Catheter-Associated UTI’s Can Be Avoided!

Invasive devices such as catheters are the leading causes of infection in healthcare facilities. And there is one type of catheter that is responsible for more healthcare-associated infections (HAIs) in hospitals, long term care and home care than any other device – the indwelling urinary catheter.

Here are the facts: More than 1 million cases of catheter-associated urinary tract infections (CA-UTIs) occur each year in U.S. hospitals and nursing homes,and CA-UTIs account for up to 40% of HAIs. It is estimated that 25% of patients in the acute care setting will have an indwelling urinary catheter at some point in their hospitalization, and 69% of patients in medical ICUs hospitalized in NNIS hospitals from 1992-1997 had urinary catheters. 

So what’s the problem?  Catheter-associated urinary tract infections or CA-UTIs are generally assumed to be benign. However, CA-UTIs may be associated with significant complications, such as cystitis, pyelonephritis, infection, prostatitis, epididymitis, orchitis in males, and encrustation; less commonly, bacteremia and complications of metastatic infection including endocarditis, septic arthritis, endophthalmitis, and meningitis may occur. CA-UTIs are the second most common cause of healthcare-associated bloodstream infection. CA-UTIs increase length of stay by 1 to 3 days and add to overall patient costs, especially if bacteremia occurs. In addition, urinary catheters often precipitate unnecessary antimicrobial therapy, and are a major reservoir for resistant pathogens. One study has linked CA-UTIs and surgical site infections.

Can all CAUTI’s be avoided? No, not all catheter-associated urinary tract infections or CA-UTI are preventable. For example, there are certain factors that increase the risk of infection that may not be modifiable in a patient. However, there are many CA-UTI that are avoidable. The fact is, many urinary catheters are left in place longer than necessary, simply because physicians forget to look for the catheter, or reassess whether the patient still needs one.  A report published in the September issue of the journal Clinical Infectious Diseases suggests that hospitals can cut CA-UTI infections by 52% simply by implementing an  automatic reminder in the electronic health record or other system that requires a clinician to check daily on the catheter and determine whether it is still needed.

Need more incentive? As of October 1, 2008, Medicare discontinued reimbursement for the extra cost of treating catheter-associated urinary tract infections that occur while the patient is in the hospital. In addition, there is a national push to “get to zero” in the incidence of reportable healthcare-associated infection rates by the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, and the Association for Professionals in Infection Control (APIC) to name a few. And as of May 2011, The Joint Commission announced a new National Patient Safety Goal to prevent CAUTIs to be fully implemented by 2013.

Follow evidence-based practices! If we are to reduce the numbers of infections, clinicians will need to first follow evidence-based practices such as those in the CDC Guideline for the Prevention of Catheter-Associated Urinary Tract Infections 2009; the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and The Joint Commission; Diagnosis, Prevention and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from IDSA;Clinical Fact Sheets by the Wound, Ostomy and Continence Nurses Society (WOCN); and other professional guidelines, and get back to the fundamentals for the care and maintenance of the urinary catheter.

Training videos can help get clinicians on board. Envision, Inc. has an award-winning staff training video that offers 1 Hour CE credit for nurses, available for free preview prior to purchase at http://www.envisioninc.net/index.php/programs/details/preventing_catheter_associated_urinary_tract_infections/.