Urinary Catheter Guide

Resources, Tips, and Medical Product Reviews for Urinary Catheters

Today I found a fact sheet on CAUTI and catheter usage and thought I’d share some of the statistics and information with you.

http://www.wocn.org/pdfs/WOCN_Library/Fact_Sheets/cauti_fact_sheet.pdf

This review of CAUTIs and urinary catheters presents factual, sourced information about the incidence, causes, diagnosis, contributing factors, treatment, and prevention of CAUTI.

Notable points:

1) Catheter infections are one of the most frequent infections today, with 8% prevalence in the homecare setting and 3-7% in the acute care setting.
2) CAUTI is the second most common cause of bloodstream infection, and 3% of patients with a catheter will develop bacteremia (a life-threatening infection). Urosepsis can also develop, which also has a high mortality rate.
3) CAUTI is diagnosed by finding bacteriuria along with an elevated white blood cell count. Some other signs are pain in the bladder or urethra, fever/chills, odorous urine, catheter obstructions, weakness, mental changes in old adults.
4) Some factors increasing the risk of CAUTI include: catheters left in place for more than 6 days, incorrect positioning of tubing, pregnancy, malnourishment, diabetes, azotemia, ureteral stent.
5) Treating CAUTI includes diagnosis and drugs and hospitalization in very serious infections.
6) Prevention starts with removal of the catheter as soon as possible. The longer a catheter is in place, the greater the risk of infection.

Here are some points to prevent CAUTI:

1) Always use sterile equipment
2) Use the smallest sized lumen possible when cashing.
3) Keep the system closed to prevent bacteria development.
4) While not proven, keeping perineal regions clean is recommended.
5) Also not proven but recommended, increased fluid intake may provide benefit.
6) Short-term silver alloy catheters can reduce incidence of CAUTI.
7) Silicone and Hydrogel catheters are recommended for cathing longer than 2 weeks.

Some more interesting points are what is NOT proven to prevent or treat CAUTI:

1) Antibiotics in the drainage bag.
2) Antibiotics and cleansers applied to the meatus.
3) Cranberry Juice (helpful in preventing recurring UTI in non-cathed people but not for preventing CAUTI.)

CAUTIs are one of the most common hospital infections, and many times these infections could be avoiding by better procedures followed by nursing staff inserting and changing the catheters. Urinary tract infections increase patient suffering, but even on a purely economical level it’s bad for hospitals because it increases the time and resources needed for care. So, in essence, everyone loses.

Regardless if an individual chooses to self-cath or is being cathed by a caretaker, good procedures should always be followed to prevent infection. And an individual needing a catheter should have a good understanding of the proper procedures for cathing – so, what can a patient do to protect themselves from improper nursing procedures and prevention of UTIs?
Educate Yourself

• Learn how Catheter-associated infections happen.
• Ask a lot of questions about the hospital’s procedures for catheterization. Understand how their process works, and ask what they do to prevent infections from happening.
• Find out the answers to how long it will be needed, why its necessary, and when it expected to be removed.
• If you don’t understand an answer, keep asking. Or perhaps you’re not asking the right questions – so talk with hospital staff who can lead you to the person who can answer your questions properly. Get family and friends involved if necessary to get the right answers.

Keeping it Clean

• Ensure any visitors, nurses, and doctors all clean their hands with soap and water. All caregivers should wash their hands before touching you, the catheter, or the tubing. Don’t touch, or let anyone else touch, the catheter and tubing without washing their hands first.
• Ensure any catheter inserted into the body is sterile and opened immediately before use.
• If you are told you have a high bacteria count on your skin, clean it with an anti-septic solution.
• Keep a stock of soaps, anti-septics, no-rinse cleansers, gels, lotions, etc. for your own personal use and for nursing care.

Getting Help

• Talk with the nurses or doctors immediately if bandages or equipment get wet or dirty.
• If there is any pain, redness, or soreness around the catheter, let the nurses and doctors know.

Catheter-associated Urinary Tract Infections are the source of the suffering of patients, extended costs, and more frequent hospital care for many patients.  In fact, CAUTIs have been on the rise in hospitals for years now.

Medline’s new catheter tray helps to improve the process of cathing patients to help prevent the costly ($4.5 – 6.65 billion dollar) healthcare-associated UTIs from cathing, most of which is due to incorrect procedure in the cathing process.  CAUTIS stand for about 40% of all healthcare-associated infections.

So whats the big idea?  Medline’s new ERASE CAUTI system helps prevent these catheter infections by helping to streamline the process of correct cathing.  Here are some of the new additions:

Photo Illustrations of Tray Contents - Easy and clear instructions for nurses and health care professionals to know exactly how to use the tray.  This is helpful not only for the health care professional, but also explaining the catheter and the tray components to the patient.

Checklist of Procedures – The instructions with the system come with a checklist of procedures for the catheter tray.  Using a checklist dramatically reduces the number of procedural errors in health care; likewise, following correct procedures can dramatically reduce incidents of incorrect cathing and infections.

Patient Education Cards – Included with the tray are materials to educate the patient for the bedside care they are receiving.  The cards are an easy, useful way of providing this information to patients.

One-Layer Tray Design – The simple design of the tray allows the caretaker to follow an easy, straightforward process that leaves little room for variance (and error).  The sequence of events followed using the ERASE CAUTI system follows the instructions from start to finish.  This helps make patient care efficient and accurate.

Visit Medline’s Website for More.

This article from the AP shows that the Catheter-associated Urinary Tract Infections (CAUTIs) have been on the rise in 2009 despite changes in policy that have failed to address the shortcomings of medical care in hospital settings.

In fact, urinary infections caused by catheterization after surgery increased in frequency by 3.6 percent last month.

CAUTIs isn’t the only lacking element of health care infections; bloodstream infections increased by 8 percent, and overall infections increased 1.6 percent.

The silver lining of the report shows that pneumonia follwowing surgery has dropped by 12 percent, but these cases are far less prevelent than CAUTIs, one of the most common forms of infection.

The study also shows us that Catheter associated urinary tract  infections are most common among the low-income patients and the uninsured, disappointing officials in the Institute of Medicine who have worked to educate about medical errors and how to prevent them, including CAUTIs.

These infections increase hospitalization time, patient suffering, and costs which puts more strain on the already complex and strained healthcare system.    Minimizing infections has the opposite effect; better care, less expenses, and one more hospital bed for a new patient.  All CAUTIs can be mediated simply by providing mindful, careful consideration for any catheter insertion.  By good nursing with sterile environments, correct procedures, and changing the catheter at the correct, recommended interval infections can be prevented and possibly eliminated.

The new CDC guidelines released in November 2009 now include the use of Bladder Volume Ultrasound to help prevent UTIs caused by catheter insertion and use.

This technology has been updated in the guidelines, dating all the way back to 1981 and were in much need of an upgrade since new technology has made the procedures safer and more preventative of UTI risk.

Bladder volume ultrasounds make it easier for hospital staff to measure the urine volume in the bladder to better determine the necessity of a urinary catheter.  There are many cases where a catheter is no longer needed or is not necessary; the bladder volume ultrasound makes it easy to make the decision.

UTIs are one of the most common risks in the hospital, and these procedures should help lessen the risk in the future.  From the original article:

In 2002, the CDC estimated that UTIs accounted for 36% of all nosocomial infections. That year, more than 13,000 deaths were attributed to hospital-acquired UTIs.(5) Up to 25% of hospitalized patients have a urinary catheter placed during their stay. The use of indwelling urinary catheters accounts for 80% of nosocomial UTIs. (2, 6)

The new CDC guidelines indicate that, “an estimated 17% to 69% of CAUTI may be preventable with recommended infection control measures, which means that up to 380,000 infections and 9000 deaths related to CAUTI per year could be prevented.