Catheter Associated Urinary

Tract Infections (CAUTI)

by Brooke Bracy and Jean-Baptiste Kagabo

A catheter-associated urinary tract infection (CAUTI) occurs

when germs (usually bacteria) enter the urinary tract through the

urinary catheter and cause infection.

*Catheter-associated Urinary Tract Infections: Frequently asked questions. Retrieved April 6, 2015 from http://www.cdc.gov/HAI/ca_uti/cauti_faqs.html.

What are CAUTIS?

● About 25% of hospitalized patients exposed to catheters

during their stay

● Occurrence of catheter associated bacteriuria is 26% in

patients with indwelling catheter for 2 to 10 days

● Roughly 3% will develop bacteremia of urinary origin

● 24% of those acquiring bacteriuria will advance to CAUTI

*Greene L, Marks J, Oriola S. Association for professionals in infection control. Guide to The Elimination of Catheter Associated Urinary Tract Infections

(CAUTIs). 2008, p. 5.

Problem

Extraluminal - Outside catheter:

Intraluminal - Inside catheter:

- Biofilm

- Biofilm

- Encrustation

- Encrustation

- Fecal incontinence

- Contamination of sample port

- Organism migration -

Contamination of outlet port

- Disconnection of drainage

system or catheter

Causes

The catheter is: left in place for more than 6 days

inserted in a place other than an operating room

used to measure urinary output

not positioned correctly and the level of the drainage tubing is above the bladder or below the level of the drainage bag

The person:

is female

is pregnant

is malnourished, frail, or has chronic illness

has diabetes mellitus

has azotemia (creatinine > 2.0 mg/dL) 4 3 drainage bag

not maintained as a closed system (e.g., switching between gravity and leg bag drainage systems)

has a ureteral stent

has other sites of infection

is immunosuppressed

has a catheter in place post fractured hip and resides in a nursing home

*Catheter Associated Urinary Tract Infections: Fact Sheet. Retrieved April 6, 2015 from

http://www.wocn.org/pdfs/WOCN_Library/Fact_Sheets/cauti_fact_sheet.pdf.

Contributing Factors

● CAUTI can cause complications, such as endocarditis, prostatitis, epididymitis,

and orchitis in males, and cystitis, pyelonephritis, gram-negative bacteremia,

vertebral osteomyelitis, septic arthritis, endophthalmitis, urosepsis, and meningitis

in all patients

● Complications can also cause discomfort in the patient, that also lead to extended

hospital stay and increased cost, as well as mortality

*Catheter Associated Urinary Tract Infections: Fact Sheet. Retrieved April 6, 2015 from

http://www.wocn.org/pdfs/WOCN_Library/Fact_Sheets/cauti_fact_sheet.pdf.

* Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) and Other

Urinary System Infection [USI]) Events. Retrieved on April 6, 2015 from http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf

Complications

● Among UTIs acquired in the hospital, about 75% are associated with a urinary

catheter

● CAUTI is the 2nd most common cause of nosocomial bloodstream infection

● Incidence of conversion from sterile urine to bacteriuria occurs at rate of 3-10%

per day

● Estimated more than 13,000 deaths per year associated with UTIs

*Catheter Associated Urinary Tract Infections: Fact Sheet. Retrieved April 6, 2015 from

http://www.wocn.org/pdfs/WOCN_Library/Fact_Sheets/cauti_fact_sheet.pdf.

*Catheter Associated Urinary Tract Infections (CAUTI) Event. Retrieved April 6, 2015 from

http://www.cdc.gov/nhsn/pdfs/pscManual/7pscCAUTIcurrent.pdf.

National Statistics

● Blodgett Hospital 3E/3G Orthopedic Unit, which has 46

beds,CAUTI statistics consist of an average of 1 infection in

2014

Spectrum Health Statistics

● Peri-operative use in selected surgical procedures

● Urinary output in critically ill patients

● Assist in healing of open perineal and sacral wounds in

incontinent patients

● Chronic indwelling urinary catheter on admission

● Acute urinary retention/bladder outlet obstruction

● Hospice or palliative care

● Prolonged immobilization for trauma or surgery

*CDC Guidelines for Appropriate Indications for Indwelling Urethral Catheter Use, 2009.

Implications for Catheter Use

● Do not change indwelling catheters, or drainage bags, at routine intervals. Should

only be changed on clinical signs of infection, obstruction, or when closed system

is compromised

● Do not inflate balloon before insertion. The silicone can form a cuff/crease at the

balloon area that can cause trauma to urethra during catheter insertion

● Do not pull back on syringe to remove fluid from Foley balloon when removing,

let it deflate, and do not cut off lumen. Slow passive balloon deflation aids return

of pre-inflated shape and decreases incidence of cuffing which can cause urethral

trauma

● Cleansing of the meatal surface during daily bathing or showering with soap and

water

* CDC Guidelines for Prevention of CAUTI, 2009.

*Smith. J. Indwelling Catheter Management: From Habit Based to Evidence Based Practice. Ostomy Wound Management, Dec 2003.vol.49-12,34-45.

*Gonzalgo. M and Walsh P. Urology 61:825-827, 2003). Mosby Procedure: Urinary Catheters: Indwelling Catheter Removal.

Recommendations

● Insert catheters only for appropriate indications

● Leave catheter in place only as needed

● Ensure that only competent health care workers insert and maintain

catheters

● Maintain unobstructed urine flow

● Proper hand hygiene

● Use aseptic technique for insertion and maintain a closed drainage

system* Catheter-associated Urinary Tract Infection (CAUTI) Toolkit (2009). Retrieved April 6, 2015 from

http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

CAUTI Prevention

● Assess for signs and symptoms of (UTI):

○ Burning or pain in the lower abdomen,fever, cloudy malodorous

urine, hematuria, chills, anorexia and malaise

● Assess the color, odor, and volume of urine

● Assess patient’s fluids intake

● Assess for kinks or twists in catheter or collecting tube

● Assess to see if collecting bag needs changing

● Assess to make sure collecting bag is below bladder level and does not

touch the floor

● Assess if patient truly needs catheterization

● For elderly patients, assess for any subtle change in physical condition or

mental status because sepsis may occur before infection is diagnosed.

*Smeltzer, S. (2010). Management of Patients with Urinary Disorders. In Brunner and Suddarth's textbook of medical-surgical nursing (12th ed., Vol. 2, p.

1373). Philadelphia, PA: Wolters Kluwer.

Nursing role: Assessment

● Acquire education materials needed for pt. education.

● Discus with pt. the possibility of intermittent catheterization instead of

indwelling catheter.

● Discuss with pt. to notify a nurse if signs and symptoms of UTI are noted.

● Plan using bladder scanner to avoid unnecessary intermittent

catheterization.

● Schedule with the pt. time to perform perineal care.

* CDC Guidelines for Prevention of CAUTI, (2009).Retrieved April 6, 2015 from http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf

Nursing role: Planning

● Educate pt. on how to maintain catheter safety while moving

● Encourage pt. to drink plenty fluids unless contraindicated

● Assess for catheter patency and kinking

● Obtain urine sample aseptically, monitor urinalysis, and also signs and symptoms

of UTI

● Instruct patient or caregiver on signs and symptoms of UTI

● Empty bag when it is ½ to ⅔ full

● se sterile technique when inserting or maintaining catheter

● Change or remove catheter as soon as indicated

● Administer antibiotics as ordered

● Properly secure indwelling catheters after insertion

● Change or remove catheter as soon as indicated

● Administer antibiotics as ordered

* CDC Guidelines for Prevention of CAUTI, (2009).Retrieved April 6, 2015 from

http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf

Nursing role: Interventions

● Evaluate patient’s ability to void

● Evaluate patient’s response to therapy

● Evaluate patient’s understanding of safety while using indwelling catheter

● Evaluate self for understanding of protocol for insertion and removal techniques

● Evaluate self for proper understanding of care of pt. with indwelling catheter

* Clinical Practice Guidelines. Care of the Patient with an Indwelling Catheter, (2005). Retrieved from

http://www.fycurology.com/indwelling_catheter_care.pdf

Nursing role: Evaluation

● Provides guidelines to help healthcare providers in ordering IUC

● Provides for nurses to follow while inserting, maintaining or removing

IUC

● Provides education materials on its website

● CAUTI surveillance committee

Spectrum’s Initiatives

● Research articles on Insite to help healthcare workers learn new

evidence-based practices.

● https://www.youtube.com/watch?v=WPFSlGccmxE

● Policies and protocols for health care workers.

Education

Materials