The webinar “Target Zero: Evidence Based Strategies for Reducing the Risk of CAUTIs”, led by Patricia Posa, MSA, BSN, RN, CCRN‐K, FAAN details the negative impacts of high CAUTI (Catheter‐Associated Urinary Tract Infection) rates for both patients and hospitals, identifies evidence‐based practices and alternative methods to prevent CAUTIs, and discusses strategies for maximizing CAUTI prevention throughout patient‐care procedures.
CAUTI is a type of HAI (Health‐care Associated Infection) that is prevalent in hospitals. The good news is that fewer CAUTIs have been reported between 2011 to 2015. However, there is still room for improvement‐‐urinary tract infections (UTIs) represent the 4th most common type of HAI.
This webinar’s focus is urinary catheters and their link to preventable CAUTIs – a critically important topic. For every 1000 in‐hospital CAUTI cases, there are 36 excess deaths. In addition, CAUTI places undue financial strain on both patients and hospitals. CAUTIs are associated with an increased cost of $400 million to $500 million annually.
The main risk factor for developing CAUTI is the presence of an indwelling urinary catheter. According to Posa, the easiest way to prevent CAUTI is to avoid inserting a catheter—eliminating step 0 of the process.
In the presence of an indwelling urinary catheter, microbes can enter the bladder extraluminally (around the external surface) or intraluminally (inside the catheter).
Typically, 2/3 of microbes enter the bladder extraluminally, while 1/3 enter through the catheter itself.
While the catheter is inserted, the daily risk of bacteriuria is between 3% to 10%. However, by 30 days that risk jumps to 100%. Removing the catheter once it is no longer indicated is important to mitigate risk of infection.
Step 0: Avoid catheter when possible (if there is no catheter, no catheter‐induced infection can occur)
Step 1: Aseptic Insertion (if it must be used)
Step 2: Maintaining Awareness and Proper Care
Step 3: Prompting Catheter Removal
Posa emphasizes that indwelling catheters are only appropriate under specific indications. The following guidelines for indwelling catheter use are supported by the CDC (Centers for Disease Control and Prevention), SHEA (Society for Healthcare Epidemiology of America), IDSA (Infectious Diseases Society of America), and NHS (National Health Service).
- Perioperative use for selected surgical procedures
- Urine output in critically ill patients
- Management of acute urinary retention and urinary obstruction
- Assistance in pressure ulcer healing for incontinent patients
- At a patient request to improve comfort (SHEA) or for comfort during end of life care (CDC)
- Bedside commode, urinal, or continence garments: to manage incontinence
- Bladder scanner: to assess and confirm urinary retention, prior to placing the catheter to release urine
- Straight catheter: for one‐time, intermittent, or chronic voiding needs
- External catheter: appropriate for men without urinary retention or obstruction
A variety of external devices have been developed for both females and males. While these options differ in design, their main function is to divert urine away from the skin, often using suction to do so when the patient voids.
A common alternative for males is condom catheters. However, there are issues with these devices, including:
- Skin irritation and maceration
- Difficult to keep the condom from falling off/retraction of the penis or decreased size
- Ischemia and penile obstruction/tightness
- Adherence difficulty: required to secure on the shaft and adhesive mechanisms are challenging
Newer devices have been developed to mitigate these problems.
Studies have found significant decrease in CAUTI rates when using external female devices, along with a decrease in catheter days for the patient as well.
If you are interested in learning more about alternatives for females, the webinar provides details on these options.
Eloquest Healthcare now offers the Uricap™ Female, a completely external female urinary management device that does not utilize “wall suction”, can be left in place for 24 hours and supports accurate urine output monitoring.
If an indwelling catheter is needed, it is important not to leave it in longer than necessary. Strategies for early removal can be driven by both physicians and nurses. Both courses of action require daily assessment of patient condition and robust communication.
Inappropriate use of indwelling catheters can be a patient safety issue, as well as a financial burden on patients and hospitals alike. It is important to continually reassess and improve catheter protocol to ensure patients receive the best possible care.
To learn more, view the full webinar here.
Eloquest Healthcare’s products support strategies that prevent hospital acquired infections and provide better outcomes, higher quality and lower healthcare costs.
For more information about the Uricap™ Female, please contact your sales consultant or Eloquest Healthcare®, Inc. or call 1‐877‐433‐7626.
- Posa, P. (December 2020) Target Zero: Evidence Based Strategies for Reducing the Risk of CAUTIs. [Webinar]. Retrieved from www.pfiedlereducation.com/diweb/catalog/item/eid/1428‐2020.