Prevention of Catheter associated Urinary Tract Infections
- Introduction
A urinary tract infection (UTI) is an infection that involves any of the organs or structures of the urinary tract, (e.g., kidneys, ureters, bladder and urethra). Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract. In addition, bacteriuria commonly leads to unnecessary antimicrobial use, and urinary drainage systems are often reservoirs for multidrug-resistant bacteria and a source of transmission to other patients.
The use of indwelling urinary catheters can result in the development of CAUTI. Each day that an indwelling urinary catheterization (IUC) remains in place, the risk of acquiring a CAUTI increases.
The core components of a urinary catheter bundle typically include:
1. Appropriate Catheter Use:
● Avoid unnecessary catheterization: Catheters should only be inserted when there is a clear medical indication.
● Consider alternatives: Explore options like intermittent catheterization, external catheters (condom catheters), or other methods for managing urinary incontinence or retention when appropriate.
● Prompt removal: The catheter should be removed as soon as it is no longer needed. Regular assessment of the continued need for the catheter is crucial.
2. Proper Catheter Insertion Technique:
● Hand hygiene: Perform thorough hand hygiene immediately before and after any manipulation of the catheter insertion site or device.
● Aseptic technique: Use sterile gloves, drapes, and equipment during catheter insertion.
● Skin preparation: Clean the periurethral area with an appropriate antiseptic solution before insertion.
● Appropriate catheter size: Use the smallest catheter size consistent with adequate drainage.
● Lubrication: Apply sterile lubricant gel to the catheter before insertion.
● Securement: Properly secure the catheter after insertion to prevent movement and urethral traction.
3. Maintaining the Catheter:
● Closed drainage system: Maintain a sterile, continuously closed drainage system. Avoid disconnecting the catheter and drainage tubing unless absolutely necessary.
● Unobstructed urine flow: Ensure the catheter and drainage tubing are free from kinks and that the collection bag is positioned below the level of the bladder.
● Regular emptying of the drainage bag: Empty the collection bag regularly using a clean container for each patient, avoiding contact between the drainage spigot and the container.
● Perineal care: Perform routine perineal hygiene.
● Avoid routine catheter changes: Do not change indwelling catheters or drainage bags at fixed intervals unless clinically indicated.
4. Daily Review and Prompt Removal:
● Assess the necessity of the catheter daily: Review the indication for the urinary catheter each day and document this assessment.
● Remove the catheter as soon as it is no longer indicated: Implement protocols or reminders to facilitate timely removal.
● Education and training: Ensure that healthcare personnel (HCP) involved in catheter insertion and maintenance are properly trained and competent in performing these procedures using aseptic techniques.
● Documentation: Document the indication for catheter insertion, the date and time of insertion, the type and size of the catheter, and the plan for removal.
● Surveillance: Implement surveillance programs to monitor CAUTI rates and provide feedback to healthcare teams to improve practices.