CDC recommends QI to reduce CA-UTIs
Implement based on facility risk assessment
The Centers for Disease Control and Prevention (CDC) recommends that infection preventionists implement quality improvement (QI) programs or strategies to enhance appropriate use of indwelling catheters and to reduce the risk of CA-UTI based on a facility risk assessment.1
That recommendation and all others in this summary unless otherwise noted is listed as Category IB, which the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) defines as: "A strong recommendation supported by low quality evidence suggesting net clinical benefits or harms or an accepted practice (e.g., aseptic technique) supported by low to very low quality evidence."
The purposes of QI programs should be:
1) to assure appropriate utilization of catheters;
2) to identify and remove catheters that are no longer needed (e.g., daily review of their continued need);
3) to ensure adherence to hand hygiene and proper care of catheters. Examples of programs that have been demonstrated to be effective include:
- a system of alerts or reminders to identify all patients with urinary catheters and assess the need for continued catheterization;
- guidelines and protocols for nurse-directed removal of unnecessary urinary catheters;
- education and performance feedback regarding appropriate use, hand hygiene, and catheter care;
- guidelines and algorithms for appropriate perioperative catheter management, such as:
1. procedure-specific guidelines for catheter placement and postoperative catheter removal;
2. protocols for management of postoperative urinary retention, such as nurse-directed use of intermittent catheterization and use of bladder ultrasound scanners.
Recommendations considered essential for all health care facilities caring for patients requiring urinary catheterization include the following high-priority recommendations, which were chosen in part on the likely impact of the strategy in preventing CA-UTI.
Appropriate Urinary Catheter Use
- Insert catheters only for appropriate indications, and leave in place only as long as needed.
- Avoid use of urinary catheters in patients and nursing home residents for management of incontinence.
- For operative patients who have an indication for an indwelling catheter, remove the catheter as soon as possible postoperatively, preferably within 24 hours, unless there are appropriate indications for continued use.
Aseptic Insertion of Urinary Catheters
- Ensure that only properly trained persons (e.g., hospital personnel, family members, or patients themselves) who know the correct technique of aseptic catheter insertion and maintenance are given this responsibility.
- In the acute care hospital setting, insert catheters using aseptic technique and sterile equipment.
Priority Recommendations for Proper Urinary Catheter Maintenance
- Following aseptic insertion of the urinary catheter, maintain a closed drainage system.
- Maintain unobstructed urine flow.
- Gould CV, Unscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. Available at: http://www.cdc.gov/ncidod/dhqp/dpac_uti_pc.html.