Prevention of Catheter associated Urinary Tract Infections

Recommendations

1. Appropriate Urinary Catheter Use

Insert catheters only for appropriate indications and leave in place only as long as needed. (Strong Recommendation)

Minimize urinary catheter use and duration of use in all patients, particularly those at higher risk for CAUTI or mortality from catheterization such as women, the elderly, and patients with impaired immunity. (Strong Recommendation)

Avoid use of urinary catheters in patients and nursing home residents for management of incontinence. (Strong Recommendation)

Use urinary catheters in operative patients only as necessary, rather than routinely. (Strong Recommendation)

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. (Strong Recommendation)

2. Consider using alternatives to indwelling urethral catheterization in selected patients when appropriate.

Consider using external catheters as an alternative to indwelling urethral catheters in cooperative male patients without urinary retention or bladder outlet obstruction. (Good Practice Statement)

Consider alternatives to chronic indwelling catheters, such as intermittent catheterization, in spinal cord injury patients. (Good Practice Statement)

Intermittent catheterization is preferable to indwelling urethral or suprapubic catheters in patients with bladder emptying dysfunction. (Good Practice Statement)

Consider intermittent catheterization in children with myelomeningocele and neurogenic bladder to reduce the risk of urinary tract deterioration. (Good Practice Statement)

3. Proper Techniques for Urinary Catheter Insertion

Perform hand hygiene immediately before and after insertion or any manipulation of the catheter device or site. (Strong Recommendation)

Ensure that only properly trained healthcare worker who know the correct technique of aseptic catheter insertion and maintenance are given this responsibility. (Strong Recommendation)

 Insert urinary catheters using aseptic technique and sterile equipment. (Strong Recommendation)

Use sterile gloves, drape, sponges, an appropriate antiseptic or sterile solution for periurethral cleaning, and a single-use packet of lubricant gel for insertion. (Strong Recommendation)

Routine use of antiseptic lubricants is not necessary. (Good Practice Statement)

Properly secure indwelling catheters after insertion to prevent movement and urethral traction. (Strong Recommendation)

Unless otherwise clinically indicated, consider using the smallest bore catheter possible, consistent with good drainage, to minimize bladder neck and urethral trauma. (Good Practice Statement)

4. Proper Techniques for Urinary Catheter Maintenance

Following aseptic insertion of the urinary catheter, maintain a closed drainage system. (Strong Recommendation)

If breaks in aseptic technique, disconnection, or leakage occur, replace the catheter and collecting system using aseptic technique and sterile equipment. (Strong Recommendation)

Consider using urinary catheter systems with preconnected, sealed catheter-tubing junctions. (Good Practice Statement)

Maintain unobstructed urine flow. (Strong Recommendation)

Keep the catheter and collecting tube free from kinking. (Strong Recommendation)

Keep the collecting bag below the level of the bladder at all times. Do not rest the bag on the floor. (Strong Recommendation)

Empty the collecting bag regularly using a separate, clean collecting container for each patient; avoid splashing, and prevent contact of the drainage spigot with the nonsterile collecting container. (Strong Recommendation)

Use Standard Precautions, including the use of gloves, during any manipulation of the catheter or collecting system. (Strong Recommendation)

Changing indwelling catheters or drainage bags at routine, fixed intervals is not recommended. Rather, it is suggested to change catheters and drainage bags based on clinical indications such as infection, obstruction, or when the closed system is compromised. (Good Practice Statement)

Unless clinical indications exist (e.g., in patients with bacteriuria upon catheter removal post urologic surgery), do not use systemic antimicrobials routinely to prevent CAUTI in patients requiring either short or long-term catheterization. (Strong Recommendation)

Do not clean the periurethral area with antiseptics to prevent CAUTI while the catheter is in place. Routine hygiene (e.g., cleansing of the meatal surface during daily bathing or showering) is appropriate. (Strong Recommendation)

Unless obstruction is anticipated (e.g., as might occur with bleeding after prostatic or bladder surgery) bladder irrigation is not recommended. (Good Practice Statement)

If obstruction is anticipated, closed continuous irrigation is suggested to prevent obstruction. (Good Practice Statement)

Routine irrigation of the bladder with antimicrobials is not recommended. (Good Practice Statement)

Routine instillation of antiseptic or antimicrobial solutions into urinary drainage bags is not recommended. (Good Practice Statement)

5. Catheter Materials

Silicone might be preferable to other catheter materials to reduce the risk of encrustation in long-term catheterized patients who have frequent obstruction. (Good Practice Statement)

6. Management of Obstruction

If obstruction occurs and it is likely that the catheter material is contributing to obstruction, change the catheter. (Strong Recommendation)

7. Specimen Collection

Obtain urine samples aseptically. (Strong Recommendation)

If a small volume of fresh urine is needed for examination (i.e., urine analysis or culture), aspirate the urine from the needleless sampling port with a sterile syringe/cannula adapter after cleansing the port with a disinfectant. (Strong Recommendation)

Obtain large volumes of urine for special analyses (not culture) aseptically from the drainage bag. (Strong Recommendation)