Practices known as a Catheter-Associated Urinary Tract Infection

Practices and Prevention Techniques to Effectively Reduce Catheter Associated Urinary Tract Infections in Hospitalized Patients
Hospital acquired infections (HAI) can occur due to a multitude of reasons. One common type of HAI is known as a Catheter-Associated Urinary Tract Infection (CAUTI). This paper will discuss CAUTI, its impact on the healthcare field, preventive recommendations, and best practices.
Catheter Associated Urinary Tract Infection
Indwelling urinary catheters are the main cause of CAUTIs, although other catheter use, such as intermittent catheterization has been associated with acquiring this infection. An indwelling catheter is a tube that is inserted into the patient’s urethra to facilitate drainage of urine from the bladder into a collection bag. Carter, Reitmeier, and Goodloe stated that indwelling catheters are often used for a variety of reasons, both medical (such as obstruction) and non-medical (such as for the management of non-mobile or elderly patients with limited cognitive abilities and incontinence) (as cited in Bernard, Hunter, ; Moore, 2012). Also, Carter, Reitmeier, and Goodloe indicated indwelling catheters may contribute to further complications particularly in older adults, including falls, delirium, or other medical issues (as cited in Bernard et al., 2012). Foreign particles like bacteria or fungi entering and traveling along the catheter tube can cause infection. This can occur during the catheter insertion procedure, or while the catheter is in the bladder. The chances of acquiring a CAUTI increases with the number of days a catheter is in place. The daily risk of bacteriuria with catheterization is 3% to 10%, approaching 100% after 30 days (Center for Disease Control, 2016). Although, this procedure is necessary due to various medical reasons it can put the patient at risk. According to the Center for Disease Control (CDC), between 15-25% of hospitalized patients receive urinary catheters during their hospital stay (Center for Disease Control, 2016). This evidence supports the fact that preventing CAUTIs in an enormous aspect of the healthcare field. Furthermore, catheter-associated urinary tract infection (CAUTI) has been associated with increased morbidity, mortality, hospital cost, and length of stay (Center for Disease Control, 2016). Patients should be carefully evaluated for signs and symptoms of urinary tract infections. CAUTI symptoms consist of fever, chills, cloudy foul-smelling urine, and irritation at the catheter insertion site. CAUTIs can cause physical, mental, and financial strain on the patient, the patients’ family, the hospital, and staff as well as the insurance companies.
Recommendations and Best Practices
The CDC has conducted research and published guidelines with measures and recommendations to prevent CAUTIs in hospitalized patients. The CDC has indicated “an estimated 17% to 69% of CAUTI may be preventable with recommended control measures” (Center for Disease Control, 2016). The healthcare industry needs to focus on prevention by communicating appropriate urinary catheter use. This involves “inserting catheters only for appropriate indications and leave in place as long as needed” (Center for Disease Control, 2016). Intermittent catheterization or external catheters are favored over indwelling catheters and should be encouraged. This recommendation should be communicated “particularly to those at higher risk for CAUTI or mortality from catheterization such as women, the elderly, and patients with impaired immunity” (Center for Disease Control, 2016). Performing hand hygiene and effectively cleaning the external urethral opening before insertion, as well as maintaining aseptic technique during insertion are critical elements to prevent CAUTI. If breaks in aseptic technique, disconnection, or leakage occur, replace the catheter and collecting system using aseptic technique and sterile equipment (Center for Disease Control, 2016). Also, providing daily cleansing of the external urethral opening with soap and water or perineal cleanser, following agency policy, aids in reduction of CAUTIs (Center for Disease Control, 2016). In addition, ensuring that the catheter is placed correctly and maintaining the collection bag below the level of the bladder, prevents backflow of urine into the bladder, thus, greatly reduces the risk of acquiring a CAUTI. Other reasonable and preventable cleanliness techniques involve not resting the bag on the floor, watching the urine levels, and following protocol to obtain urine samples aseptically.
Although the chances of CAUTI occurring in the hospital setting has a high risk, following the recommended practices and prevention techniques can greatly reduce the occurrence of hospital acquired infections, especially CAUTI.


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