Catheter Associated Urinary Tract Infections

1. Catheter Associated Urinary Tract Infections Colinda Marquez, RN Northeastern State University EBP Symposium April 23, 2010 colindaguthrie@hotmail.com

2. PICO In the acute care setting does early removal of urinary catheters reduce the instance of Catheter Associated Urinary Tract Infection (CAUTI)?

3. Problem 36-40% Hospital associated infections are CAUTIs ~ 400,000 CAUTIs occur annually Minimal cost to treat $1,006 (Association for Professions in Infection Control, 2008)

4. Significance Nurses are in a position to influence the outcomes of urinary catheter use Place urinary collections devices Maintain urinary devices through the duration Perform routine assessments Implement interventions if infection occur

5. Impact Longer hospital stays Other complications Pyelonephritis, miningitis, osteomyelitis, encrustations, multidrug resistant organisms, urethral strictures, and obstructions. (Association for Professions in Infection Control, 2008.)

6. Other Impacts Reimbursement Medicare “Present on Admission Indicator” Absence of indicator means hospital acquired UA on admission to protect the institution could lead to unnecessary abx use leading to drug resistance (Saint, 2009) 80% post op asymptomatic bacteriuria resolves spontaneously (Sciotz, & Tanbo. 2006).

7. Placement As many as 32% catheters were inappropriate (Elpren, E., Kileen, K., Ketchem, A., Wiley, A., Patel, G., & Leteef, O. 2009).

8. Appropriate Placement Urinary tract obstruction or retention Prolonged procedure > 2 hrs Recent surgery Monitoring output Sedation Stage III & IV ulcers or surgical repair of Terminal illness movement impairment

9. Inappropriate Placement Incontinence without complications Diuresis Frequent output Nurse concert for pt discomfort Diarrhea Patient preference Convenience

10. Duration Studies Orthopedic surgical, abdominal, medical & gynecological Agree on early removal Orthopedic and gynecological interventions immediate vs 6 hr vs >delayed Risk for infection starts at 2-3 days (Alessandri, F., Mistrangelo, E., Lijoi, D., Ferrero, S., & Gagni, N. 2006)(Apisarnthanarak, A., Thongphubeth, K., Sirinvaravong, S., Kitkangvan, D., Yuekyenk, C., Boonyasit, W., . . . Frasier, V. 2007)(Johnson, J., Kuskowski, M., & Wilt T. 2006)

11. Stop Orders Verbal reminders with daily rounds Prewritten stop orders Automated stop orders EHR Decision making algorithm Highest success Average 5days to >3 days Verbal reminders based on catheter audit (Blodgett 2009) (Apisarnthanarak, A., Thongphubeth, K., Sirinvaravong, S., Kitkangvan, D., Yuekyenk, C., Boonyasit, W., . . . Frasier, V. 2007) (Loeb, M., Hunt, D., Halloran, K., Carusone, S., Dafoe, N., & Walters, S. 2008)

12. Types of Catheters Standard- silicone or latex Silver catheters No significant decrease CAUTI (Seymore, 2006 & Srinivasan, A., Karchmer, T., Richards, A., Song X., Perl, T., 2006.) Nitrofuninate Risk reduction 7% (Johnson, 2006, p. 119.)

13. Catheters Condom catheters 5 times less likely to develop symptomatic UTI over standard catheters VAMC (Saint et al, p. 1058.) Drawback- not for patients with dementia

14. Catheter Care Insertion Sterile technique Some institutions use a check off list Hand Hygiene Bag position Secure bag Prevent friction/rubbing or dislodge (Upton, 2008, p. 484.)

15. Catheter Care Cleansing Daily cleansing with soap and water Strokes away from the entry area Women toward anus Avoid irritation Cleans and retract foreskin Don’t forget about it No aseptic solutions Gentle- avoid irritation Scrubbing increases risk of infection (Leaver, 2007, p. 40.)

16. Strategy Policy Catheter audit Good reporting Taylor reminder to facility Teaching Poster presentation In services

17. Leadership Administration Nurse education Charge nurses Team leaders Infection control officer

18. Evaluation Decreased antibiotic use Decreased hospital stays Reflected on census Decreased cost to treat Reflected retrospectively on budget Decreased return for repeated UTI

19. More Questions One question leads to another and the wheel moves forward!