No catheter, No CAUTI (catheter associated urine No catheter, No CAUTI (catheter associated urine infection)infection)

Reducing avoidable harm in patients with catheters

January 2015

Faculty: <insert faculty>

No Catheter, No CAUTI - Background

• GSTT/ Health Innovation Network for South London– Project lead – Dr Adrian Hopper

• Reduce patient harm from catheterisation specifically catheter associated urinary tract infections (UTI’s)

• Catheter associated UTI’s are a major cause of hospital acquired bacteriemia– devastating impact on patients

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No Catheter, No CAUTI - The facts

• CAUTI– significant financial burden– extended hospital stay – can contribute to delirium & falls

• 26% of catheters inserted in A&E are inappropriate

• 1/3 of urinary catheter-days have been shown to be unnecessary

• Risk of CAUTI begins to increase after 48 hours of insertion

Source: xxxxx

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No Catheter, No CAUTI - The facts

Examples of Serious Harm Caused by CAUTIs...

1. Patient JC - 13 emergency admissions, 2 months period in hospital over 18 months due to CAUTI or blocked catheter

2. Patient CR - dementia diagnosis: died from severe sepsis despite critical care treatment following a CAUTI

Source: KHP 2014

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No Catheter, No CAUTI-The background

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No Catheter, No CAUTI Group work

Group 1Indications & contraindications of catheters. Why insert a catheter & why not?

Group 2Risks & complications of catheters. List & discuss implications inc to patients & services

Catheters - appropriate use

• Acute urinary retention or chronic urinary retention only if associated with renal impairment

• Clinical need to monitor urine output

• Severe sacral pressure ulcers

• Measurement of post void residual urine volume-if bladder scanner is unavailable

• Instillation of medication-e.g.. Chemotherapy

• Urethral stricture therapy

• Urological investigations

• Management of intractable urinary incontinence

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Catheters-inappropriate use

• Urinary incontinence (NB complete continence assessment - inc patient choice in provision of pads & products)

• Advanced age

• Immobility

• Urinary tract infection

• Signs of urethral trauma

• Patient refusal

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Risks/ Complications

•Injury/ trauma - urethra / bladder wall punctured

•Perforation of prostate gland

•Catheter associated urine infections

•Narrowing of urethra - secondary to scar tissue caused by repeated use of a catheter

•Bladder stones (usually develop after years of catheterisation)

•Psychological effect

•Pain/ Bladder spasm

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Anatomy and catheter placement

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Keeping our patients safe- what can we do

• Consider risk/ benefits before insertion

– Use clinical guidance to support decision making

• Review catheters every shift

– Are they needed? Can they be removed?

• Ensure documentation complete

– EPR insertion & continuing care forms to support decision making

• Daily clinical reviews

• Catheter passport

– Empowering & educating patients

Keeping our patients safe- what we can do?

Coffee Break

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References

© SaIL Centre 2015