Preventing Catheter-associated Urinary Tract Infections: The CAUTI Bundle
Preventing catheter-associatedurinary tract infections:The CAUTI Bundle1
CAUTI Reduce and ultimately prevent cases ofsymptomatic CAUTI What is “symptomatic CAUTI”?– Infection-causing symptoms as defined bythe CDC’s National Health Safety Network(NHSN) in the setting of an indwellingurinary catheter that is in place or has beenremoved within the past 48 hours
Why CAUTI? Most common healthcare-associatedinfection: 40% of all HAIs 1 million cases annually (hospitals &nursing homes) 12-25% of all hospitalised patientsreceive a urinary catheter– Half of these found to not have a validindication
Potential Impact Increased length of stay 0.5 – 1 day Estimated cost per case of CAUTI
Evidence-Based Guidelines APIC CA-UTI Elimination Guidewww.apic.org/CAUTIGuide SHEA-IDSA ium.cfm CDC Guidelinehttp://www.cdc.gov/ncidod/dhqp/gl catheter assoc.html#
Evidence of Success Numerous published studies reportingreductions in CAUTI rates of 48-81%– Use of reminders– Nurse-driven protocols– Reduction in duration of catheter days“The duration of catheterisation is the mostimportant risk factor for development ofinfection.”SHEA-IDSA Compendium, October 2008
Preventing CAUTI Avoid unnecessary urinary cathetersInsert using aseptic techniqueMaintain catheters based on recommendedguidelines (daily care)Review catheter necessity daily and removepromptly
Preventing CAUTI Avoid unnecessary urinary cathetersInsert using aseptic techniqueMaintain catheters based on recommendedguidelines (daily care)Review catheter necessity daily and removepromptly
Avoid unnecessary urinarycatheters Studies:– 21% of catheters not indicated at insertion– 41-58% in place found to be unnecessary Catheters– Are uncomfortable for patients– Decrease mobility, which may impairrecovery and contribute to othercomplications (e.g. pressure ulcers, deepvein thrombosis)Saint S, Lipsky BA. Preventing catheter-related bacteriuria: Should we? Can we?How? Arch Intern Med. 1999 Apr 26;159(8):800-808.Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tractcatheter in hospitalized medical patients. Arch Intern Med. 1995;155:1425-1429.
Preventing CAUTI Avoid unnecessary urinary cathetersInsert using aseptic techniqueMaintain catheters based on recommendedguidelines (daily care)Review catheter necessity daily and removepromptly
Insert urinary catheters using aseptictechnique Utilise appropriate hand hygiene practice Insert catheters using aseptic technique and sterileequipment, specifically using:– gloves, a drape, and sponges;– sterile or antiseptic solution for cleaning theurethral meatus; and– single-use packet of sterile lubricant jelly forinsertion Use as small a catheter as possible that is consistentwith proper drainage, to minimise urethral trauma.
Preventing CAUTI Avoid unnecessary urinary cathetersInsert using aseptic techniqueMaintain catheters based onrecommended guidelines (daily care)Review catheter necessity daily and removepromptly
3. Maintain catheters based onrecommended guidelines Maintain a sterile, continuous closed drainage system Keep catheter properly secured to prevent movementand urethral traction Keep collection bag below the level of the bladder atall times Maintain unobstructed urine flow Empty collection bag regularly, using a separatecollecting container for each patient, and avoidallowing the draining spigot to touch the collectingcontainer Maintain meatal care with routine hygiene
Preventing CAUTI Avoid unnecessary urinary cathetersInsert using aseptic techniqueMaintain catheters based on recommendedguidelines (daily care)Review catheter necessity daily andremove promptly
Daily review of necessity with promptremoval“The duration of catheterisation is the mostimportant risk factor for development ofinfection.” SHEA-IDSA Compendium, October 2008 74% of hospitals surveyed did not monitor catheter duration 47% of patient days had no justification for continuedcatheterisation 41% of the time, physicians were unaware of patientsinappropriately catheterisedSaint S, Kowalski. 2008.Jain P, Parada JP.1995.
MeasurementOutcome Measure:Urinary catheter-associated UTI rate# Symptomatic CAUTI*# Urinary catheter daysX 1000* Infection-causing symptoms as defined by the NHSN in the setting of anindwelling urinary catheter that is in place or has been removed withinthe past 48 hours
Saint S, Lipsky BA. Preventing catheter-related bacteriuria: Should we? Can we? How? Arch Intern Med. 1999 Apr 26;159(8):800-808. Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med. 1995;155:1425-1429.
an indwelling urinary catheter. The indwelling urinary catheter is considered a foreign object in the lower urinary tract, which means a CAUTI differs from an infection occurring in the urinary bladder of a patient who is not catheterized (Leidl 2001). CAUTIs do not produce the
Urinary Tract Infections & Treatment Banerjee A & Marotta F 1. Introduction Urinary tract infections (UTI) predominantly occurs in the urinary tract and it is caused by the microorganisms, most often by the bacterial species. The urinary tract comprises of kidney, ureter, bladder and urethra. Based on their infect
Urinary catheter status Defined as the status of a urinary catheter device on the Date of Event One of three options is selected to describe urinary catheter status "In place": an indwelling urinary catheter was present on the date of the event "Removed within last 2 calendar days": an indwelling urinary
pressure ulcers, urinary catheter presence was associated with 1.8 times risk of pressure ulcer compared to those without urinary catheter (p 0.03). The most significant association was between urinary catheterurinary catheter catheter use andcatheter use and stage 2 pressure ulcer. 34 Downloaded from www.catheterout.orgFile Size: 813KBPage Count: 54
Preventing Catheter-Associated Urinary Tract Infection (CAUTI): Making It Happen Prof. Sanjay Saint, University of Michigan School of Medicine . A 1-page (10-item) trouble-shooting guide Help identify the key reasons why hospitals may not be successful in preventing CAUTI Once the barriers are identified, can then
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Do not change device association during the RIT . Condom catheter (Texas catheter) 17. Unless an indwelling urethral catheter is also present, . complained of urinary frequency: 3/29. No fever: 3/30. Elevated wbc's: 3/31 . Positive urine culture with 105 CFU/ml E coli: The Patient's
Superior Court of California County of Imperial “NOTICE OF UNCLAIMED MONIES” I, Maria Rhinehart, Court Executive Officer, Superior Court of California, County of
