This document discusses catheter-associated urinary tract infections (CAUTI). CAUTIs occur when germs travel along a urinary catheter into the bladder or kidneys, causing an infection. People with urinary catheters have a much higher risk of UTIs than those without. Symptoms can include burning during urination or fever. To prevent CAUTIs, catheters should only be used when necessary and removed promptly using sterile technique. Proper catheter care including hand hygiene and keeping the drainage bag below the bladder level is also important. Hospitals should have nurse-driven protocols to assess ongoing need for catheters and ensure prompt removal when no longer required.

1. Catheter Associated
Urinary Tract Infections
Christina Rone RN, OCN and Norman Swope BSN, RN, OCN
1 hour
Stop
CAUTI

2. • Also know as UTI (Urinary Tract
Infection)
• It is an infection in the urinary system,
which includes the bladder and kidneys.
• Germs do not normally live in these
areas; but if germs are introduced, an
infection will occur.
• If you have a urinary catheter, germs
can travel along the catheter and cause
an infection in the kidneys and bladder.
WHAT IS
CAUTI?

3. Possible causes:
• Neutropenia
• Improper Technique of insertion
• Procedures or Surgery involving the bladder and/or kidney.
PEOPLE WITH URINARY CATHETERS HAVE A MUCH HIGHER CHANCE OF
GETTING A URINARY TRACT INFECTION THAN PEOPLE WHO DON’T HAVE A
CATHETER.

4. • Burning or pain in the abdomen
• Burning during urination, or increase in
frequency of urination after catheter
removal
• Bloody urine
• Fever
• Sometimes there are “NO” symptoms
of infection
SIGNS AND
SYMPTOMS OF UTI

5. • Catheters are to be used only when necessary and removed as soon as possible
• Use Sterile Technique: Hand Hygiene before and after insertion of urinary
catheter
• Clean skin in the area where catheter will be inserted before inserting the
catheter
TO PREVENT UTI’S TAKE THE FOLLOWING ACTIONS:
CATHETER INSERTION

6. • Always Wash hands with soap and water or using the alcohol- based hand rub
before and after touching the catheter.
• Avoid disconnecting the catheter and drain tube to keep a closed system. This will
prevent germs from getting into the tubing.
• Use the stat-lock device to prevent tugging/ pulling which will cause irritation/
inflammation to the urethra.
• Avoid twisting and kinking of tubing
• Keep the bag lower than the bladder to prevent urine from back-flowing into the
bladder.
• Empty the bag regularly. The drainage spout should never touch anything while
empting the bag.
CATHETER CARE

7. • Removal of catheter within 24 hours from insertion.
• Consider all alternatives to indwelling catheter.
• Catheter/peri care is to be done daily or more frequently as needed.
• Always keep urine bag below the level of the bladder, but off the floor.
• Secure catheter tubing to the leg using a catheter stabilization device.
• Empty storage bag frequently, do not allow tip to touch anything.
KEYS TO CAUTI PREVENTION

8. NURSE DRIVEN URINARY CATHETER REMOVAL PROTOCOL
• Must be implemented on all patients who have a urinary catheter
placed.
• D/C Urinary catheter within one day following insertion unless the patient
meets one of the following criteria:
• Need for accurate I & O in critically ill patients or patient undergoing
aggressive diuresis.
• Relief of urinary tract obstruction/ urinary retention, neurogenic bladder
dysfunction or patient has a suprapubic catheter.
• Patients in who catheter has been inserted for urologic or pelvic surgery.
• Gross hematuria in patients with potential for clots(irrigation).
• Management of urinary incontinence in patients with stage 3 or 4
pressure ulcers or wounds.
• Promote comfort in terminally ill patients who have significant pain when
moved.
• Patient with an epidural.
• Post-op per physician order.
• Foley placed by urologist due to technical difficulty
• Patient had chronic indwelling catheter on admission.

9. DOES THE PATIENT MEET THE CRITERIA TO CONTINUE USE
OF THE CATHETER?
If they meet the criteria
• Continue to assess the
appropriateness of the catheter
daily. Continue Care Protocol.
If they do not meet the criteria
• Discontinue urinary catheter per
procedure and follow the Post
Urinary Catheter Removal Care.

10. NURSE DRIVEN URINARY CATHETER REMOVAL PROTOCOL CONT.
http://intranet.uams.edu/nursingmanual/Protocols/protocol-178.pdf
Post Urinary Catheter Removal Care
 Document time of removal and amount of urine in bag on I&O
 Encourage PO fluid intake (unless contraindicated)
 Scheduled toileting q 2-3 hours to provide opportunity to urinate—OOB or BSC if
possible
If patient spontaneously voids within 4 hours ≥ 250 ml, continue to measure urinary
output per MD order. If no void or voids < 250 ml within 4 hours
• Perform bladder scan every 4 hours until spontaneous voiding resumes.
• If bladder volume ≥ 350 ml, perform straight cath.
• If bladder volume <350, rescan in 2 hours if patient has not voided; perform straight
catheter if volume >350 ml.
• If straight catheter is required X 2, call MD for further orders.
• Call MD if urinary output < 250 ml over 8 hours.
• Consider alternatives to indwelling catheterization such as condom catheters.
Consider patient’s medications for side effect such as urinary retention.

11. • Always clean your hands before and
after doing catheter care.
• Always keep the urine bag below the
level of the bladder.
• Do not tug or pull the tubing.
• Do not twist or kink the catheter
tubing.
• Always remove as soon as possible
IMPORTANT
REMINDERS

12. REFERENCES:
1. GouldCV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, and HICPAC. Guideline for
Prevention of
Catheter‐associated Urinary Tract Infections
2009.http://www.cdc.gov/hicpac/cauti/001_cauti.html
2. IHI Program to Prevent CAUTI http://www.ihi.org/
3. APIC CAUTI Elimination Guide http://www.apic.org/
4. IDSA Guidelines (Clin Infect Dis 2010;50:625‐63)
5. SHEA/IDSA Compendium (ICHE 2008;29:S41‐S50)
6. National Quality Forum (NQF) Safe Practicesfor Better Healthcare – Update April
2010
7. CDC/Medscape collaboration http://www.cdc.gov/hicpac/
8. Dalehousie University, 2005, Medical Procedures video, male catheterization