UTI Prevention in Patients with Foley Catheters

Lourdes Health Network

2011

Background UTIs account for over 6 million

patient visits to physicians per year in the United States.

UTIs are the most common hospital acquired (HA) infection

80% of HA-UTI are attributable to indwelling urethral catheters.

12-16% of hospitalized patients will get a Foley and half of them do NOT have a valid indication.

Risk of UTI increases 3-7% for every day with Foley

Relevance UTIs increase a patient’s length of

stay an average of 0.5 -1 day The estimated cost per Catheter

Associated UTI (CAUTI) ranges $500- $3000

If not documented upon admission (CAUTI), then hospital cannot code for higher reimbursement DRG for Medicare patients in some hospitals

Urinary Tract Infections

Definition of UTIa microbial

infection (typically bacterial) of the urethra, bladder, ureters, or kidneys.

Most common is Escheria coli

UTI Definition continued…

Symptomaticmore typical presentation (burning

with urination, urinary frequency, low fever, cloudy urine (possibly), foul odor to urine, pressure or cramping in lower abdomen

Asymptomatic bacteriuriaa significant number of bacteria in the

urine that occurs without usual symptoms such as burning during urination or frequent urination. Those with urinary catheters will more likely have this condition.

3 Primary Routes of Infection

1. Catheter-meatal junction More often in females (shorter urethra)

2. Catheter manipulation Example: allowing drainage spout to

touch the ground or contaminating the catheter tubing while placing a new drainage bag.

3. Retrograde bacterial migration Example: lifting bag above level of

bladder during transport or repositioning

More about indwelling catheters…. They are uncomfortable for patients Can be unnecessary for patient treatment plan (41-58% in place found to be not indicated) Can be associated with negative outcomes

Urethral inflammationUrethral stricturesMechanical trauma to urethra/bladder

Can DECREASE mobility (because the patientdoes not have to get out of bed to urinate)

which may impede recovery or contribute to

complicationslike pressure ulcers, pneumonia, and/or DVT

Appropriate Indications For Foley Catheters per LHN Protocol

Criteria for Continuing Foley CatheterStrict I & O or aggressive treatment with diuretics or fluidsChronic urinary retention or bladder outlet obstructionCritically ill patient – hemodynamic instabilityRenal failure Recent renal/urology procedureAcute neurogenic bladderHistory of chronic, prolonged catherization or suprapubic catheterHematuriaChemical sedation or paralyzationTerminally ill or palliative care patientEpidural catheterPelvic or hip fractureStage 3 or greater pressure ulceration on coccyx or buttocks

Urinary Catheters are NOT Indicated for:

Immobility or poor mobility General incontinence Skin excoriation Obtaining urine specimens Patient request Nurse convenience

What is a Nurse Initiated Foley Removal?

A policy developed in keeping with national best practice standards which ensures that Foley catheters are used appropriately.

Facilitates nursing assessment for approved indications for the use of a Foley catheters

Nurses are empowered to remove unnecessary catheters (those not meeting an approved criteria) without a doctors order.

Enables catheters to be removed earlier! Decreases potential for hospital acquired UTIs

in our patients!!!

This policy has been supported and approved by MEC!

Foley Removal Assessment & Documentation on Meditech

Foley Removal Assessment & Documentation on Meditech continued . . . .

Look up for

continuing Foley

If the patient does not meet any of the criteria for continuing the Foley catheter, REMOVE THE CATHETER!

Post catheter removal Educate patient about what to expect (e.g.

to notify nursing with the first voided specimen, measuring urine, getting help if needed to go to the BR, etc.)

Document due to void time(5 – 8 hours post catheter removal) and communicate this with the oncoming shift!

Scan patients bladder and notify physician of inability to void if the patient is unable to void post removal.

Documentation of removal &due to void time (DTV)

Document Output - Post Catheter Removal

If Urinary Catheterization continues to be appropriate. . . . Use aseptic technique during subsequent

catheter insertion and care Properly manage the system and components

Keep closed drainage system Keep bag below level of the bladder Prevent excessive manipulation of the

catheter Keep bag off of the floor Secure catheter to leg Provide catheter care daily and after

bowel movements Continue to educate and advocate for the

prompt removal of the Foley catheter

References

Institute for Healthcare Improvement-Preventing CAUTI http://www.ihi.org/IHI/Programs/ImprovementMap/PreventCathete

rAssociatedUrinaryTractInfections.htm Lo, E., Nicolle, L, Classen, D., et al. (2008). Strategies to prevent

catheter-associated urinary tract infections in acute care hospitals. Infection control and hospital epidimiology. October, Vol 29, Supplement 1. (Supplement article: SHEA/IDSA practice recommendations)

Nazarko, Linda (2008). Reducing the risk of catheter-related urinary tract infection. British Journal of Nursing, Vol 17, No 16.

Gotelli, J., Merryman, P., Carr, C., McElveen, Epperson, C., & Bynum, D. (2008). A quality improvement project to reduce the complications associated with indwelling urinary catheters. (Society of Urologic Nurses and Associates) Urologic Nursing. pp.465-473.

Vieira, Fabricia (2009). Nursing actions to prevent urinary tract infection associated with long-standing bladder catheter. A Literature Review. Einstein; 7 (3 part 1): 372-5.

References continued . . . .

Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN) Association for Professional Infection Control and Epidimiology

(APIC) Busuttil Leaver, Rachel (2007).The evidence for urethral meatal

cleansing. Nursing Standard. June, vol 21, no 41. 2009 NACNS National Conference Abstracts (March 5-7, 2009), St.

Louis, Missouri.Creating a foley free zone by preventing and removing unnecessary urinary catheters.

www.cconline.org. Clinical Nurses finding evidence for practice: reducing catheter-associated urinary tract infections. Critical Care Nurse. April, 29 (2)