The powerpoint narrates how to prevent CAUTI and application of Catheter care bundle

1. PREVENTION OF CAUTI
AND APPLICATION OF
CATHETER
CARE BUNDLE
Ms JASMIN DEBORA, Professor,
Department of Medical Surgical Nursing.
Ms .N. Swetha, Msc .Nurse
Department of Medical Surgical Nursing.
Nurses caring
catheterized clients
in MICU and SICU
NRI General Hospital,
Chinakakani,Guntur.
Topic
BY GROUP
Hospital

2. STRUCTRED TEACHING
PROGRAMME ON
PREVENTION OF CAUTI
AND APPLICATION OF
CATHETERCARE BUNDLE

3. GENERAL OBJECTIVES
At the end of the teaching session, the participants will be able to acquire knowledge on
UCCB maintenance and practice catheter care bundle guidelines in prevention of CAUTI.
SPECIFIC OBJECTIVES
•define the CAUTI
•describe the epidemiology of CAUTI
•list down the causes of CAUTI
•explain the pathogenesis of CAUTI
•enlist the prevention guidelines for CAUTI
•define care bundle
•define catheter care bundle

4. •define catheter care bundle
•identify the aim of CAUTI maintenance bundle
•distinguish the purpose of CAUTI bundle
•enumerate the principles of CAUTI bundle
•explain the insertion of Catheter
• explain the maintenance of Care bundle
•demonstrate the CAUTI maintenance bundle checklist

5. CAUTI PREVENTION

6. CAUTI increase
patients mortality,
morbidity, length of
hospital stays and
cause an economic
burden to the health
care system
CAUTI
The centre for disease
control and prevention
(CDC) mentioned that,
catheter associated
urinary tract infections
were the most common
health care associated
infections.
CAUTI
INTRODUCTION

7. A Catheter associated urinary tract
infection occurs when germs enter
the urinary tract through the urinary
catheter & cause infection.
CAUTI
The risk of CAUTI can be reduced
by ensuring that catheters are used
only when needed and removed as
soon as possible
CAUTI
Catheters are placed using
proper aseptic technique and
closed sterile drainage is
maintained,.
CAUTI

8. CAUTI
 >30% of HAIs
reported to
NHSN.
Estmated
>560,000
nosocomial UTIs
annually.
Estimated
13,000 attributable
deaths annually.
Leading cause
of secondary BSI
with 10%
mortality
CAUTI CAUTI
Urinary tract
infections are the
fourth most common
type of health care
associated infection
with an estimated
93,300 UTIs in acute
Care hospitals; UTIs
additionally account
for more than 12% of
infections reported by
acute care hospital.
CAUTI
The National
health care safety
network reported
CAUTI rates to be
from 3.1 to 7.5 per
1000 catheter days
in acute care
hospital
IMPACT OF CAUTI
Among UTIs
acquired in the
hospital,
approximately
75% associated
with a urinary
catheter.
Excess length of
stay 2-4 days.
Increased cost 0.4-
0.5 billion a year
nationally

9. 21.4%
Escherichia coli
21%
Candida
14.9%
Enterococcus
10%
pseudomonas
aeruginosa
7.7%
Klebisiella
pneumonia
enterobacter
4.1%.
CAUSES
OF
CAUTI

10. 3,4,
5
 URINARYRETENTION
 INCONTINENCE
LOWER PROFESSIONAL
TRAINING OF INSERTER.
1,2
 AGE
 GENDER
7,8,
9
DISCONNECTION
DRAINAGE SYSTEM
DURATION OF
CATHETERIZATION
IMPAIRED IMMUNITY.
6,7
 DIABETES
 ORTHOPEADIC
/NEUROLOGY SERVICES.
RISK FACTORS FOR CAUTI
10,11
 MEATAL
COLONIZATION.
 CREATININE(RENAL
DYSFUNCTION.)

13. Fever
Suprapubic tenderness
CostoVertebral Angle tenderness
Altered mental status
Dysuria,frequency,stranguria in the
abscence of catheter.
Flank tenderness
 Delirium.
13

15.  Leukoesterase
 Nitrates
 Wbc in microscopy
 Bacteria
 Positive blood culture
 Positive urine culture
 At least1 matching
uropathogenorganism.

16. Pediatric challenges
Urine bags should not
be used for culture
catheter inserted >10 days
new catheter specimen
catheter inserted < 10
days use the collection
port.
DONT’S FOR
INVESTIGATION

17. Non infectious complications includes non bacterial
urethral inflammation, urethral strictures, mechanical
trauma and mobility impairment
INFECTIOUS AND NON
INFECTIOUS
Infectious complications include urinary catheter
obstruction, bladder urolithiasis, purulent
urethritis ,gland abscesses and for males,
prostatitis.
COMPLICATIONS OF
CAUTI

18. STEP
CORE
MEASURES
SUPPLEMENTAL
MEASURES
STEPPREVENTIVE MEASURES
FOR CAUTI

19. CORE
MEASURES
FOR
PREVENTION
1,2
1.placement only for
appropriate indications.
2.Leave catheters in place
only as long as needed.
3
4.Insert catheters using aseptic
technique and sterile
equipment.
3.Ensure that only
properly trained persons
insert and maintain
catheters
4
5.Following aseptic insertion,
maintain a closed drainage
system.
5,6
7
6.Maintain unobstructed
urine flow.
7.Hand hygiene and standard
precautions.

20. SUPPLEMENTAL
MEASURES TO
PREVENT
CAUTI
1
2
3
4
5,6
5.Electronic reminders
1..Alternatives to indwelling
catheterization
6.Nurse based interventions
3.Intermittent catheterization
4.Use of anti microbial/
antiseptic catheters.
2.Portable bladder
ultrasound scanner

21.  Complex urinary drainage systems.(eg.antiseptic-releasing
cartridges in drain port.)
 Changing catheters or drainage bags at routine,fixed
intervals(clinical indications include infection ,obstruction
,or compromise of closed system.
 Routine antimicrobial prophylaxis.

22.  Cleaning of periurethral area with antiseptics
while catheters is in place.
 Irrigation of bladder.
 Instillation of antiseptic or antimicrobial
solutions into the drainage bags.
 Routine screening for asymptomatic bacteriuria.

23.  Compliance with hand hygiene.
 Compliance with educational programme.
 Compliance with documentation of catheter insertion and
removal.
 Compliance with documentation of indications for catheter
placement.

24. Examples of metrics
Number of CAUTI per 1000 catheter days.
Number of BSI secondary to CAUTI per 1000
catheter days.
Catheter utilization ratio (urinary catheter-
days/patient-days)*100.
Use CDC/NHSN definitions for numerator data.

25. 25

26. 2.It is defined as a group
of interventions related
to a diseases process that
when implemented
individually
CARE BUNDLE
1.A Care bundle is a group
of evidence based practices
that improve the quality of
care when consistently
applied to all participants
CARE BUNDLE
DEFINITION
OF CARE
BUNDLE

27. Urinary catheter care bundle
are shown to be effective in
reducing the rate of catheter
Associated Urinary tract
infections.

28. 28
Remove the
catheters as
soon as
possible.
To reduce
the rate of
catheter
urinary tract
infections.
care for
catheters
individually
.

29. CAUTI BUNDLE
The implementation of care
bundles can assist in enhancing
compliance to evidence based
quality process measures to
improve patient care
01
USES
CAUTI BUNDLE
Care bundles include a set of evidence
based measures that when implemented together
have shown to produce better out comes and have a
greater impact than that of the isolated
implementation of individual measures
02
USES
CAUTI BUNDLE
Strong clinician engagement and endorsement
03
USES
CAUTI BUNDLE
Bundles also help to create reliable and consistent care
systems in hospital settings .
04
USES
USES OF CAUTI
BUNDLE

30. Each element must be
implemented collectively and
be adapted to the local setting;
appropriately followed.
Health care providers are
advised to follow each bundle
element by all members of the
health care team involved
Develop and promote a positive habit
forming behavior among providers and
ultimately a reliable care processes
CPRINCIPLE
BPRINCIPLE
APRINCIPLE
GENERAL
PRINCIPLES OF
CAUTI BUNDLE

31. INSERTION OF CATHETER
There are a multitude of varieties each with their
own unique attributes for special situations. The
ones you will most commonly see on this rotation
are regular, coude tip, 3-way and whistle tip.
UNIVERSAL PRECAUTIONS
There is the potential for contact with a patient's
blood/body fluids when working with catheters, this risk
increases with the inexperience of the operator. This is a
sterile procedure & should be treated as such.

34. INDICAT
ION 1
Foley catheter insertion allows us to drain,
decompress, obtain a specimen, and irrigate
the bladder. This will allow you to treat
urinary retention, bladder outlet obstruction,
evacuate clot, and monitor urine output
INDICATI
ON 2
In some cases, as in urethral stricture
or prostatic hypertrophy, insertion
will be difficult and may require
consultation with urology

35. Sterile gloves - consider Universal
Cleansing solution e.g. Betadine or aqueous
Precautions
Sterile drapes
Cotton swabs
Chlorhexidine
Sterile water & syringe (usually 10 cc)
Forceps
Lubricant (water based jelly or xylocain
Foley catheter (usually 16-18 French)
EQUIPMENTS

36. STEP
03
STEP
01
Explain procedure to
the patient
Open catheterization kit
and catheter
Gather Equipment
STEP
02
Assist patient into supine position with
legs spread for men (and patient truly
flat) and in women feet together or frog
leg
STEP
04
PROCEDURE

37. c
Generousl
y coat the
distal
portion
(2-5 cm)
of the
catheter
with
lubricant
STEP 8
Do not check
balloon for
patency,
inflating
alters the
contour &
can make
insertion
more
difficult &
uncomfortab
le
STEP 7
Put on
sterile
gloves
STEP 6
If male
patient
retract
foreskin
STEP 5
c
STEP 9
Remove
the cap on
the
syringe
containing
sterile
water.
You can
choose to
attach to
catheter
now or
after you
have
successfull
y inserted

38. STEP 11b
For men – until the hub of
the catheter reaches the
meatus, ie to the hilt
STEP 11a
For women - until 2 to 3
inches beyond where urine
is noted
STEP 11
Identify the
urinary meatus
and gently insert
STEP 10
Discard all except two cotton swabs
in the kit. You don’t need them and
they soak up prep. Pour prep on the
cotton swabs
STEP 11c
Inflate balloon, using
correct amount of sterile
liquid (usually 10 cc but
check actual balloon size)

39. Gently pull catheter
so that inflation
balloon is snug
against bladder neck
Connect catheter
to drainage
system
Secure catheter to
thigh, with a bit of
slack
Remove gloves, dispose
equipment
appropriately, wash
hands
Document size of
catheter inserted,
amount of water
in balloon
STEP 12
STEP 13
STEP 14
STEP 15
STEP 16

40.  Antimicrobial prophylaxis
 Urinary antiseptics (i.e., methanamine)
 Bladder irrigation
 Antiseptic instillation in the drainage bag
 Periurethral care
 Routine catheter or bag change
 Catheter lubricants

41.  Securing devices
 Bacterial interference
 Catheter cleansing
 Catheter removal strategies (clamping vs. free drainage prior to
removal, postoperative duration of catheterization)
 Assessment of urine volumes

42.  Evaluate post void residual (PVR) using handheld ultrasound.
 High PVR is not equal to retention.
 Take into account voided volume and symptoms .
 If PVR over 300ml_ consider alternative drainage.
 If empty assess volume status.
Catheter removal strategies

43. MAINTENANCE BUNDLE CHECKLIST YES NO
Hand hygiene was performed before and after client contact?
Gloves were used to manipulate the catheter and/or the drainage
system?
Catheter is anchored by a stabilization device (to the upper thigh in
women – upper thigh or lower abdomen in men)?
Catheter has been continuously connected to tubing and drainage
system?
If catheter was disconnected from the drainage tube, was the
connection site disinfected again prior to reconnection of tubing?

44. Drainage bag is below level of the bladder and not in contact with
the floor? .
Drainage bag was emptied regularly into a separate clean container
dedicated for client use only ?
There was no contact between the non-sterile container and the
drainage bag spout when emptied?
Perineal area and catheter entry site were cleansed with soap and
water (or an approved product) at least once daily and after each
bowel movement
Is there a planned date for catheter replacement based on the 12
week maximum or the client’s catheter change record?

45. CONCLUSION
Catheter associated urinary tract infections were the most common health care
associated infections. A Catheter associated urinary tract infection occurs when germs
enter the urinary tract through the urinary catheter & cause infection. Urinary catheter
care bundle are shown to be effective in reducing the rate of catheter Associated
Urinary tract infections. Hand hygiene was performed before and after client contact,
Gloves were used to manipulate the catheter and/or the drainage system, Catheter is
anchored by a stabilization device . There was no contact between the non-sterile
container. Drainage bag is below level of the bladder . Perineal area and catheter entry
site were cleansed with soap and water. Catheter replacement to be done on based
catheter change record.

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associated urinary tract infection (CAUTI) among patients with indwelling catheter
in selected wards of MGMRI ”,volume 1, issue 2, 2018, ISSN- 2639-3629.
3.Eglal hassanein abdel “the effect of implementing urinary catheter care bundle on the
prevention of CAUTI” IOSR journal of nursing and health science , vol.7,
no.1,2018,pp.37-46.

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 7.Sean Wasserman,Angelika messina “guide to infection control in the hospital”
Chapter 16,February 2018
 8.http://www.nihms.com/er
 9. www.ahqr.gov,pub no.15-0073-2-EF,September 2015.
 10. http://www.ECRI.org/ signs and symptoms.