Prevention of UTI (non-CAUTI)
- Ensure proper hydration and nutrition.
- Provide good perineal hygiene.
- Promote healthy voiding habits.
Prevention of CAUTIs
(APIC 2014, Meddings et al, 2014, IHI 2011, Gould et al, 2010, Lo et al, 2014)
CAUTI Risk Assessment
- Assess whether an effective organizational program exists.
- Assess population at risk.
- Assess baseline data.
Measurement/Surveillance: surveillance and reporting program in place with standardized definitions
Insertion: Use appropriate technique for catheter insertion
Only trained persons to insert and maintain catheter.
Insert urinary catheters only when necessary for patient care and leave in place only as long as indications remain.
Consider other methods for bladder management, such as intermittent catheterization, where appropriate.
Practice good hand hygiene and routine practices.
Use aseptic technique and sterile equipment for catheter insertion.
Use sterile gloves, drape, and sponges; a sterile or antiseptic solution for cleaning the urethral meatus; and a sterile single-use packet of lubricant jelly for insertion.
Use as small a catheter as possible consistent with proper drainage, to minimize urethral trauma.
Maintenance: Ensure appropriate maintenance of indwelling catheters
- Properly secure indwelling catheters after insertion to prevent movement and urethral traction.
- Maintain a sterile, continuously closed drainage system.
- Replace the catheter and the collecting system using aseptic technique when breaks in aseptic technique, disconnection, or leakage occur.
- For examination of fresh urine, collect a small sample by aspirating urine from the needleless sampling port with a sterile syringe/cannula adaptor after cleansing the port with disinfectant. Obtain larger volumes of urine for special analyses aseptically from the drainage bag.
- Employ routine hygiene; cleaning the meatal area with antiseptic solutions is unnecessary.
Maintain unobstructed urine flow:
- Keep the collecting bag below the level of the bladder at all times; do not place the bag on the floor;
- Keep catheter and collecting tube free from kinking; and
- Empty the collecting bag regularly using a separate collecting container for each patient. Avoid touching the draining spigot to the collecting container.
Removal: Review urinary catheter necessity daily against pre-specified criteria
- Urinary catheter reminders.
- Urinary catheter automatic stop orders.
- Medical directives for nurse-guided urinary catheter removal.
- Develop a protocol for management of postoperative urinary retention, including nurse-directed use of intermittent catheterization and use of bladder scanners.
Special Considerations for Recurrent UTI in Pregnancy
(Epp et al, 2010)
- Early detection, identification and management of UTI.
- all women with a pre-pregnancy history of recurrent UTIs.
- persistent symptomatic or asymptomatic bacteriuria after two antibiotic treatments.
- after only one UTI for a woman who has other conditions that potentially increase the risk of urinary complications during the episode of UTI (e.g., diabetes or sickle cell trait).
Special Considerations for Prevention of Post-partum UTI
- Early detection, identification and management of urinary retention.
- Steps to avoid and manage urinary retention:
- Instruct women to void frequently with good amounts of urine.
- Early ambulation following delivery.
- Pain management.
- Offer privacy when voiding.
Special Considerations for Prevention of CAUTI in Children
The prevention of CAUTI in children, especially healthcare-associated infections (HAIs), is not procedurally different from the concerns confronted in serving adult patients. In pediatrics, the rationale for catheter insertion, catheter size, attention to aseptic technique on insertion, and the reliance on a "bundle" strategy for quality of care in managing the device are all necessary to prevent these infections. However, the additional concerns specifically inherent in the care of children include, but are not limited to:
- The child's age and the use of developmentally appropriate approaches to care.
- Attention to family-centered care, cultural competency of the clinicians, and health literacy of the family.
- Provision of emotional comfort (presence of parent, comforting objects, music, positive distraction).
- Daily care and assessment for allergies, skin sensitivities, especially in the choice of cleansing agents and issues of catheter securement.
Special considerations for prevention of CAUTI in neonates (0-28 days)
- Similar to older children and adults, an indwelling catheter is a risk factor and should be minimized as much as possible.
- Circumcision may be considered for uncircumcised male infants at higher risk for UTI including those with recurrent infections (Sorokan et al., 2015).
- The strategies of antibacterial prophylaxis for the prevention of recurrent UTIs are changing as its benefits have not yet been proven by evident data (Beetz, 2012). It used to be that most infants with febrile UTI and any grade of reflux/hydronephrosis would be prophylaxed, there is a movement towards now prophylaxing only high grade reflux/significant hydronephrosis with recurrent febrile UTIs (Herz et al, 2014, Braga et al, 2015, Tullus, 2015).
Conduct Clinical and System Reviews (see details below)
Given the broad range of potential causes of this clinical group, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.
Clinical and System Reviews, Incident Analyses
Occurrences of harm are often complex with many contributing factors. Organizations need to:
- Measure and monitor the types and frequency of these occurrences.
- Use appropriate analytical methods to understand the contributing factors.
- Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
- Have mechanisms in place to mitigate consequences of harm when it occurs.
To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for analysis methods are included in Resources for Conducting Incident and/or Prospective Analyses section of the Introduction to the Hospital Harm Improvement Resource.
Chart audits are recommended as a means to develop a more in-depth understanding of the care delivered to patients identified by the HHI. Chart audits help identify quality improvement opportunities.
Useful resources for conducting clinical and system reviews: