What are the priority actions a nurse should take to prevent a catheter associated urinary tract infection CAUTI )?
CAUTI InformationWhat is CAUTI?CAUTI is an infection of the urinary tract caused by a tube (urinary catheter) that has been placed to drain urine from the bladder. The urinary tract consists of the kidneys, ureters (tubes joining the kidneys to the bladder), bladder, and urethra (tube leading from the bladder to the outside of the body). Show
Urinary catheters are used to drain urine in patients who are not able to urinate on their own, to measure the amount of urine produced during intensive care, or during and after surgery or tests of the kidneys and bladder. Germs can travel along the urinary catheter and cause an infection in your bladder or your kidney; this type of infection is called a catheter-associated urinary tract infection (or "CAUTI"). The definition of CAUTI falls into two groups:
CAUTI includes those infections in which a patient had an indwelling urinary catheter at the time or within 48 hours before onset of the event. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated. CAUTI is the most common type of HAI and causes 1of 3 HAIs in patients in hospitals. Among urinary tract infections acquired in the hospital, approximately 75% area associated with a urinary catheter. There are an estimated 13,000 annual death attributed to CAUTI. CAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible. Core Prevention Strategies:
Resources:
Guidelines for CAUTI prevention:
Chapter 10. Tubes and Attachments Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required:
Catheter-Associated Urinary Tract InfectionsCatheter-associated urinary tract infections (CAUTI) are a common complication of indwelling urinary catheters and have been associated with increased morbidity, mortality, hospital cost, and length of stay (Gould et al., 2009). Urinary drainage systems are often reservoirs for multidrug-resistant organisms (MDROs) and a source of the transmission of microorganisms to other patients (Gould et al., 2009). The most important risk factor for developing a CAUTI, a health care associated infection (HAI), is the prolonged use of a urinary catheter (Centers for Disease Control and Prevention [CDC], 2015). Urinary tract infections (UTIs) are the most commonly reported HAIs in acute care hospitals and account for more than 30% of all reported infections (Gould et al., 2009). Catheters in place for more than a few days place the patient at risk for a CAUTI. A health care provider must assess patients for signs and symptoms of CAUTIs and report immediately to the primary health care provider. Signs and symptoms of a CAUTI include:
The following are practices for preventing CAUTIs (Perry et al., 2014):
Urinary CatheterizationUrinary catheterization refers to the insertion of a catheter tube through the urethra and into the bladder to drain urine. Although not a particularly complex skill, urethral catheterization can be difficult to master. Both male and female catheterizations present unique challenges. Having adequate lighting and visualization is helpful, but does not ensure entrance of the catheter into the female urethra. It is not uncommon for the catheter to enter the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a new catheter into the urethra, but you must remember to remove the one in the vagina. For some women, the supine lithotomy position can be very uncomfortable or even dangerous. For example, patients in the last trimester of pregnancy may faint with decreased blood supply to the fetus in this position. Patients with arthritis of the knees and hips may also find this position extremely uncomfortable. Catheterization may also be accomplished with the patient in the lateral to Sims position (three-quarters prone). The male urinary sphincter may also be difficult to pass, particularly for older men with prostatic hypertrophy. There are two types of urethral catheterization: intermittent and indwelling. Intermittent catheterization (single-lumen catheter) is used for:
Indwelling catheterization (double- or triple-lumen catheter) is used for:
The steps for inserting an intermittent or an indwelling catheter are the same, except that the indwelling catheter requires a closed drainage system and inflation of a balloon to keep the catheter in place. Indwelling catheters may have two or three lumens (double or triple lumens). Double-lumen catheters comprise one lumen for draining the urine and a second lumen for inflating a balloon that keeps the catheter in place. Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder. Indwelling urinary catheters are made of latex or silicone. Intermittent catheters may be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible than indwelling catheters (Perry et al., 2014). The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal diameter of the tube. Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males. Smaller sizes are used for infants and children. The balloon size also varies with catheters: smaller for children (3 ml) and larger for continuous bladder irrigation (30 ml). The size of the catheter is usually printed on the side of the catheter port. An indwelling catheter is attached to a drainage bag to allow for unrestricted flow of urine. Make sure that the urinary bag hangs below the level of the patient’s bladder so that urine flows out of the bladder. The bag should not touch the floor, and the patient should carry the bag below the level of the bladder when ambulating. To review how to insert an indwelling catheter, see Checklist 80.
Video 10.2Video 10.3Removing a Urinary CatheterPatients require an order to have an indwelling catheter removed. Although an order is required, it remains the responsibility of the health care provider to evaluate if the indwelling catheter is necessary for the patient’s recovery. A urinary catheter should be removed as soon as possible when it is no longer needed. For post-operative patients who require an indwelling catheter, the catheter should be removed preferably within 24 hours. The following are appropriate uses of an indwelling catheter (Gould et al., 2009):
When a urinary catheter is removed, the health care provider must assess if normal bladder function has returned. The health care provider should report any hematuria, inability or difficulty voiding, or any new incontinence after catheter removal. Prior to removing a urinary catheter, the patient requires education on the process of removal, and on expected and unexpected outcomes (e.g., a mild burning sensation with the first void) (VCH Professional Practice, 2014). The health care provider should instruct patients to
Review the steps in Checklist 81 on how to remove an indwelling catheter. Checklist 81: Removing an Indwelling Catheter
If a patient is unable to void after six to eight hours of removing a urinary catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a bladder scan may be performed. A bladder scan can assess if excessive urine is being retained. Notify the health care provider if patient is unable to void within six to eight hours of removal of a urinary catheter. If a patient is found to have retained urine in the bladder and is unable to void, an intermittent/straight catheterization should be performed (Perry et al., 2014). Video 10.4
What actions should the nurse take to prevent catheterHand hygiene before and after manipulating the catheter and providing perineal care is imperative for infection prevention. Perform hand hygiene and don gloves immediately before and after accessing the drainage system, emptying the drainage bag, and collecting a urine sample.
What is the best intervention to prevent a CAUTI catheterCatheter-associated urinary tract infections (CAUTI) are preventable by reducing unnecessary catheter use, length of catheter use, and improving insertion technique [3].
How will you prevent catheterMinimising the risk of CAUTI. ensure that the urinary catheterisation is absolutely necessary for the patient.. remove the urinary catheter as soon as it is no longer needed.. perform hand hygiene and wear appropriate personal protective equipment (PPE) before catheter insertion or manipulation.. Which nursing intervention decreases the risk for catheterLimited evidence suggests that the following interventions reduce the incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure catheterization only when ...
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