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1. Foley Catheters and the Risk for Infection By:?
Corrin Fesko, RN
Sarah Waronek, RN
2. 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
3. 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
4. Complications of CAUTI?s: Cystitis
5. Incorrect Reasons for Inserting Foley Catheters: Incontinence
Prolonged use after surgery
6. 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
Comfort in end of life care
(Gould, Carolyn V., Umscheid, Craig A., Agarwal,
Rajender., Kuntz, Gretchen., Pegues, David A., 2009)
7. Methods of surveillance of catheter associated urinary tract infections (CAUTI?s) include: Obtain/monitor urine C&S results
Presence of bacteriuria Human error may be a factor resulting in the presence of bacteria. Special attention should be payed to the method and technique in obtaining a urine sample.Human error may be a factor resulting in the presence of bacteria. Special attention should be payed to the method and technique in obtaining a urine sample.
10. According to the SHEA Compendium, most patients with Urinary Tract Infections (UTI?s) are asymptomatic. (Lo et al., 2008)
11. The SHEA Compendium made recommendations for acute care facilities to incorporate into their existing practices. By adopting The SHEA Compendium?s strategies, infection rates decreased.The SHEA Compendium made recommendations for acute care facilities to incorporate into their existing practices. By adopting The SHEA Compendium?s strategies, infection rates decreased.
12. CAUTI prevention includes staff involvement of: Insertion
13. 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
14. 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)
15. 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)
16. 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)
19. 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)
20. Total CAUTI (Symptomatic and Asymptomatic) vs. SUTI (Symptomatic) UTI rates from 2006 to 2009 From the Conemaugh Hospital Intranet Website on the infection control page.From the Conemaugh Hospital Intranet Website on the infection control page.
22. 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
(Hoeg, L, 2009)
23. Prior to developing the order sheet, Conemaugh Memorial Medical Center was using ?Best Practice? methods for foley catheter insertion. ?Best Practice? methods included and washing and keeping the field as sterile as possible. Standards were not as strict before implementation of the foley order sheet at Conemaugh Hospital.?Best Practice? methods included and washing and keeping the field as sterile as possible. Standards were not as strict before implementation of the foley order sheet at Conemaugh Hospital.
24. 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
25. 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
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