Strategies for Nurse Driven CAUTI Prevention

Most Common HAI

According to the Centers for Disease Control (CDC), Catheter Associated Urinary Tract Infections (CAUTIs) are the most common type of healthcare acquired infection (HAI), likely due to approximately 1/4 of hospitalized patients receiving a urinary catheter at some point during their inpatient admission (3). Patients who acquire CAUTIs are more likely to be transferred to a higher level of care, are more likely to get readmitted, and are at greater risk of dying (11).

Additionally the CDC contends that the factor most greatly impacting potential for CAUTI is length of time the catheter is in use (3). Because indwelling urinary catheters are often inserted, maintained, and discontinued by nursing staff, it is the nurse who has the greatest potential to advocate for discontinuation of the catheter at the earliest possible time.

As CAUTI makes up approximately 1/3 of Healthcare acquired infections (HAIs), costing hospitals and patients money and increasing mortality and morbidity, it is evident that the management of urinary catheters needs improvement (11).  The CDC asserts that minimizing the length of catheterization is the intervention that most decreases risk (3). 

A wide variety of strategies and tools are available to decrease CAUTI and assist with nurse-driven catheter discontinuance.

Decreasing CAUTI Strategies:

• Using electronic checklists to ensure each patient is assessed at regular intervals using uniform and specific evaluation and discontinuance criteria. (1, 12)

• Group rounding to impact the overall awareness of the activity and committee decision-based catheter discontinuance. (15)

• Nurse champions to coach staff and increase the culture of safety. (13)

• Updating policy and procedure standards for specific continuance/discontinuance criteria to allow caregivers a standard reference to access for consistent care practice. (8, 9, 12)

• Using Maintenance bundling to include: Assessment of catheter need, hand hygiene, seal intact, securement device, metal hygiene, ensuring unobstructed flow, empty drainage bag. (2, 4, 5, 10) 

The goal: discontinue use as early as possible

The goal is to decrease CAUTIs by discontinuing the urinary catheter at the earliest possible time. Adopting specific evaluation and discontinuance criteria, educating nursing staff, and ensuring criteria are being utilized by auditing compliance using some of the tools and techniques above will assist in decreasing CAUTI’s.

What tools should you employ to assist nurses in evaluating daily patient need for catheter continuance and to discontinue as soon as the patient no longer meets the criteria?  

For more reference, view our free CAUTI sample checklist.

 Works Cited

1. Baillie, C. A., Epps, M., Hanish, A., Fishman, N. O., French, B., & Umscheid, Craig A, C. A. (2014, September). Usability and Impact of a Computerized Clinical Decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections. Infection Control & Hospital Epidemiology, 35(9), 1147-1155. http://dx.doi.org/10.1086/677630
2. Carter, N. M., Reitmeier, L., & Goodloe, L. R. (2014, September-October). An evidence-based approach to the prevention of catheter-associated urinary tract infections. Urologic Nursing, 34, 238-245.
3. Catheter-associated Urinary Tract Infections (CAUTI). (2015, October 16). http://www.cdc.gov/HAI/ca_uti/uti.html
4. Cheng, W., Lin, H., Lin, Y., Lai, C., & Chao, C. (204, June). Achieving zero catheter-associated urinary tract infections in a neurosurgery intensive care unit. Infection Control & Hospital Epidemiology, 35, 746-747. http://dx.doi.org.wgu.idm.oclc.org/10.1086/676440
5. Clarke, K., Tong, D., Pan, Y., Easley, K., Norrick, B., Ko, C., ... Stein, J. (2013, February). Reduction in catheter-associated urinary tract infections by bundling interventions. International Journal for Quality in Health Care, 25(1), 43-49. http://dx.doi.org/10.1093/intqhc/mzs077
6. Elliott, J., & Drake, D. (2015, April). EB63 eliminating catheter-associated urinary tract infections in the trauma intensive care unit. Critical Care Nurse, 35. Retrieved from http://eds.b.ebscohost.com.wgu.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=1a406f3c-132a-4710-badd-183c4512dffa%40sessionmgr114&vid=15&hid=121
7. Elpern, E. H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009, November). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal of Critical Care, 18(6), 535-542. http://dx.doi.org/10.4037/ajcc2009938
8. Greene, D. (2015, April). EB93 A comprehensive approach to sustainable reductions in catheter-associated urinary tract infections. Critical Care Nurse, 35, e45-e46. Retrieved from http://eds.b.ebscohost.com.wgu.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=1a406f3c-132a-4710-badd-183c4512dffa%40sessionmgr114&vid=19&hid=121
9. Hake, M., Auret, K., Van Gessel, H., & Sinclair, C. (2013, Summer). Prevention and management of catheter-associated urinary tract infections (CAUTI) in a regional WA hospital - utilising clinical practice improvement principles to optimise practice. Australian & New Zealand Continence Journal, 19(4), 105-106. Retrieved from http://eds.b.ebscohost.com.wgu.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=1a406f3c-132a-4710-badd-183c4512dffa%40sessionmgr114&vid=33&hid=121 http://dx.doi.org.wgu.idm.oclc.org/10.7257/1053-816X.2014.34.5.238
10. Hanchett, B. (2012, Autumn). Preventing CAUTI:A patient-centered approach. Retrieved from http://apic.org/Resource_/TinyMceFileManager/epublications/CAUTI_feature_PS_fall_12.pdf
11. Healthcare-Acquired Infections (HAIs). (2015). Retrieved from https://www.patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais/
12. Miller, B. L., Krein, S. L., Fowler, K. E., Belanger, K., Zawol, D., Lyons, A., ... Saint, S. (2013, June). A multimodal intervention to reduce urinary catheter use and associated infection at a veterans affairs medical center. Infection Control & Hospital Epidemiology, 34, 631-633. http://dx.doi.org/10.1086/670624
13. Richardson, T., Lantos, D., Keller, S., Schweder, J., & Combs, H. (2015, April). EB140 catheter-associated urinary tract infections: a culture of unit-based safety for patients. Critical Care Nurse, 35(2), e70-e71. Retrieved from http://eds.b.ebscohost.com.wgu.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=1a406f3c-132a-4710-badd-183c4512dffa%40sessionmgr114&vid=25&hid=121
14. Smith, D. (2003). Five principles for research ethics. Retrieved from http://www.apa.org/monitor/jan03/principles.aspx
15. Vacca, M., & Angelos, D. (2013, December). Elimination of catheter-associated urinary tract infections in an adult neurological intensive care unit. Critical Care Nurse, 33(6), 78-80. http://dx.doi.org/10.4037/ccn2013998

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