CAUTI stands for Catheter Associated Urinary Tract Infection. This is caused when microorganisms, most commonly E.coli, enter the bladder during or after the insertion of a urinary catheter. It is the center of the word PRECAUTION, and therefore it should be the center of your focus.
CAUTI is the #1 Hospital acquired infection (HAI), & can account for 40% of all nosocomial infections. AND This is 100% preventable which is why Medicare/medicaid determined to be a “never event” meaning it should never happen. - And you and I both know what that means, NO MONEY $$$$$$$ In 2005, The Centers for Medicare and Medicaid (CMS) identified CAUTI as a “never event”, determining that it was completely preventable if appropriate steps were taken during the insertion and maintenance process. The Centers for Medicare & Medicaid Services (CMS), as a result of the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005, has identified CAUTI as a “never event.” -APIC-
d/t lack of knowledge or sloppiness, this is caused by microorganisms that are introduced either during or after insertion. Simple solution- learning the procedure and following the procedure every time This is not a time to cut corners or cheat.
How it occurs: Outside the catheter- Inside the catheter- Urinary Catheter Contamination can occur in two ways, Extraluminal- Insertion of the urinary catheter tip, from organisms on the external urethral meatus Dragging of organisms along the full length of the urethra as the catheter is inserted fully into the bladder Pathogens in the perineum ascending from the catheter to the urethra. Ex. Enterococci , Staphylococci , and Candida species Capillary action in the thin mucous film surrounding the catheter, can lead to BSI Intraluminal- Retrograde reflux of contaminated urine. Moving or manipulating the catheter or collection system. Opening the closed drainage system. The most common organisms associated with CAUTI are Escherichia coli (21.4%), Candida (21%), Enterococcus (14.9%), Pseudomonas aeruginosa (10%), Klebsiella pneumonia (7.7%), and Enterobacter (4.1%). If a biofilm occurs when the catheter is not properly inserted causing damage to the urethra or when catheter care is not performed. This leads to a polysaccharide matrix caused by multiple microorganisms growing on the catheter. Occurs within 18 ° can lead to bladder obstruction, sepsis/ BSI, and/or death. The only way to rid of a biofilm on the catheter is to replace it with a new one.
What Criteria must be met to insert cath Foley Catheter Management System A unique removable sticker ‘flags’ the clinician to identify if there is a valid clinical reason for the patient to be catheterized. Once confirmed, a checklist is provided to ensure policies and procedures are followed. -Medline
State alt./pref. methods to catheterization
Hand/Cath hygiene – Washing hands c soap or antibacterial foam a and p patient care (WHO My 5 Moments) washing cath c soap and water during bathing “ Remember is it never acceptable to replace hand hygiene with glove usage.”- CDC
Go over primary & Secondary patient related factors… Caregiver related factors
Female, age > 50, fecal incontinence, previous UTI, having diabetes, hx of previous catheter, duration that catheter is in place--risk for infection increases each day catheter is left in place.
* Mention increased costs, LOS, and death rate* *Stats derived from CDC Use of indwelling urinary catheters is unnecessary in more than one third of patients. A total of 256 physicians and students completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. Overall, providers were unaware of catheterization for 28 percent of their patients. Catheter use was inappropriate in 31 percent of the 117 patients. Catheterization was more likely to be appropriate if respondents were aware of the catheter. - Saint, et al 2000 Are physicians aware/cracking the case Any benefit of urinary catheters for patients postoperatively is offset, however, by the substantial risk of a urinary tract infection (UTI), accrued in direct relationship with the duration of catheterization, estimated to be 5% to 10% per catheter-day beyond the first 48 hours of catheterization. Indwelling cath. (2008)
Patient Education: Patient Education What is a catheter? What should you know about a catheter? Can you reduce your chances of getting an infection? What is a catheter-associated urinary tract infection (CAUTI)? What are some symptoms if you have a urinary tract infection (UTI)? What about when you are going home? When to remove a urinary catheter? – ASAP Preferably in 24 hrs or less Document the catheterization procedure and patient education in the nurse’s notes.
Staff Education: Per CDC guidelines- Ensure that healthcare personnel and others who take care of catheters are given periodic in-service training stressing the correct techniques and procedures for urinary catheter insertion, maintenance, and removal. ERASE Implement quality improvement (QI) programs or strategies to enhance appropriate use of indwelling catheters and to reduce the risk of CAUTI based on a facility risk assessment. Examples of programs that have been demonstrated to be effective include: 1. A system of alerts -reminders to identify all patients with urinary catheters and assess the need for continued catheterization 2. Guidelines and protocols for nurse-directed removal of unnecessary urinary catheters- OFMQ 3. Education and performance feedback regarding appropriate use, hand hygiene, and catheter care- MY 5, pocket cards, 4. Guidelines and algorithms for appropriate peri-operative catheter management, such as: a. Procedure-specific guidelines for catheter placement and postoperative catheter removal - ERASE b. Protocols for management of postoperative urinary retention, such as nurse-directed use of intermittent catheterization and use of ultrasound bladder scanners 2D.2. Routine screening of catheterized patients for asymptomatic bacteriuria is not recommended. 2D.3.Perform hand hygiene immediately before and after insertion or any manipulation of the catheter site or device. My 5
An example of a quality improvement program available for hospitals is the ERASE program by MEDLINE. This program serves to teach the healthcare staff about proper technique and maintenance of urinary catheters to decrease and prevent the occurrence of CAUTI. End presentation c something about how this program is being used and has been show to reduce the rate of CAUTI within hospitals by teaching staff on technique and care. While this program is normally only accessible for health care facilities, MEDLINE has given OSU-OKC access to this learning module in order to help educate us in “the race to ERASE CAUTI” (teaching to prevent CAUTI) STEPH: “ Race to ERASE CAUTI” is what is imprinted on bracelets.. If you can think of someway to incorporate that with this slide, GREAT!! If not, no big deal..
Pre caut ions12611
Presentation By : Bobbie’s “Best Sunday Group Yet”
Female Age > 50 Fecal Incontinence Previous UTI Diabetes Mellitus Hx of previous urina ry catheter Duration of time ca theter is left in place
Blodgett, T. J. (2009). Reminder Systems to Reduce the Duration of Indwelling Urinary Catheters: A Narrative Review. Urologic Nursing , 29 (5), 369-378. Butler, T. (2010). Professional nurses can and must prevent urinary tract infections. Oklahoma Nurse , 55 (4), 10. Centers for Disease Control and Prevention. Catheter-associated urinary tract infection (CAUTI) event. 2009. http://www.cdc.gov/nhsn/pdfs/pscManual/7pscCAUTIcurrent.pdf . Dumont, Cheryl, and Janine Wakeman. "Preventing catheter-associated UTIs: survey report." Nursing 2010 40 (2010): 24-30. 18 Nov. 2011 <http://journals.lww.com/nursing/Fulltext/2010/12000/Preventing_catheter_associated_UTIs__Surv ey_report.9.aspx#P34>. Elpern, Ellen, and Kathryn Killeen, and Alice Ketchem, and Amanda Wiley, and Gourang Patel, and Omar Lateef. Reducing use of indwelling urinary catheters and associated urinary tract infections.." American journal of critical care : an official publication, American Association of Critical-Care Nurses 18 (2009): 535-541. "ERASE CAUTI program." Medline University. 1998. 28 Oct. 2011. <https://www.medlineuniversity.com/Courses/Uploaded/1010000042/transcript.htm>. Falconio-West, Margaret. "CAUTI prevention: cracking the case." The OR Connection 62-74. 10 Nov. 2011 <https://www.medlineuniversity.com/elearning/course/1010000457/?tabId=62&moduleId=144&Go BackTo=4DF>. Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs). APIC. Available at: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/APICEliminationGuides/CAUTI_ Guide 0609.pdf . Accessed November 19, 2011.
Joint Commission. R3 Report. “Catheter-associated urinary tract infections: Issue 2, September 28, 2011, available at: http://ow.ly/709mW Maki DG and Tambyah PA. Engineering Out the Risk of Infection with Urinary Catheters. Emerg Infect Dis, 2001; 7(2) . http://www.cdc.gov/ncidod/EiD/vol7no2/pdfs/maki.pdf Saint, S. Catheter Out. 1 Nov. 2011. <http://catheterout.org/>. Saint S, Wiese J, Amory JK, Bernstein ML, Patel UD, Zemencuk JK, et al. Are physicians aware of which of their patients have indwelling catheters? The American Journal of Medicine. 2000; 109(6):476-480. Trautner, Barbara W, and Rabih Darouiche. "Catheter-associated infections: pathogenesis affects prevention.." Archives of internal medicine 164 (2004): 842-850. 11 Nov. 2011 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963580/?tool=pubmed>. Wald,H; Bratzler,D; Kramer,A Indwelling Urinary Catheter Use in the Post-operative Period : Analysis of National Surgical Prevention Project Archives of Surgery Vol 143 No.6 June 2008 World Health Organization. WHO Guidelines for Hand Hygiene in Health Care (Advanced Draft). Geneva, Switzerland: World Health Organization, 2006. Why The Foley. Advertisement. GiggleMed. 19 Nov 2011. <http://gigglemed.com/catheter-related-infections-wtf-foley- humor?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+gigglemed+%28Giggle Med.com+Medical+Humor%29>.