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Preventing Catheter-Associated UTIs

October 12th, 2016

Urinary tract infections can involve any part of the urinary tract system, including the bladder, ureters, urethra, or kidneys. Most UTIs (75%) are associated with a Foley catheter or an indwelling catheter. There has been a push to reduce the number of catheter-associated UTIs by ensuring there is proper indication and that they are removed as soon as no longer necessary.

Motivated by the high rate of infection, and based on the CDC’s 2009 “Guideline for the Prevention of Catheter Associated Urinary Tract Infections” and their “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update”, The Joint Commission has proposed changes to all five of its elements of performance under NPSG.07.06.01. Under the proposed changes hospitals will be required to implement evidenced-based practices to prevent catheter-associated urinary tract infections (CAUTI).

The hospital will have to educate staff and LIPs who are involved in the use of Foley catheters, during orientation and then annually. Hospitals will need to develop written criteria for placement of a Foley. This criteria may include critical patients who need accurate urinary output monitoring. There must also be procedures on when it is appropriate to insert and maintain a Foley. The hospital’s guidelines would also need to include hand hygiene, how to secure the Foley, how to use aseptic technique in inserting, how to collect samples, how to maintain sterility of the system, and the requirements for educating patients and their families.

CMS has a catheter-associated tracer that is located in its infection control worksheet that all hospitals should be familiar with. Every hospital is required to have guidelines for the appropriate indications for urinary catheters.

  1. There must be documentation indication for the catheter insertion.
  2. Staff must do hand hygiene before and after insertion.
  3. The catheter must be secured after insertion.
  4. The bag must be below the level of the bladder.
  5. Staff should ensure he tubing is not kinked or disconnected and irrigation should be avoided.

In summary, hospitals who are accredited by TJC should be aware of the proposed changes and any hospitals that received Medicare reimbursement should be familiar with the CMS infection control worksheet.

Resources:

  • The Joint Commission’s proposed revisions to the National Patient Safety Goal on Catheter Associated Urinary Tract Infections can be reviewed here.
  • Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update” is available here.
  • Catheter-associated urinary tract infection resources for the CMS Partnership for Patients, including links to many toolkits and other useful resources, can be found here.
  • The CDC’s website on catheter-associated urinary tract infections includes recommendations along with many resources, FAQs, prevention and toolkits, podcasts, slide presentations and information on monitoring catheter-associated UTIs through the National Healthcare Safety Network.
  • The CDC’s “Guideline for the Prevention of Catheter Associated Urinary Tract Infections” is here.
  • FAQs about catheter associated urinary-tract infection is here.
  • The CMS worksheet on infection control is available here.

Related Webinar: National Patient Safety Goals for Hospitals

Related Webinar: Infection Prevention & Control Standards from CMS: the Latest.

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