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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

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
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
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
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)

incorrect reasons for inserting foley catheters
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
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
Methods of surveillance of catheter associated urinary tract infections (CAUTI’s) include:
  • Obtain/monitor urine C&S results
  • Fevers
  • Presence of bacteriuria
slide8
The Society for Healthcare Epidemiology of America (SHEA) Compendium set forth a set of written guidelines for foley catheters:
    • Use
    • Insertion
    • Maintenance
slide9
The SHEA Compendium was "a compendium of strategies to prevent healthcare-related infections.“

(Lo et al., 2008)

slide10
According to the SHEA Compendium, most patients with Urinary Tract Infections (UTI’s) are asymptomatic.(Lo et al., 2008)
slide11
The SHEA Compendium guidelines include facility specific criteria for catheter usage and removal.

(Lo et al., 2008)

insertion
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)

slide14
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
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
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)

slide17
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)

slide18
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)

slide19
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)

slide20
Total CAUTI (Symptomatic and Asymptomatic) vs. SUTI (Symptomatic) UTI rates from 2006 to 2009

(Hoeg, L, 2009)

slide21
By using the CDC and SHEA

Compendium Guidelines, a

standardized foley catheter

order sheet was developed.

foley protocol orders include
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)

slide23
Prior to developing the order sheet, Conemaugh Memorial Medical Center was using “Best Practice” methods for foley catheter insertion.

(Hoeg, L, 2009)

summary
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
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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