Healthcare-associated infections affect millions of hospital patients each year, causing prolonged hospital stays, increased costs, and preventable deaths. Urinary tract infections are the most common type of healthcare-associated infection, with catheter-associated UTIs accounting for the majority. Inserting and leaving urinary catheters in place when not medically necessary can increase infection risks. Proper training of staff, following guidelines for catheter insertion and maintenance, and removing catheters as soon as possible can help reduce unnecessary catheter use and prevent catheter-associated UTIs.

2. Discomfort to the patient
 Limit mobility
 Prolonged hospital stay
 Increased cost and mortality

3.  Each year 1.7- 2 million Americans (5-10% of
hospitalized patients) acquire at least one
infection while hospitalized
 90-100 thousand die of those infections
 One third of these are believed preventable
 Conservatively HAI cost $33 billion each year

4.  Urinary tract – most common site of healthcare
associated infections; most are associated with
urinary catheterization
◦ 15 - 25% of inpatients are catheterized
 80% of hospital associated UTIs caused by a urinary
catheter

5.  CAUTI cost $500 – $1000 - $2,800 if bacteremia
 Most CAUTIs are asymptomatic bacteriuria, 1-5%
lead to secondary bacteremia
 5% of all deaths from HAI are urinary catheter
associated.

6.  The good news is that many CAUTIs may be
prevented with recommended infection
control measures.
 Up to 380,000 infections and 9000 deaths
related to CAUTI per year could be prevented
http://www.cdc.gov/ncidod/dhqp/hai.html
Umscheid et al. Infec Control & Hospital Epidemiology 2011; Scott, 2009

7.  Proper management and use of catheters could
prevent infections
 Study in Lansing, MI: Less than half of urinary
catheters in teaching hospital were indicated.
Am J Infect Control. 2004 Jun;32(4):196-9. Inappropriate use of urinary
catheters in elderly
patients at a midwestern community teaching hospital.Gokula RR, Hickner JA,
Smith MA.
 Most of physician are unawaer that their patients
have a urinary catheter.
 Urinary catheters are uncomfortable, limit mobility

8.  Virtually all healthcare associated urinary
tract infection are caused by instrumentation
of the urinary tract
 CAUTI can lead to complications

9.  Risk of CAUTI is 5% per day catheter is in situ
 Increases to 25% after 1 week in situ
 Increases to 100% after 1 month in situ

10.  Cystitis
 Pyelonephritis
 Gram-negative bacteremia
 Prostatitis
 Epididymitis
 Orchitis in males

11.  Endocarditis
 Vertebral osteomyelitis
 Septic arthritis
 Endophthalmitis
 Meningitis

12. GUIDELINE FOR PREVENTION OF CATHETER-
ASSOCIATED URINARY TRACT INFECTIONS 2009
Carolyn V. Gould, MD, MSCR 1; Craig A. Umscheid, MD, MSCE 2; Rajender K.
Agarwal, MD, MPH 2; Gretchen Kuntz, MSW, MSLIS 2; David A. Pegues, MD 3
and the Healthcare Infection Control Practices Advisory Committee (HICPAC) 4

13. Category IA A strong recommendation supported by high to
moderate quality evidence suggesting net clinical
benefits or harms
Category IB A strong recommendation supported by low quality
evidence suggesting net clinical benefits or harms or an
accepted practice (e.g., aseptic technique) supported by
low to very low quality evidence
Category IC A strong recommendation required by state or federal
regulation.
Category II A weak recommendation supported by any quality
evidence suggesting a trade off between clinical benefits
and harms
No recommendation/
unresolved issue
Unresolved issue for which there is low to very low
quality evidence with uncertain trade offs between
benefits and harms

14.  1A.1. Use urinary catheters in operative patients
only as necessary, rather than routinely.
(Category IB)
 1A.2. Avoid use of urinary catheters in patients
and nursing home residents for management of
incontinence. (Category IB)

15.  1A.2.a. Further research is needed on periodic
(e.g., nighttime) use of external catheters in
incontinent patients or residents and the use of
catheters to prevent skin breakdown. (No
recommendation/unresolved issue)
 1A.3. Further research is needed on the benefit
of using a urethral stent as an alternative to an
indwelling catheter in selected patients with
bladder outlet obstruction. (No
recommendation/unresolved issue)

16.  1A.4. Consider alternatives to chronic indwelling
catheters, such as intermittent catheterization,
in spinal cord injury patients. (Category II)
 1A.5. Consider intermittent catheterization in
children with myelomeningocele and neurogenic
bladder to reduce the risk of urinary tract
deterioration. (Category II)

17.  1B.2. Insert catheters only for appropriate
indications, and leave in place only as long as
needed. (Category IB)
 1B.3. Minimize urinary catheter use and
duration of use in all patients, particularly
those at higher risk for CAUTI such as
women, the elderly, and patients with
impaired immunity. (Category IB)

18.  1B.4. Ensure that only properly trained
persons (e.g., hospital personnel, family
members, or patients themselves) who know
the correct technique of aseptic catheter
insertion and maintenance are given this
responsibility. (Category IB)
 1B.5. Maintain unobstructed urine flow.
(Category IB)

19.  1C.1. Minimize urinary catheter use and
duration in all patients, particularly those who
may be at higher risk for mortality due to
catheterization, such as the elderly and
patients with severe illness. (Category IB)

20.  2A.1. Consider using external catheters as an
alternative to indwelling urethral catheters in
cooperative male patients without urinary
retention or bladder outlet obstruction. (Category
II)
 2A.2. Intermittent catheterization is preferable to
indwelling urethral or suprapubic catheters in
patients with bladder emptying dysfunction.
(Category II)

21.  2A.3. If intermittent catheterization is used,
perform it at regular intervals to prevent bladder
over-distension. (Category IB)
 2A.4. For operative patients who have an
indication for an indwelling catheter, remove the
catheter as soon as possible postoperatively,
preferably within 24 hours, unless there are
appropriate indications for continued use.
(Category IB)

22.  Urinary Tract Obstruction and Neurogenic Bladder
 Urologic Study/Surgery
 Urine monitoring in critically ill patients
 Assistance in pressure ulcer management for
incontinent patients
 Exception – Patient request to improve comfort end
of life.

23.  Incontinence
 Immobility
 Patient/Staff Convenience
 Obtaining Periodic Urine Specimens

25. HAI-CAUTI reported in Medical departmet 1433H at KAASH – Taif
Incidence Rates/1000 device-days:

26. 6
2.4
9
5.7
0
8.7
1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6
4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7 4.7
5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.3
0
1
2
3
4
5
6
7
8
9
10
Catheter associated UTI(CAUTI) in medical department (male & female) 1434
CAUTI Rate Pooled mean 90% KAASH RATE 1433

27. Equipment
Minimising
catheter
associated
urinary tract
infections
Health Care Workers (HCWs)
Environment
Avoid, as far as possible,
caring for a patient with a
catheter close to (in the
same bay as) other
patients with catheters.
Urinary catheters (UCs) increase
the risk of UTI by:
 Enabling organisms to gain
entry to the bladder – via
external surface or opened
connection.
 Reducing the body’s defence of
flushing out organisms during
micturition.
 Facilitating biofilm formation.
The organisms causing UTI, can
be endogenous – from the
patient’s own gut flora, or cross-
transmitted through poor
infection control practices.
Only competent HCWs, or those
working under close supervision who
are committed to infection control
and patient safety, may catheterise
patients and undertake catheter
care procedures.
There must be sufficient HCWs on the ward to
enable clinical procedures to be performed as
per the procedure.
Store catheters and other
sterile single-use items in
clean dry areas, away from
any splash contamination and
following any manufacturer’s
instruction. Pre-use check
the packaging is intact,
correctly marked, undamaged
and is within expiry date.
HCWs caring for patients with UCs do not wear
jewellery. HCWs don PPE, i.e. sterile gloves for
insertion; clean gloves for maintenance, apron
for all procedures and perform hand hygiene
effectively.
Ensure there is a selection of
the most appropriate
catheters (size and material)
on the ward. Consider expert
help in assessing ward
catheter stocks.
Maintain a clean ward, free
from clutter. Do not
undertake clinical
procedures during ward
cleaning procedures.
How UCs cause infection
Create a culture where
HCWs strive for
excellence in performance
and patient safety.
Methods - Catheterisation
Methods - Maintenance
 Alternatives to indwelling
catheterisation have been considered
and the need for catheterisation in this
patient outweighs possible catheter
related complications.
 Explain the reason for a UC to the
patient and gain consent.
 Use an insertion checklist to document
care/reason for catheterisation.
 The UC material will depend on usage.
 Choose the smallest gauge catheter for
effective drainage.
 Use a small sized balloon – 10ml (adult).
 Prior to commencement, reassure the
patient and explain the procedure.
Methods Pre Insertion
 The procedure is performed aseptically using:
sterile gloves, apron and creating a sterile field.
 The catheter is lubricated with a sterile gel.
 The urethral meatus is cleaned with sterile
saline.
 To ensure the balloon is inflated in the
bladder and not urethra, insert the catheter
a little further once urine starts to drain
before inflating the balloon.
 The catheter is connected to a closed sterile
approved drainage bag.
 If a pre-existing UTI is thought possible, a
specimen of urine is sent for culture.
 The UC drainage bag is positioned below the
level of the bladder to facilitate drainage.
 Perform a daily review of the need for the UC.
 Hand hygiene is performed, and gloves & apron worn
before catheter maintenance procedures; when
finished, hand hygiene is repeated after PPE removed.
 Urinary drainage bags are not routinely changed, but
are emptied regularly, as separate procedures, each
into a clean container (avoiding contact between the
container and the tap).
 UCs are continuously connected to the drainage bag.
 Patients are involved in their UC care and educated as
to how they can minimise complications.
 Routine daily meatal hygiene is performed.
 HCWs monitor for signs of infection, e.g. fever, pain,
cloudy urine. Abnormal findings are reported.
 Samples are taken aseptically from the sample port if
infection is suspected.

28. ** URINARY CATHETER REMINDER **
Date: __ __ / __ __ / __ __
This patient has had an indwelling urethral catheter since __ __ / __ __ / __ __.
Please indicate below EITHER (1) that the catheter should be removed OR (2) that the catheter
should be retained. If the catheter should be retained, please state ALL of the reasons that apply.
Please discontinue indwelling urethral catheter; OR
Please continue indwelling urethral catheter because patient requires indwelling catheterization
for the following reasons (please check all that apply):
Urinary retention
Very close monitoring of urine output and patient unable to use urinal or bedpan
Open wound in sacral or perineal area and patient has urinary incontinence
Patient too ill or fatigued to use any other type of urinary collection strategy
Patient had recent surgery
Management of urinary incontinence on patient’s request
Other - please specify: ___________________________________________________
__________________________________________ _____________
Physician’s Signature Doctor Number

29. FOCUS Description/List
F: Find an Opportunity to
Improve
( ) High Risk ( ) High
Cost
( ) High
Volume
( ) Problem Prone ( ) Other
Risk Assessment Grade: 11
O: Organize a Team Action Plan: IPC-AP-1434
Team: leader : Dr Abdaziz Alfify, Members :Dr. Khorshed Anwar. Dr. Diaa
Abdullah, Dr Magdy Abulkhier, Dr Mohamed Esmael, Dr Munera
ALHuthaify, Dr.Yaminalden khoga. Sis Elcy, and Sis Cheril
Process: 7 steps.
C: Clarify the Current Process
U: Understand the
problems/variations in the
process
S: Select the Desired
Outcome(s)
Action Plan: IPC-AP-1434 Recommendations/Report to: Head of medical
department.
PDCA Description/List
P: Plan the Project Assign
Tasks
Action Plan: IPC-AP-1434
Tasks: step number 1-7.
D: Do the work that's needed Action Plan: IPC-AP-1434
Follow up: steps 1, 2, 3, 4, and 5.
C: Check the Results, and
Measure Changes
Action Plan: IPC-AP-09-1434
Follow up: steps 4, 5, 6 and 7.
Report to: Head of medical departement and ICC
A: Act to Maintain the
Changes
Communications: Head ofMedical Departement and ICC.
Advertising and recognition for positive changes.
Ongoing monitoring indicators.
PDCA cycle again, when indicated.
PI Process Control
(Initiate/Date)
PI Team Leader: Dr Abdaziz Alfify Date: 15.2.1434
Medical department Head: Date: 15.2.1434
JCIA Related
( ) ACC ( ) AOP ( ) PFR ( ) PFE ( ) COP ( ) PCI
( ) QMI ( ) GLD ( ) FMS ( ) SQE ( ) MOI

30.  The must effective strategy to reduce
complications of urinary bladder catheters is
the avoidance of unnecessary catheterization.
 Adequate training of hospital staff is
essential.
 Proper care , early recognization and
treatment of complications is mandatory.