Once considered so benign and low priority they were termed the “Rodney Dangerfield” of infections, catheter-associated urinary tract infections (CAUTIs) are gaining respect – but giving little ground.
Nationally, there was no reduction in CAUTIs between 2009 and 2014 despite a national emphasis on prevention. However, there was progress in non-ICU settings between 2009 and 2014, and progress in all settings between 2013 and 2014, the CDC reports.1
Some programs are having significant success, but first a note on the prevailing myth that CAUTIs are a nuisance infection of little clinical consequence. A study of 7,217 bloodstream infections traced 1,510 (21%) of them back to a urinary source, usually involving a Foley catheter. Indeed, the presence of a Foley catheter – along with other patient risk factors -- was associated with mortality at 30 days.2 Even less serious CAUTIs - one of the most common healthcare-associated infections - restrain patient movement, contribute to antibiotic use and resistance, and may not be reimbursed because they are increasingly seen as preventable.
A key to CAUTI prevention – if it can be reduced to a single intervention - is removing catheters promptly when they are no longer medically indicated. To do this, one approach is having someone monitor catheter days and regularly update staff, says Vicki Allen, RN, MSN, infection prevention director at CaroMont Regional Medical Center in Gastonia, NC.
“That’s done through our department,” she tells Hospital Infection Control & Prevention.
Allen and colleagues create and circulate a line list daily on the status of patient catheterization, prompting discussions of removal when medically indicated. The measure is part of the recommendations in a CAUTI prevention toolkit3 created by the Agency for Healthcare Research and Quality (AHRQ).
According to an AHRQ report4 on CaroMount’s program, CAUTIs fell to an estimated nine infections per 100,000 patient days in 2015, as incremental progress dramatically reduced the 87 CAUTIs per 100,000 patient days reported in 2009. The infection prevention effort has been highly effective in the general medical wards, but it remains difficult to prevent CAUTIs in critical care patients.
“The patients in the critical care unit are much more dependent on the catheters, so it is harder to remove them,” Allen says.
Other basic CAUTI prevention measures recommended in the AHRQ toolkit include:
- Urinary catheters should not be used solely for the convenience of health care workers. Document attempts at and inadequacy of alternative methods for bladder elimination prior to insertion of the indwelling catheter.
- Urinary catheters should be placed only under the direction of a physician order. However, if the patient’s nurse feels the catheter does not meet the indications for placement, the nurse should question the need.
- Indwelling, straight, and suprapubic urinary catheters should be inserted using aseptic technique and sterile equipment.
- Sterile gloves, drape, and sponges; an appropriate antiseptic solution for periurethral cleaning and a single-use packet of lubricant jelly should be used for insertion.
REFERENCE
- CDC. Healthcare-associated Infections (HAI) Progress Report. March 2016: http://1.usa.gov/21bDcdo
- Fortin E, Rocher I, Frenette C, et al. Healthcare-associated bloodstream infections secondary to a urinary focus: the Québec provincial surveillance results. Infect Control Hosp Epidemiol 2012 May;33(5):456-462.
- Toolkit for Reducing CAUTI in Hospitals. October 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://1.usa.gov/1WJkoW4
- Agency for Healthcare Research and Quality AHRQ. North Carolina’s CaroMont Regional Medical Center Uses AHRQ Toolkit to Reduce Urinary Infections. March 2016, Rockville, MD: http://www.ahrq.gov/policymakers/case-studies/201601.html
