Catheter-Associated Urinary

Tract Infections (CAUTI)

Quality Improvement

Wilson F., Felicia V, Angel J.,

Kristin M., Alona V.

Facts About CAUTI

According to the CDC
.

15-25% of people receive urinary catheters during their stay in the hospital.
UTI is most common healthcare associated infection (HAI).
-About 30% of HAI are CAUTI & estimated > 560,000 nosocomial UTI annually
75% of UTI acquired in hospitals are from urinary catheters.
Most important risk factor of CAUTI is prolonged use of urinary catheters.

Function of Biofilm in CAUTI

-Biofilms, or colonies of bacteria are formed in the indwelling catheter
-These biofilms are VERY dangerous, in which they can resist hosts
immune response and antimicrobials.
-Biofilms may form within 3 days after catheter insertion and tend to
form on external surface for less than 10 days of insertion
-Patient at increased risk of INFECTION! leads to CAUTI

QI Model- PDSA Example from Institute for Healthcare

Improvement
Project: Reducing Catheter-Associated Urinary Tract Infections
Objective for This PDSA Cycle: Test whether a nurse using criteria for continued need of urinary catheter can determine readiness
to remove in concurrence with the physician, as a basis for possible nurse-driven protocol
PLAN: Develop a list of criteria for continued need of urinary catheters and test with assessment of several patients. Questions:
Will nurses using the criteria concur with physicians as to whether catheter is ready for removal? Will nurses feel comfortable
making recommendation for catheter removal? Will physicians be willing to approve nurse-driven protocol for catheter removal?
Predictions: Nurses and physicians will concur for patients for whom criteria clearly apply. If there is concurrence during testing,
nurses and physicians will be comfortable moving to a protocol. Plan for change or test who, what, when, where: What: Assess
two patients with urinary catheters using the criteria, and compare nurse recommendation to physician decision about whether to
remove catheter. Who: Stan (nurse), Margaret (physician) Where: 3 South medical unit When: Tomorrow day shift Plan for
collection of data who, what, when, where: Who: Stan What: Note nurse recommendation using criteria and physician decision.
When: Tomorrow day shift, while assessing patients and then during discussion with physician Where: 3 South medical unit
Do: Carry out the change or test. Collect data and begin analysis. Stan identified two patients with urinary catheters with the
criteria and determined that patient A met the criteria for continued catheter necessity and patient B did not. He noted that
patient B could have the catheter removed. Margaret (MD) reviewed Stans assessments with him and concurred; she ordered that
patient Bs catheter be removed

Continued
STUDY: Complete analysis of data: How did or didnt the results of this
cycle agree with the predictions that we made earlier? Summarize the
new knowledge we gained by this cycle: Nurse and physician did concur
on whether catheters in these patients should be continued. More
testing with other nurses and physicians is necessary to ensure criteria
are clear and understood.
ACT: List actions we will take as a result of this cycle: Train other nurses
in use of the criteria and test further, monitoring concurrence between
nurses recommendations and physicians orders. Plan for the next
cycle (adapt change, another test, implementation cycle?): Test the
criteria with all day shift nurses on 3 South for three days. Stan will train
nurses on using criteria. Margaret will be liaison to other physicians and
communicate that this is still a test.

What's the Big Deal?

Estimated that about 13,000 CAUTI attributed to death of a patient
annually.
Increases the patient's stay 2-4 days longer
Increased cost $400-500 million per year nationally.

National and Hawaii Statistics on CAUTI

Hawaii: 19% increase in CAUTI from 2013 to 2014

Hawaii vs. Nation: 24% below National average for CAUTI

Nation: 5% decrease in CAUTI incidence from 2013 to 2014

Oxford Journal on Reduction of CAUTI

1.The first intervention was the exclusive use of silver alloy catheters in the
hospital's acute care areas.
2. The second intervention was a securing device to limit the movement of the
catheter after insertion.
3. The third intervention was repositioning of the catheter tubing if it was found
to be touching the floor.
4.The fourth intervention was removal of the indwelling urinary catheter on
postoperative Day 1 or 2, for most surgical patients.

Association of Periop Registered Nurses (AORN)

Journal
1- Use foley only as necessary and not routinely
2- Appropriate catheter use
3- Proper technique for insertion and maintenance
4- Quality improvement programs
- In 2009 this article found that out of 1653 ICUs
27-68% had a CAUTI prevention policy
6-27% adhered to the prevention policy

Continued
-23% of ER admits have a foley placed and is often unnecessary.
-21-63% of those patients did not have an appropriate clinical indication
So what are some appropriate clinical indication?
According to AORN
1. Acute urinary retention
2. Measurement of UOP for critically ill patient.
3. Periop surgery
4. Open sacral or perineal wound in incontinent patients

Toolkit for Reducing CAUTI in Hospitals

ANA Cauti prevention tool
CAUTI toolkit CDC http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
National CAUTI prevention initiatives
- Partnership for patients
- CUSP

Statistics from Evidenced-Based Article for

Infection and Prevention Control
30% of hospitals in USA do not monitor for UTI rates
More than 50% do not monitor # of patients that have urinary
catheters
>70% do not regularly monitor duration and discontinuation of
urinary catheters
<10% of hospitals in USA have adopted stop order or reminder
systems

CDC Recommended Modifiable Interventions

1.Appropriate indications only
2.Remove within 24 hours unless indicated otherwise
3.Inserted by properly trained personnel
4.Aseptic technique and sterile equipment
5.Maintain a closed drainage system
6.Maintain unobstructed urine flow
7.Hand hygiene and standard precautions

Conclusion:
Ways to Improve CAUTI Statistics for QI
-Follow Evidence-Based Guidelines for preventing CAUTI in the healthcare setting.
-Compliance monitoring of urinary catheter use (AUDITS)
-Provide continuing education for new and long-term clinical staff on indications for
urinary catheters, proper insertion, maintenance, and timely removals.

References

Centers for Disease Control and Prevention. 2014 National and State Healthcare-Associated Infections Progress Report. Published March, 2016.
Available at
www.cdc.gov/hai/progress-report/index.htm
Centers for Disease Control and Prevention. (2015, October 16). Catheter-associated Urinary Tract Infections (CAUTI). Retrieved March 3, 2016, from
http://www.cdc.gov/HAI/ca_uti/uti.html
Clarke, K. (2012, December 6). Reduction in catheter-associated urinary tract infections by bundling interventions. Retrieved March 21, 2016, from
http://intqhc.oxfordjournals.org/content/25/1/43
Hawaii State Department of Health. (2014, July 9). Healthcare-Associated Infections in Hawaii. Retrieved March 3, 2016, from
http://health.hawaii.gov/docd/files/2014/07/Hawaii-2013-HAI-Report-Final2.pdf
Knudson, L. (2014, May). CAUTI prevention requires improved practices and policies. Retrieved March 27, 2016, from http://www.aornjournal.org/article/S00012092(14)00377-9/pdf
Giles, Michelle (2015). Does our bundle stack up. Innovative nurse-led changes for preventing catheter-associated tract infections. Retrieved March 30, 2016 from
http://www.publish.csiro.au/?act=view_file&file_id=HI14035.pdf
Gould,
C.
(n.d.).
Catheter-associated
Urinary
http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

Tract

Infection

(CAUTI)

Toolkit.

Retrieved

Srejic, Elizabeth (2016, February). Biolfims and catheters: the mechanisms of infection.
http://www.infectioncontroltoday.com/articles/2016/02/biofilms--catheters-the-mechanisms-of-infection.aspx

March

Retrieved

How-to Guide: Prevent Catheter-Associated Urinary Tract Infections. (2011, December). Retrieved March 31, 2016, from
http://www.mnreducinghais.org/documents/CAUTI_How_to_Guide.pdf

March

30,

30,

2016,

from

2015

from: