Catheter-Associated Urinary Tract Infection Prevention Document Library… · HEALTHCARE-ASSOCIATED INFECTIONS PROGRAM UTI in Long Term Care (LTC) • The ost common m infection in

HEALTHCARE-ASSOCIATED INFECTIONS PROGRAM

Catheter-Associated Urinary Tract Infection Prevention

Basics of Infection PreventionHealthcare-Associated Infections Program

Center for Health Care QualityCalifornia Department of Public Health

Last updated 2017


Objectives Define the scope of healthcare-associated urinary tract

infections (UTI) Review evidence-based clinical practices shown to prevent

catheter-associated urinary tract infections (CAUTI) Discuss strategies to reduce CAUTI within healthcare settings Discuss adherence monitoring and feedback

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UTI Epidemiology

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80% UTI are catheter-associated (CAUTI)

Leading cause of secondary bloodstream infection (BSI)

10% mortality rate (13,000 attributable deaths annually)

Increases length of stay by 2-4 days Results in antimicrobial overuse and antimicrobial resistance

IHI Catheter-Associated Urinary Tract Infectionhttp://www.ihi.org/topics/CAUTI/Pages/default.aspx

Catheter-Associated Urinary Tract Infection (CAUTI) Toolkit, CDC, 2009https://www.cdc.gov/infectioncontrol/tools/index.html#Infection

APIC Guide to the Elimination of CAUTI, 2008https://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-

676c27592de2/File/APIC-CAUTI-Guide.pdf

http://www.ihi.org/topics/CAUTI/Pages/default.aspxhttps://www.cdc.gov/infectioncontrol/tools/index.html#Infectionhttps://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdfhttp://www.ihi.org/topics/CAUTI/Pages/default.aspxhttps://www.cdc.gov/infectioncontrol/tools/index.html#Infectionhttps://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdf


Urinary Catheter Use Use of indwelling urinary catheters high

Medical surgical unit: 10-30% patients ICU: 60-90% patients Nursing home: 7-10% residents

40-50% patients with a urinary catheter in hospital (non-ICU ward) do not have a valid indication for placement

Physicians frequently unaware of use Risk of CAUTI increases each day the urinary catheter remains

NHSN Patient Safety Manual, Chapter 7, UTICDC: Catheter Associated UTI, https://www.cdc.gov/hai/ca_uti/uti.html

APIC Infection Preventionists Guide to Long Term Care, 2013)https://apic.org/APICStore/Products/Product?id=SLS6008

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https://www.cdc.gov/hai/ca_uti/uti.htmlhttps://apic.org/APICStore/Products/Product?id=SLS6008https://www.cdc.gov/hai/ca_uti/uti.htmlhttps://apic.org/APICStore/Products/Product?id=SLS6008


UTI in Long Term Care (LTC)

The most common infection in LTC is UTI Bacteriuria also very common

By itself, not associated with adverse outcomes and does not affect survival

Prevalence of indwelling urethral catheters is 7% to 10% Catheterization predisposes to clinical UTI Catheterized urinary tract is the most common source of

bacteremia

SHEA/APIC Guideline: Infection Prevention and Control in Long-Term Care, 2012: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375028/#

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375028/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375028/

HEALTHCARE-ASSOCIATED INFECTIONS PROGRAMCAUTI Etiology

Source: Patients colonic or perineal flora Bacteria on hands of personnel

Microbes enter bladder via one of two routes: Extraluminal: the external surface Intraluminal: inside the catheter

Risk of bacteriuria with catheterization Daily: 3% - 10% By day 30: 100%

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Maki D & Tambyah P. Engineering out risk of Infection with urinary catheters. Emerg Infect Dis, 2001


Pathogens Associated with CAUTI

Escherichia coli 24% Candida albicans 12% Pseudomonas aeruginosa 10% Klebsiella pneumoniae/oxytoca 10% Enterococcus faecalis 7%

NHSN Antimicrobial Resistance Report: Distribution of all Pathogens Reported by HAI Type, Appendix to Table 4, 2011-2014

https://www.cdc.gov/nhsn/xls/reportdatatables/2014-appendix-pathogens.xlsx

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https://www.cdc.gov/nhsn/xls/reportdatatables/2014-appendix-pathogens.xlsxhttps://www.cdc.gov/nhsn/xls/reportdatatables/2014-appendix-pathogens.xlsx


CAUTI Prevention 69% CAUTI can be prevented with currently recommended

infection prevention practices 380,000 infections prevented annually 9,000 lives saved

National 2020 CAUTI 5-year prevention goal: 25% decrease from 2015 baseline CDPH HAI Advisory Committee recommended adoption

of national goal for California hospitals

CDC CAUTI Prevention guidelines, 2009: www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf

HHS National Action Plan, 2013: https://health.gov/hcq/prevent-hai-action-plan.asp

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http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdfhttps://health.gov/hcq/prevent-hai-action-plan.asphttp://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdfhttps://health.gov/hcq/prevent-hai-action-plan.asp


CDC Prevention Recommendations

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Core CAUTI Prevention Strategies Insert catheters only for appropriate indications Leave in place only as long as needed Ensure only properly trained persons insert and maintain Perform hand hygiene Use aseptic technique and sterile equipment for insertion Maintain closed drainage system and unobstructed urine

flow Implement improvement program to achieve appropriate

use of catheters

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http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdfhttp://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf


Appropriate Indications for Urinary Catheters Acute urinary retention or obstruction Peri-operative use in select (not all) surgeries Assist healing of perineal and sacral wounds in incontinent

patients Hospice, comfort care, palliative care Required immobilization for trauma or surgery Chronic indwelling urinary catheter on admission

Necessity must still be evaluated on admission Accurate measurement of urinary output in critically ill

patients (intensive care, those monitored hourly)CDC CAUTI Prevention guidelines, 2009:

www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf

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CAUTI Prevention Supplemental Care Practices

Consider alternatives to indwelling urinary catheters Use portable ultrasound devices to assess urinary retention,

reduce unnecessary catheterizations Consider antimicrobial/antiseptic impregnated catheters

Supplemental care practices will not be effective unless primary care practices are used routinely


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Preventing CAUTI in LTC LTC recommendations are the same as hospital

recommendations (3 previous slides) Facility-wide commitment to

Limit catheter use Ensure aseptic catheter insertion by trained personnel Use smallest diameter catheter as possible Avoid irrigation unless the catheter is obstructed Keep collecting bag below the bladder Ensure adequate nutrition and hydration

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CAUTI Prevention Bundle Examples

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Not RecommendedNo evidence to support UTI prevention:X Complex urinary drainage systemsX Routinely changing of catheters or drainage bagsX Routine antimicrobial prophylaxisX Cleaning the periurethral area with antisepticsX Antimicrobial irrigation of the bladderX Antiseptic / antimicrobial solution instillation into drainage

bagsX Routine screening for asymptomatic bacteriuria


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UTI Prevention Process Measures Measure catheter use:

Days with Foley catheter Patient days (x 100) = __%

Measure health care provider adherence: Hand hygiene Documentation of catheter insertion and removal Daily assessment of Foley catheter Documentation of indications for use

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http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf


Adherence Monitoring Tool - UTI Prevention 17


UTI Prevention Outcome Measure

Measure infections: Perform UTI surveillance using standardized definitions and

protocols Bacteria in urine alone is not an infection

Must evaluate for other UTI symptoms or have supporting laboratory data

NHSN Patient Safety Module: Chapter 7 Device-Associated Module, CAUTI

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IP Role in CAUTI Prevention Ensure policies and practice reflect current evidence based

recommendations CDC guidelines

Ensure staff competency upon hire and at least annually New hire orientation Annual skills fair Return demonstration to ensure competency

Establish an adherence monitoring program for core care practices Use tools to measure adherence

Perform UTI surveillance Provide feedback to frontline staff and leaders

Present adherence results with CAUTI incidence to each unit

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HEALTHCARE-ASSOCIATED INFECTIONS PROGRAM 20

CDPH CAUTI Observations, 131 Facilities, 2016


Are CAUTI Prevention Core Care Practices Used Routinely in YOUR facility?

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Additional CAUTI Prevention References and Resources Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, and HICPAC. Guideline

for Prevention of Catheter-associated Urinary Tract Infections, 2009http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf

IHI Program to Prevent CAUTI http://www.ihi.org/topics/CAUTI/Pages/default.aspx

APIC Preventing CAUTI: A patient-centered approach ,2012, http://apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdf

IDSA Guidelines , Clin Infect Dis 50:625-63, 2010

SHEA/IDSA Compendium, ICHE, 35:464-479, 2014

National Quality Forum (NQF) Safe Practices for Better Healthcare,2010

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http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdfhttp://www.ihi.org/topics/CAUTI/Pages/default.aspxhttp://apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdfhttp://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdfhttp://www.ihi.org/topics/CAUTI/Pages/default.aspxhttp://apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdf


Questions?

For more information, please contact any

HAI Liaison IP Team member

Or [email protected]

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mailto:[email protected]

Catheter-Associated Urinary Tract Infection PreventionObjectivesUTI Epidemiology Urinary Catheter UseUTI in Long Term Care (LTC)CAUTI EtiologyPathogens Associated with CAUTICAUTI PreventionCDC Prevention RecommendationsCore CAUTI Prevention StrategiesAppropriate Indications for Urinary CathetersCAUTI Prevention Supplemental Care PracticesPreventing CAUTI in LTCCAUTI Prevention Bundle ExamplesNot RecommendedUTI Prevention Process Measures Adherence Monitoring Tool - UTI Prevention UTI Prevention Outcome MeasureIP Role in CAUTI PreventionSlide Number 20Are CAUTI Prevention Core Care Practices Used Routinely in YOUR facility?Additional CAUTI Prevention References and ResourcesQuestions?

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Catheter-Associated Urinary Tract Infection Prevention Document Library… · HEALTHCARE-ASSOCIATED INFECTIONS PROGRAM UTI in Long Term Care (LTC) • The ost common m infection in