Foley Catheters and the Risk for Infection
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Foley Catheters and the Risk for Infection

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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\'sDescribe guidelines for foley catheter useage, insertion, maintenance, and removalExamine the development and use of a standard set of foley catheter physician orders based on the CDC and SHEA Compendium.
Foley Catheters and the Risk for Infection

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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 Pyelonephritis Prostititis Endocarditis Sepsis/Septic shock Meningitis

5. Incorrect Reasons for Inserting Foley Catheters: Incontinence Diuretic use Convenience 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 Prolonged immobilization 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 Fevers 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 Care Management Removal

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 Physician?s signature (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 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


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