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Foley Catheters and the Risk for Infection


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Foley Catheters and the Risk for Infection. By:  Corrin Fesko, RN &  Sarah Waronek, RN. At the completion of this presentation, the viewer will be able to:. Define and describe catheter related urinary tract infections (CAUTI’s) Discuss complications associated with CAUTI’s

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Foley Catheters and the Risk for Infection

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Foley catheters and the risk for infection l.jpg

Foley Catheters and the Risk for Infection

By: 

Corrin Fesko, RN

Sarah Waronek, RN


At the completion of this presentation the viewer will be able to l.jpg

At the completion of this presentation, the viewer will be able to:

  • Define and describe catheter related urinary tract infections (CAUTI’s)

  • Discuss complications associated with CAUTI’s

  • Describe guidelines for foley catheter useage, insertion, maintenance, and removal

  • Examine the development and use of a standard set of foley catheter physician orders based on the CDC and SHEA Compendium


Catheter related urinary tract infections cauti s are defined as l.jpg

Catheter Related Urinary Tract Infections (CAUTI’s) are defined as:

  • Urinary tract infection occurring in a patient that had an indwelling urinary catheter placed with in the past seven days of onset of infection, or within 48 hours of discharge from a facility

(Gould, Carolyn V., Umscheid, Craig A., Agarwal,

Rajender., Kuntz, Gretchen., Pegues, David A., 2009)


Complications of cauti s l.jpg

Complications of CAUTI’s:

  • Cystitis

  • Pyelonephritis

  • Prostititis

  • Endocarditis

  • Sepsis/Septic shock

  • Meningitis

(Lo, E; Nicolle, L; Classen, D; Arias, A M; Podrgorny, K; Deverick, J A; Burstin, H; Calfee, D; Coffin, S E; Dubberke, E R; Frasier, V; Gerding, D N; Griffin, F A; Gross, P; Kaye, K S; Klompas, M; Marschall, J; Mermel, L A; Pegues, D A; Perl, T M; Saint, S; Salgado, C D; Weinstein, R A; Deborah, S, 2008)


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Incorrect Reasons for Inserting Foley Catheters:

  • Incontinence

  • Diuretic use

  • Convenience

  • Prolonged use after surgery


Center for disease control and prevention cdc guidelines for foley catheter insertion l.jpg

Center for Disease Control and Prevention (CDC) Guidelines for Foley Catheter Insertion:

  • Urologic surgery

  • Prolonged surgical procedure where foley is removed in PACU

  • Patients receiving large volume infusions or diuretics during surgery

  • Critically ill patients for accurate urinary output

  • Assist for healing of perineal or saccral wounds in incontinent patients

  • Prolonged immobilization

  • Comfort in end of life care

    (Gould, Carolyn V., Umscheid, Craig A., Agarwal,

    Rajender., Kuntz, Gretchen., Pegues, David A., 2009)


Methods of surveillance of catheter associated urinary tract infections cauti s include l.jpg

Methods of surveillance of catheter associated urinary tract infections (CAUTI’s) include:

  • Obtain/monitor urine C&S results

  • Fevers

  • Presence of bacteriuria


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  • The Society for Healthcare Epidemiology of America (SHEA) Compendium set forth a set of written guidelines for foley catheters:

    • Use

    • Insertion

    • Maintenance


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The SHEA Compendium was "a compendium of strategies to prevent healthcare-related infections.“

(Lo et al., 2008)


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According to the SHEA Compendium, most patients with Urinary Tract Infections (UTI’s) are asymptomatic.(Lo et al., 2008)


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The SHEA Compendium guidelines include facility specific criteria for catheter usage and removal.

(Lo et al., 2008)


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CAUTI prevention includes staff involvement of:

  • Insertion

  • Care

  • Management

  • Removal


Insertion l.jpg

Insertion:

  • Only trained staff may insert an indwelling urethral catheter

  • Sterile technique must be used

  • Sterile gloves, drapes, sponges, betadine for cleaning the meatus, and lubricating jelly must be used for catheter insertion

  • The smallest possible sized catheter is to be used

(Lo, et al)


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Care:

  • Catheters should be secured with a device to minimize discomfort

  • Maintain a continuous, sterile system without breaks

  • Catheter care should be done at least twice daily using castile soap towlettes

    (Lo, et al)


Management l.jpg

Management:

  • Avoid catheter irrigation unless for obstruction

  • Foley renewal orders should be used for keeping track of device usage days

  • Implement daily rounds for physician and nursing staff to decide the continued need for a catheter

    (Lo, et al)


Removal l.jpg

Removal:

  • Establish daily reminders to renew or discontinue urethral catheter

  • Daily rounding to determine necessity of catheter

  • Remove after surgical procedure when no longer needed

  • Implement the use of bladder scanning and intermittent straight catheterization when possible

    (Lo et al., 2008)


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In 2006, Conemaugh Memorial Medical Center studied the number of CAUTI's and set a goal to decrease the number by half.

(Hoeg, L, 2009)


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  • In 2006, the number of total

  • CAUTI's was 10.7 (per 1000

  • device days).

  • As of September 2009, total

  • CAUTI's was reduced to 2.7 (per

  • 1000 device days).

(Hoeg, L, 2009)


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A special team was constructed to accomplish this goal at Conemaugh Memorial Medical Center including:

  • Dr. Louis Schenfeld, MD, Epidemiologist 

  • Dr. Daniel Wehner, MD, Chairman of Department of Emergency Medicine

  • Lisa Hoegg, RN Director for Quality Excellence

    (Hoeg, L, 2009)


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Total CAUTI (Symptomatic and Asymptomatic) vs. SUTI (Symptomatic) UTI rates from 2006 to 2009

(Hoeg, L, 2009)


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By using the CDC and SHEA

Compendium Guidelines, a

standardized foley catheter

order sheet was developed.


Foley protocol orders include l.jpg

Foley Protocol Orders Include:

  • Reason for inserting foley

  • Orders for intermittent bladder scan

  • Discontinue or renewal order

  • Intermittent bladder scan or straight cath instead of foley

  • Physician’s signature

    (Hoeg, L, 2009)


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Prior to developing the order sheet, Conemaugh Memorial Medical Center was using “Best Practice” methods for foley catheter insertion.

(Hoeg, L, 2009)


Summary l.jpg

Summary:

  • In following the recommendations made by the CDC and the SHEA Compendium, Conemaugh Memorial Medical Center implemented a standing foley catheter order sheet to outline usage and discontinuation of an indwelling urethral catheter

  • By following the physician order sheet, Conemaugh Memorial Medical Center was able to decrease CAUTI’s by more than half


Sources l.jpg

Sources:

Ervin NE. (2002). Evidence-based nursing

practice: are we there yet [Electronic

version]. Journal of the New York State

Nurses Association, 33(2): 11-6.

Gould, Carolyn V., Umscheid, Craig A., Agarwal,

Rajender., Kuntz, Gretchen., Pegues, David A.,

Healthcare Infection Control Practices Advisory

Committee. (2009). Guidelines for prevention

of catheter-associated urinary tract infections.

Retrieved October 1, 2009, from

http://cdc.gov.

Hoeg, L. RN, Director for Quality Excellence at Conemaugh Memorial Medical Center. Personal Interview. 2009.

Lo, E; Nicolle, L; Classen, D; Arias, A M; Podrgorny, K; Deverick, J A; Burstin, H; Calfee, D; Coffin, S E; Dubberke, E R; Frasier, V; Gerding, D N; Griffin, F A; Gross, P; Kaye, K S; Klompas, M; Marschall, J; Mermel, L A; Pegues, D A; Perl, T M; Saint, S; Salgado, C D; Weinstein, R A; Deborah, S.(2008). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. (Vol. 29, Supplemental 1). The Society for Healthcare Epidemiology of America. Retrieved October 1, 2009, from, http://www.sheaonline.org/publications/shea_position_papers.cfm