Hi-R-Ed Online

This course was written by Cindy Nissen, RN, MSN, CWCN, and edited for presentation by Hi-R-Ed Online, a continuing education program development company. Hi-R-Ed Online is an accredited provider of continuing education courses for nurses, case managers, social workers and registered dietitians.

The focus of today’s program is an examination of catheter-associated urinary tract infections. This course will give healthcare team members a better understanding of the causes of CAUTIs, and best practices for how to prevent and manage them.

Let's begin with our learning objectives.

Learning Objectives

The Learning Objectives for this course are fairly straightforward. While we will assume you have some knowledge of diabetes and insulin pumps, we will make an effort to provide you with a working knowledge of insulin pumps, how they’re used, what options there are when selecting a pump and continuous monitor, and we will define some of the terms used in the discussion of these devices as we go.

The purpose of setting learning objectives at the beginning of the course is to set the framework and goals for the information that we will cover.

Once the course is completed you should be able to:

1. Describe 3 categories of impact that CAUTIs may have on patients and healthcare facilities.

2. Identify 4 indications for indwelling urinary catheter use.

3. Explain 3 best practice recommendations to reduce CAUTI risk.

4. Describe 3 strategies for teaching patients and their families about best practices used to reduce the risk of CAUTI.

Before we get started, think about these questions if you work in a patient care facitlity:

--Do you know how many Foleys (indwelling urinary catheters) are currently in use in your practice setting or unit?

--If Foleys are currently in use in your facility, do you know why they are being used?

--What training do you have in place currently-related to catheter insertion and catheter maintenance?

Now let’s cover some background information to describe the impact of CAUTIs on patients and healthcare facilities.

The National Healthcare Safety Network defines CAUTI as a urinary tract infection or UTI that occurs in a patient who has or had an indwelling urinary catheter in place within the 48-hour period before the onset of the UTI.[1] There is no minimum amount of time that the catheter must have been in place in order to be considered a CAUTI and it may be symptomatic UTI (SUTI), asymptomatic bacteremic UTI (ABUTI), or other UTI (OUTI). These will be briefly discussed in a moment. Of the 1.7 million healthcare-acquired infections (HAIs), UTIs represent 40% of these infections (680,000) and is the most common HAI. Eighty percent of these (544,000) are catheter-related.[2]

In acute care it is estimated that between 12-25% of all patients have a catheter placed at some time during their stay and of those 50% have no appropriate indication for its use. In long term care, an estimated 5-10% indwelling catheter prevalence rate and 11% in the home care setting. Most catheters in the non-acute care setting are usually in place for longer than 30 days. The costs of CAUTI are impressive. In terms of money, CAUTI’s increase length of stay by 2-4 days or $400 to $500 million/annually.[2] Added costs include catheter related supplies, laboratory specimen collections, and antimicrobial use, to name a few. If CAUTI results in a bloodstream infection, care costs increase to $2500-3000/case.[3] Effective 10/1/2008, inpatient PPS hospitals do not receive higher payment for hospital-acquired conditions like CAUTI. There will be no reimbursement for the care and treatment of the CAUTI acquired during the hospital stay. Costs in terms of morbidity include those on the urinary tract itself: pain/spasms/uncomfortable feeling due to presence of catheter, strictures, urethral erosion/trauma. The catheter may restrict the patient’s mobility and increase risk for deep vein thrombosis (DVT), pressure ulcer and social isolation or depression.[4] Sanjay Saint, MD refers to a urinary catheter as a “one-point restraint.”[5] 17% of healthcare acquired bloodstream infections are sourced from the urinary tract and are associated with a 10% mortality rate, equivalent to 13,000 deaths/year.[4]

1. Citation: Wound Ostomy and Continence Nurses Society. Catheter Associated Urinary Tract Infections (CAUTI): Fact Sheet. Available at: http://c.ymcdn.com/sites/www.wocn.org/resource/collection/6D79B935-1AA0-4791-886F-E361D29F152D/Catheter_Associated_Urinary_Tract_Infections_(CAUTI)_-_FS_(2008).pdf

2. Citation: Virginia Department of Health. Urinary Tract Infections and Catheter-Associated Urinary Tract Infections. Available at: http://www.vdh.virginia.gov/epidemiology/surveillance/hai/uti.htm

3. Citation: Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases. 2009;50(5):625-663. Available at: http://cid.oxfordjournals.org/content/50/5/625.full

4. Citation: Gould C. Catheter-associated urinary tract infection (CAUTI) toolkit. Presentation available at: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

5. Citation: Saint S, Olmstead RN, Fakih MG, et al. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf. 2009;35(9):449-455.