PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS. (CAUTIs)

Transcription

1

2 PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs)

3 CAUTIs A UTI where an indwelling urinary catheter was in place for >2 calendar days on the date of event. OR If an indwelling urinary catheter was in place for > 2 calendar days and then removed, the date of event for the UTI must be the day of discontinuation or the next day for the UTI to be catheter-associated.

4 CAUTIs Urinary tract infections (UTI) are the commonest healthcare-associated infections (HAI), accounting for up to 40% of all HAIs. Most involve urinary drainage devices, such as bladder catheters. The risk of a catheterized patient acquiring bacteriuria increases with the duration of catheterisation,rising from approximately 5% per day during the first week to almost 100% at 4 weeks. One to four percent of patients with bacteriuria will ultimately develop clinically significant infection, e.g., cystitis, pyelonephritis, and septicaemia

5

6 Recommendations from CDC, SHEA-IDSA for indications of placement of urinary catheter Perioperative use for selected surgical procedures Urine output monitoring in critical ill patients Management of acute urinary retention and urinary obstruction

7 Recommendations continued... Assistance in pressure ulcer healing for incontinent patients At patient request to improve comfort or for comfort during end of life care (CDC)

8 Another indications for urinary bladder catheters During surgery to assess fluid status (ie, prolonged procedures, large volume fluid infusion). Management of hematuria associated with clots. Management of immobilized patients (eg, stroke, pelvic fracture). Management of patients with neurogenic bladder. Intravesical pharmacologic therapy (eg, bladder cancer). Management of patients with urinary incontinence following failure of conservative, behavioral, pharmacologic and surgical therapy

9 Contraindication The only absolute contraindication to the placement of a urethral catheter is the presence of urethral injury which is typically associated with pelvic trauma. The presence of blood at the meatus or gross hematuria associated with trauma is evaluated first with retrograde urethrogram; urologic consultation and urethroscopy may be necessary.

10 Inappropriate use of catheters Unwarranted urinary catheters are placed in 21 to 50 percent of hospitalized patients. The most common inappropriate indication for placing an indwelling urethral catheter is management of urinary incontinence. While catheter use in these patients may have a shortterm nursing benefit, the increased risk of complications associated with their use outweighs any benefit

11 It is also inappropriate to use catheters to obtain urine for testing in individuals who are capable of voiding spontaneously or who can reliably collect urine for monitoring output. Catheters are also often used to measure residual urinary bladder volume in hospitalized patients; however, its preferable to the use of a portable ultrasound unit (eg, BladderScan ). These devices correctly estimate residual volume greater than 50 ml in >90 percent of patients

12 Complications The most common complication of urinary bladder catheters is catheter-associated urinary tract infection. In males, urinary infection can lead to epididymitis or orchitis. Other rare complications of indwelling catheters include urinary tract obstruction from retained balloon fragments, bladder fistula, bladder perforation, or bladder stone formation. Improper or prolonged application of condom catheters can cause pressure-related complications including skin depigmentation, ulceration, or penile necrosis. These complications are more frequent in patients with penile sensory loss and can be prevented with proper application of the device and frequent patient monitoring.

13 The traumatic insertion of urethral catheters can create a false passage which may, if infected, lead to periurethral abscess. This complication is more frequent in patients with prior urethral stricture and can result in significant soft tissue infection. Long-term complications associated with chronic urethral catheters (indwelling or intermittent) include urethral stricture and incontinence

14 CHOICE OF CATHETER Indications Urinary retention Urine output monitoring in critically ill patient Patients undergoing prolonged duration of surgery Indwelling urethral Type of catheter Intermittent urethral Suprapubic Condom Y Y Y N Y Y Y N Intra- and post-operative monitoring: Y N Y N

15 Type of catheter Indications Indwelling urethral Intermittent urethral Suprapubic Condom Patients requiring large volume infusions or diuretics Patients requiring intraoperative monitoring of urinary output Patients with urinary incontinence Y N Y N Y N Y N Y N Y Y

16 Type of catheter Indications Indwelling urethral Intermittent urethral Suprapubic condom Post-prostate, bladder or gynecologic surgery Hematuria with clots Prolonged immobilization Urinary incontinence in patients who fail behavioral and pharmacologic al therapy and incontinence pads Y Y Y N Y N Y N Y Y Y Y Y N N Y

17 Type of catheter Indications Indwelling urethral Intermitten t urethral Suprapubic condom Neurogenic bladder/ spinal cord patients Assist in healing of open sacral or perineal wounds in incontinent patients Improve comfort for end of life care Y Y Y Y Y Y Y Y Y Y Y Y

18 CAUTI s... Increases patient length of stay Increases antibiotic use Increase patient discomfort

19 Risk factors for catheter associated UTIs Errors in catheter insertion Not doing pericare routinely Duration of catheterization Microbial colonization of the drainage bag Female gender Use for reasons other than surgery or output measurement Diabetes

20 Prevention Strategy No single strategy used to prevent these infections have been found to help decrease CAUTI. A recent Compendium of Strategies to Prevent Healthcare Associated Infections in Acute Care Hospitals emphasized the importance of reducing CAUTIs by using the bundle approach. - This information was taken published by SHEA-IDSA

21 What is a bundle approach? The bundle is a collection of process needed to effectively and safely care for patients undergoing a particular treatment/procedure with inherent risk. Several interventions are bundled together and, when combined, significantly improve patient care outcomes. SHEA-IDSA: Society for Healthcare Epidemiology of America/Infectious Disease Society of America

22

23 Hand Washing The CAUTI Bundle: Avoid unnecessary urinary Catheters Insert urinary catheters using aseptic technique Maintain urinary catheters based on recommended guidelines Review urinary catheter necessity daily

24 CAUTI bundle in detail Hand Washing: First and most important preventative measure Avoid unnecessary urinary Catheters: No invasive device should ever be used unless absolutely necessary(placing catheters increase risk of infection, decreases mobility and increases urethral trauma)

25 CAUTI bundle in detail continued... Criteria for foley catheter has been meet Verification that these have been met are required prior to insertion. Assessing a patient for urinary retention, severely ill thus decreasing mobility, and lack of bladder control. Never place for convenience for staff

26 CAUTI bundle in detail continued... Insert urinary catheters using aseptic technique: Utilize appropriate hand hygiene practice Insert catheters using aseptic technique and use sterile equipment Use as small a catheter as possible that is consistent with proper drainage to minimize urethral trauma

27 CAUTI bundle in detail continued... Review urinary catheter necessity daily and remove promptly Keeping foley catheter in place greater than 48 hours puts patient at risk for infection

28 Maintain urinary catheters based on recommended guidelines: Assure that foley care occurs for every patient, every day, and every shift Do pericare for patients that don t have a foley catheter everyday and every shift Maintain a closed drainage system Keep catheter properly secured to patient to prevent movement and urethral trauma

29

30 Maintain urinary catheters based on recommended guidelines: Keep collection bag below the level of the bladder at all times Maintain unobstructed urine flow

31 Maintain urinary catheters based on recommended guidelines: Empty collection bag at least every eight hours or as needed. Do not allow the drainage spigot to touch the collecting container, to avoid cross contamination when emptying foley Collection of specimen is done with aseptic technique Never take a sample from the urinary drainage bag. Take a urine sample from the sample port

32 Short Term Urinary Catheter Care Bundle User friendly Patient documentation Care pathway Recommend practice Recommend selection of catheter product and size Record of CSU s sent Record of patient education given

33 INSERTION Date / / (Day 1) 1. REASON FOR CATHETERISATION (please circle) Retention Residual Volume.mls Fluid Monitoring Post Operative Spinal / Epidural 2. CATHETER CHOICE (please circle) Does the patient have a confirmed latex allergy? NO / YES NO Latex allergy use latex PTFE coated catheter Female 12Fg FSS949 female FSS588 standar 3. INSERTION TECHNIQUE Hand hygiene Male 14Fg standard FSS589 16Fg standard FSS592 Haematuria Debris TURP State size:..fg Paediatric State size:...fg Latex allergy use silicone catheter Female 12Fg FSS650 (F) FSS 601 (M) Male 14Fg FSS602 16Fg Other Please state: Haematuri a Debris TURP State size:..fg Paediatric State size:...fg YES NO YES NO Catheter Sticker (found on Sterile gloves catheter packaging) Facial protection (If risk of splashing) Apron /Gown Urethral meatus cleaned prior to insertion (0.9% normal saline) Instillagel used Sterile Field... mls of water used to inflate the balloon Signed Print.

34 Catheter Specimen Urine (CSU) CSU s are ONLY to be taken if there is a clinical suspicion of Infection, with the exception of Critical Care patients. For further details please consult the Trusts policy. Date UTI suspected YES N O If YES please state symptoms Sample taken aseptically from catheter port Results Lab Specime n nos. Treated YES NO YES NO Patient details Patient Education Undertaken Assessors details Signature Name Signature Position

35 D A Y DATE Is the catheter still needed? Drainage bag positioned below the bladder & off the floor Gloves worn - manipulate catheter preceded & followed by hand hygiene Urethral Meatal hygiene performed Catheter circuit not broken (except for good clinical reason) Overnight link system discarded (Leg bags only) SIGN & Designati on YES NO YES NO YES NO YES NO YES NO YES NO Catheter drainage bag changed? YES / NO 28 IF THE CATHETER IS STILL REQUIRED CHANGE THE CATHETER, DRAINAGE BAG & COMMENCE NEW DOCUMENTATION Date catheter removed / /

36

37

38

39 Implementation Care Bundle piloted in acute areas, using PDSA cycle adjusted accordingly and introduced Weekly then monthly compliance audits Developed Short Term Urinary Catheter policy to support Care Bundle Staff Training & Education Saving 1000 Lives campaign Gained Clinical Governance support

40

41 Recommendations for future Practice Continue to roll out Implementation & audit of care bundle until Trust wide Develop the policy & documentation for long term catheters

42 In summary... looks at foley catheter placement in a bundle approach. When caring for and inserting foley catheters, be sure to: Wash your hands Avoid unnecessary catheters Always use aseptic technique Maintain catheters based on current recommended guidelines Review the necessity daily Implementation of bundles is so important

43 THANK YOU

44