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Be Very, Very Scared! What You Don’t Know CAN Kill You…

Hospital Associated Infections Part 2: Catheter Associated Urinary Tract Infections (CAUTI)

Posted by Deborah Caputo Rosen

54,500. That is the number of reported urinary tract infections linked to the use of a catheter in acute care hospitals in 2012. (cdc.gov/hai/progressreport/index.html) That is the GOOD news. The number of reported urinary tract infections linked to the use of a catheter was 93,000 in 2011! (cdc.gov/Other/disclaimer.html) Focused efforts to reduce healthcare associated infections such as these helped to reduce the incidence.

In 2008 the Federal Center for Medicare and Medicaid Services announced new rules for payment for the cost of treating “conditions that could reasonably have been prevented” (CMS 2012). Hospitals could no longer bill those e patients for any charges associated with hospital-acquired complications. Catheter associated urinary tract infections (CAUTIs) were identified as among those complications.

Why? Let’s understand urinary catheters.

A urinary catheter is a thin, flexible, sterile tube that is inserted into the urinary bladder through the urethra. Catheters can be used to drain the bladder only once and then removed or they may be “indwelling” and remain in place once inserted.. Indwelling catheters have a balloon that is inflated inside the bladder. This prevents the tube from slipping out of the body. Such catheters (often called Foley catheters) are connected to sterile tubing and a bag to collect and measure urine.

Catheters are inserted when a patient cannot urinate normally. Catheters can prevent damage to the urinary tract (bladder, ureters and kidneys) caused by retained urine. They may be used when a patient is anesthetized for lengthy surgery, for reconstructive surgery to the urinary tract, and when normal urination is not physically possible due to spinal cord injury.

Catheter associated urinary tract infections result from microorganisms entering the body via the catheter during insertion or handling of the tube. The system may also become contaminated by opening the collecting tubing and/or drainage bag. The drainage system works by gravity and must be kept below the level of the patient’s bladder to avoid backward flow of urine. Many of the common organisms that cause infection form “biofilms” on the catheter and are difficult to eliminate with antibiotics.

Catheters should be inserted only for appropriate medical indications and left in place for the shortest period of time necessary. Skin and mucous membranes that remain intact are good barriers to microorganisms. It is critical that the professional who inserts a catheter utilizes proper sterile technique and minimizes irritation to the lining of the urethra and bladder. All healthcare staff caring for patients with a catheter system always must practice correct hand hygiene, assure that the drainage system is not opened and maintain it below the patient’s bladder.

One challenge faced by patients is that the doctor or clinician who prescribed the catheter may not remember or notice that a patient remains catheterized; resulting in longer than necessary catheterization. As a precaution, patients and family members should be prepared to remind the healthcare team. The nurse caring for you should assume responsibility to obtain orders to remove the catheter.

Know, Ask, Speak

Wilson-Stronks advises all patients and their care companions to keep in mind the Wilson-Stronks patient safety mantra of “Know-Ask-Speak” to decrease risk of healthcare acquired infections, including catheter associated urinary tract infections (CAUTIs). When you or a patient you love enters the hospital….

Know:

  • What a catheter associated urinary tract infection or CAUTI is.
  • Why a catheter is being recommended/was used.
  • The name and credentials (MD, RN, PA, NP, medical or nursing student)) of the professional who will/did insert the catheter.
  • The difference between a single catheterization and an indwelling catheter.
  • This fact: The risk of CAUTI increases after 24 hours with an indwelling catheter.
  • This fact: If you/the patient is older than 60 years or has had a compromised immune system the risk of CAUTI is increased.
  • Fever is one sign of infection.
  • Collection of urine specimens (if indicated) should be done without opening the drainage system.
  • Urine should drain freely. Debris from the body can sometimes collect and obstruct a catheter. If the catheter is still necessary it must be replaced, not irrigated.

Ask:

  • Are there any alternatives to catheterization?
  • Can an ultrasound of the bladder can be done before catheterizing to measure the volume of urine and allow safe waiting for natural urination?
  • If a catheter must be inserted, can a single (“straight”) catheterization be performed instead of an indwelling type? When will the catheter be removed? And who will remove it?
  • Every day: Why the catheter is still in place and when it will be removed.
  • Whether you/the patient has a fever.
  • How the any required urine specimen will be collected. (It should be done without opening the collecting system and should follow sterile procedures).

Speak:

  • Request that providers wash their hands in front of you.
  • If a collection system is above your/the patient’s bladder insist that it is relocated correctly below the bladder to prevent back flow of urine.
  • If a specimen of urine is needed, insist that it is collected with sterile procedures without opening the collecting system.
  • Refuse to allow anyone to disconnect the drainage system.
  • Refuse to have the catheter irrigated because it is “clogged”. If it is still medically necessary, it must be replaced.
  • Tell your nurse and doctor if you have pain or feel feverish or achy.
  • Tell your nurse if you/ the patient seem(s) confused or unusually restless.
  • Notify your nurse if the urine in the collection bag appears cloudy or unusual in color.
  • If you/the patient may have fluids, drink as much as possible.