What is a Catheter-Associated Urinary Tract Infection (CA-UTI)?  The urinary tract includes the organs that make, store, and release urine from your body.  They are the kidneys, ureters, bladder, and the urethra.  A urinary tract infection (UTI) is an infection that occurs anywhere in the urinary tract.  When a patient has a device known as urinary catheter inserted into their bladder to drain urine, an infection is more likely to occur.  The longer a urinary catheter is left in place, the more likely an infection is to occur.  This infection can spread to other parts of the body, including the blood (bacteremia) and cause even more serious infections.

 

Catheter-Associated Urinary Tract Infections (CA-UTI) are included in a group of other healthcare associated infections that are considered potentially preventable.  Urinary tract infections account for approximately 40% of all hospital-acquired infections annually around the world.  With a catheter in place, the daily risk of developing a urinary tract infection ranges from 3% to 7%, and the longer the catheter remains in place the higher the risk:  25% greater at 1 week and 100% greater at 1 month.  Besides the physical impact, developing a UTI at Baystate Medical Center has been shown to increase the length of stay (LOS) and the cost of care.   For some patients, a bacteremia may develop which not only increases the LOS and cost per case, but also increases the patient’s risk of dying.  These compelling numbers have caused hospitals, including Baystate Health hospitals, to focus on UTI prevention.  UTI prevention includes inserting urinary catheters only in those patients who need them, maintaining them correctly and removing them as soon as they are no longer necessary as part of the patient’s supportive care.

 

Highlights

 

A multidisciplinary UTI prevention team has been in place for several years.  Various interventions have been implemented, including the use of the engineered silver hydrogel Foley catheter and house-wide education to all direct care givers.  UTI prevention strategies are updated on an ongoing basis and include a critical daily review of the need for the catheter, reinforcement of hand washing, pre-prep perineal cleansing, proper insertion techniques, and management of the system once inserted.  Additionally, in 2012 the team continued to reinforce the nursing driven protocol for urinary catheter removal and post-removal management.  The protocol includes detailed criteria for insertion, daily assessment of need, and nursing autonomous Foley catheter removal.  Urine culture collection integrity and specimen labeling became a new focus in 2012, with reinforcement of aseptic practice and identification of patient signs and symptoms of urinary tract infection documented with each culture order. 

These interventions as well as others are derived from the latest recommendations from the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiologists (SHEA), and the Infectious Disease Society of America (IDSA).

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Baystate Medical Center

• BMC focuses on evidence-based practices and interventions specifically designed to prevent catheter associated UTI.
• Bedside staff engagement activities this past year included:
  • Education: Criteria, Insertion, Management, Removal protocol
  • Criteria for indwelling Foley catheter
  • Pre-prep cleansing
  • Securement of catheter
  • Catheter and drainage system management
  • Duration of catheterization, criteria for removal
  • Culture collection survey and education
  • Empowerment/Autonomy of bedside nursing staff to assess the patient, remove the catheter and assess for successful urination with the Nursing driven post-removal protocol
  • Bedside rounding and assessment of urinary elimination
• Supportive Infrastructure for prevention includes:
  • CIS nursing driven protocol including criteria for insertion, forcing function for assessment, automated
  • Our electronic medical record identifies patients with urinary catheters; daily nursing rounds increase awareness, foster communication, and drive daily catheter needs assessment.  Catheters that are no longer necessary are removed and managed using the post-removal management protocol.
  • MD notification
  • Policy development, authorized by Medical Staff Executive Committee for Nursing Driven Protocol
  • Supportive Physicians
  • Urinary tract infection "bundle" measures including day to day management of the urinary tract drainage system
• Product support includes:
  • Engineered Silver hydrogel Foley catheter kits
  • Castile wipes for pre-prep cleansing
  • Commodes, bladder scanners
• Feedback Mechanisms for Stakeholders: outcome measures identify successes and areas for continual improvement; Catheter associated urinary tract infection (CA-UTI) rates are provided to all units monthly to track healthcare-associated UTIs and posted on our internal e-workplace intranet to facilitate data sharing.

 

Baystate Mary Lane Hospital

• Regular educational materials on measures to prevent CA-UTI are presented to patient care staff.
• The need for a urinary catheter is evaluated prior to initial placement.
• Staff includes toileting in regularly scheduled Patient Care Rounds.
• An evaluation of the continued need for the catheter appears on the CIS RN task list daily.  This prompts a decision from the physician to either discontinue the catheter or to document the rationale for continuation of the catheter.  
• A bladder scanner is used for alternative management of bladder and urinary drainage problems.
• The CA-UTI rate for CY 2012 year to date is zero infections per 1000 catheter days.

 

Baystate Franklin Medical Center   

• Data related to CA-UTIs are monitored by the Infection Control Committee, appropriate service line teams and the Hospital Quality Council.
• BFMC participates in the health-system wide CA-UTI Task Force exploring best practice and use of nursing driven protocol.
• BFMC focuses on executing best practices for UTI prevention through annual staff education and validation on aseptic technique and management of urethral catheters.

 

Future Work

 

The CA-UTI prevention infection control policy has been revised to streamline the removal protocol and provide ease of decision making . Once updated in CIS, education and reinforcement of best practices will occur across all inpatient settings. Unit or area specific indwelling urinary catheter alternatives such as straight catheterization, non-catheter urinary collection or diversion techniques, and other products will be investigated.  We will also continue to work on standardized evidence-based procedures for obtaining urine culture specimens.

 

 

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