Take a minute to read this slide. This will guide you through the insertion and removal key-points..

[Audio] Insert a catheter only for appropriate indications. Use sterile equipment which includes sterile gloves, drape, sponges, and antiseptic solution. Use aseptic technique to insert catheter. If aseptic technique is broken, replace the catheter and collection system aseptically with sterile equipment. Always, secure the catheter to prevent catheter movement and urethral traction. Please remember to Label drainage bag with orange sticker which is included in the foley kit..

[Audio] Catheter care includes a stat lock stabilization device is in use and that there is a labeled graduate cylinder for each patient for output measurements..

[Audio] When it comes to urinary catheter tubing, positioning matters. The goal is to maintain an unobstructed urine flow as well as a closed system. The foley bag needs to be always below the level of the bladder. It may not rest on the floor. No dependent loops. Catheter drainage bags are emptied before the patient is transferred to a test or procedure and at the 1000 milliliter mark..

[Audio] Although UTIs can result from the patient's own flora, they may also be the result of microorganisms transmitted by staff when handling the urinary catheter drainage system and/or providing incontinence care. Hand hygiene remains one of the most effective infection control tools available..

[Audio] Catheter care included perineal care. Preform perineal care daily and after each bowel movement. Perineal care for a patient with an indwelling urinary catheter is essential. We need to keep the perineal area clean to keep contaminants away. Utilize the bathing towelettes to perform perineal care..

[Audio] Always change your gloves before starting the perineal care to prevent contamination. Use one wipe per swipe while performing perineal care. Wipe around the meatus from top to bottom..

[Audio] Assess the patient every shift for catheter need. Take steps to remove the catheter when the patient no longer meets indication. Talking about the catheter and the indications at every hand off and during interdisciplinary rounds will help prompt Early catheter removal..

A Word About NOT Culturing. Checklist to order a urine culture in a patient with a current or recent foley catheter: The patient must meet one of the following criteria for culture to be ordered. (If another organ system infection is present or criteria below are not met, CAUTI is unlikely and sending a urine culture is not recommended). New or worsening fevers (with no other identified source) Altered mental status (with no other identified source) Rigors (with no other identified source) New flank pain or costovertebral angle tenderness New pelvic pain or discomfort.

[Audio] Remember the A B C D E of the bladder bundle..

[Audio] Documentation of catheter is found on the assessment intervention flowsheet. To add the Urethral Catheter row to your flowsheet, right click and 'add parameter'. Type in urethral catheter in the search box..

[Audio] The foley catheter maintenance elements include a daily assessment of the catheter..

[Audio] This included the indication or necessity of the catheter..

[Audio] It is essential to fully document the care provided which included that the tamper seal is intact, there is a free flow of urine, the catheter bag is below the bladder and not touching the floor. All three of these are located under Catheter Drainage Method..

[Audio] The securement of the catheter is also documented..

[Audio] On the Intake and Output flowsheet, document the amount of urine emptied under output, catheter, indwelling urethral in milliliters..

[Audio] The catheter care also includes the perineal care that was provided. Document this on the Assessment and Intervention flowsheet under Skin Care, Hygiene Care..

[Audio] This slide shows perineal care radial box located under Hygiene Care..

[Audio] To document that a labeled graduate cylinder was used, on the assessment intervention flowsheet under DAILY Care there is a row labled Elimination assistance. The last item in the elimination assistance box is 'drainage bag emptied into a patient specific container'..

[Audio] The patient and or family needs to be instructed on why they are receiving a catheter, and what to report to the nurse. Provide Exit Care instructions for them to review as well. There are two titles we provide; Foley Catheter Adult and Facts about CAUTI..

[Audio] This slide shows the exit care selections..

[Audio] Data collection and analysis are important for performance improvement activities. Catheter audits are performed on every unit. This is a way to track our rates, compliance with best practices and identify areas for improvement. Participate in audits and ask for feedback..

[Audio] Thank you.. References:. MSSN Policy: Indwelling Urinary Catheters PF-IC-198 7.22.2022 MSSN Policy: Standard Precautions Transmission Based Precautions PF- IC- 260 Surestep Foley Tray System Foley catheter insertion and removal procedure. Retrieved from surestep.bardmedical.com/media/675892/ud-surestep-insertion-removal-procedure.pdf Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide. Content last reviewed October 2015. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/hai/cauti-tools/impl-guide/index.html.