Instructions
Take Another Course
The chart above summarizes some of the proper techniques for urinary catheter insertion. For those of you in patient care facilities, it will be worth reviewing your catheter insertion policy and procedure and comparing it with one from a reputable nursing procedure manual for accuracy and thoroughness. Keep a checklist readily available prior to insertion to review the procedure, and most importantly identify the appropriate indication for catheter placement. Make sure all of your supplies for catheter insertion are readily available and are sterile. Consider a catheter competency or skills validation program for catheter insertion and catheter maintenance. Identifying those skilled at sterile insertion techniques as “Catheter Champions” can aid in staff training and competency retention. Chart citation: CDC. Guideline for the prevention of catheter-associated urinary tract infections, 2009. Available at: http://www.cdc.gov/hicpac/cauti/02_cauti2009_abbrev.htm
When true infection is suspected, a specimen should be collected from a newly and properly inserted catheter when indicated, or specimens may be collected aseptically by cleansing the sampling port with disinfectant and aspirating urine from the needleless sampling port (and not from the drainage bag).
Specimen should be cultured within 2 hours of collection. Sterile collection container should hold at least 50 ml and the container (not the lid) should be labeled. For CAUTI, remove old catheter before obtaining specimen to eliminate biofilm contamination. If a catheter is still required, collect the specimen after the old one is replaced. If no catheter is in place, use the morning’s first void, using a clean catch mid-stream. NO routine UA C&S should be done on all patients admitted to the hospital with or without catheters. NO routine UA C&S is required after catheter insertion or when catheter is discontinued. Only obtain specimens when patients have symptoms of a UTI (either typical or atypical).
CAUTI prevention, detection and management requires a well-educated multidisciplinary team who are responsible for providing and delivering care. It is not the sole responsibility of your infection control champion. A comprehensive education program should be mandatory for all on the team. Curriculum should include at a minimum content related to the appropriate and inappropriate indications for catheterization, prevention strategies as it relates to aseptic catheter insertion and catheter maintenance. Skills validation and competency assessments should be required and you can get assistance from your medical suppliers with that. Nurses should be empowered to remove catheters without an MD order when specific indication criteria are not met, and also to inform prescribers of catheter alternatives. Systems should be put in place to remind the team that a catheter is in place, including the use of automatic stop orders which have been used with success to get catheters out quicker and decrease the risk for CAUTI. Quality monitoring of both process and outcomes and sharing of these results with all team members. Process monitoring can track compliance with any of the best practices to prevent CAUTI. For example, a random chart audit looks at compliance with documentation of the reason or indication for catheterization. A simple math calculation is performed: # of patients with catheter placed and proper documentation divided by # of patients with catheter in place multiplied by 100= % compliance. Outcomes measurement can look at CAUTI rates: # of CAUTI’s on each unit/location divided by the total # of catheter days for all patients that have a catheter multiplied by 1000 = number of cases/1000 catheter days. Rick Fields-Gardner |
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