What are the guidelines to prevent Catheter-Associated Urinary Tract Infections (CAUTI)?

From the Guidelines

To prevent Catheter-Associated Urinary Tract Infections (CAUTI), healthcare providers should follow evidence-based guidelines focusing on appropriate catheter use, proper insertion techniques, and ongoing maintenance, as outlined in the most recent guidelines from 2024 1. The most important recommendation is to avoid unnecessary catheterization and remove catheters as soon as they are no longer medically necessary.

Key Recommendations

• Before insertion, perform thorough hand hygiene and use aseptic technique with sterile equipment, including sterile gloves, drape, antiseptic solution for periurethral cleaning, and single-use lubricant.
• Only properly trained personnel should insert catheters.
• Once inserted, maintain a closed drainage system, keep the collection bag below bladder level but off the floor, and secure the catheter to prevent movement and urethral traction.
• Daily care includes cleaning the perineal area with soap and water, but avoid routine irrigation unless obstruction is suspected.
• Perform regular assessments to determine continued need for catheterization, with documentation of insertion date, indication, and removal plans. Some studies suggest that antimicrobial-coated catheters may be considered for high-risk patients, but should not replace basic prevention measures 1. However, the most recent and highest quality study 1 emphasizes the importance of implementing evidence-based preventive strategies to lower CAUTI rates, reduce related costs, and enhance patient outcomes.

Additional Considerations

• Catheter irrigation with antimicrobials should not be used routinely to reduce or eradicate CA-bacteriuria or CA-UTI in patients with indwelling catheters 1.
• Institution-specific strategies should be developed to ensure that disconnection of the catheter junction is minimized and that the drainage bag and connecting tube are always kept below the level of the bladder 1.

From the Research

Guidelines to Prevent CAUTI

To prevent Catheter-Associated Urinary Tract Infections (CAUTI), several guidelines have been established based on research and evidence. These guidelines can be categorized into general and targeted strategies.

• General Strategies:

  • Adherence to hand hygiene 2
  • Minimizing the use of indwelling urinary catheters and stopping their use as soon as medically possible 3, 4
  • Implementing infection control guidelines in healthcare institutions, including monitoring device use and the suitability of device justifications 3

• Targeted Strategies:

  • Limiting the duration of catheterization, as it is a key risk factor for developing CAUTI 2, 5, 4
  • Using aseptic technique for catheter insertion 2, 5
  • Maintaining a closed drainage system 5
  • Considering the use of anti-infective catheters in some settings 2
  • Educating nursing personnel and implementing training programs to effectively lower the incidence of CAUTI 4

Key Considerations

• The duration of catheterization is a determinative risk factor for CAUTI, and catheters should be left in place for the shortest possible time 4.
• Careful consideration of the indication for catheterization is crucial to prevent unnecessary use 4.
• The available data on antibiotic prophylaxis show a small benefit from antibiotic-impregnated catheters and from systemic antibiotic prophylaxis, but more research is needed to make definitive conclusions 4.
• Technological advancements in device materials that inhibit colony generation will be necessary to prevent CAUTIs in the future 3.