From the Guidelines
To prevent Catheter-Associated Urinary Tract Infections (CAUTI), healthcare providers should prioritize the use of silver alloy hydrogel-coated (SAH) catheters, as they have been shown to significantly reduce CAUTI rates in critically ill patients, according to the most recent and highest quality study available 1.
Key Recommendations
- Only insert urinary catheters when medically necessary, such as for acute urinary retention, accurate measurement in critically ill patients, perioperative use for specific surgeries, and for patients with stage 3-4 pressure ulcers with urinary incontinence.
- Always use aseptic technique during insertion, including hand hygiene, sterile gloves, drapes, sponges, antiseptic solution for periurethral cleaning, and single-use sterile lubricant.
- For maintenance, secure the catheter to prevent movement and urethral traction, maintain a closed drainage system, keep the collection bag below bladder level but off the floor, and empty the bag regularly using a clean container for each patient.
- Daily assessment of continued catheter need is essential, with prompt removal when no longer required.
- Additional preventive measures include using the smallest appropriate catheter size, maintaining unobstructed urine flow, performing routine hygiene with soap and water, avoiding irrigation unless needed for obstruction, and implementing nurse-driven removal protocols.
Rationale
The use of SAH catheters has been demonstrated to reduce CAUTI rates by minimizing bacterial entry into the urinary tract and reducing the duration of catheterization, which is the primary risk factor for CAUTI 1. This is supported by a study that showed significant differences in positivity rates for urinary white blood cells, positive urine cultures, and CAUTIs between patients using SAH catheters and conventional catheters 1.
Best Practices
- Develop and implement national guidelines and institutional policies for CAUTI prevention, including regular in-service education and training programs 1.
- Ensure access to necessary materials and supplies, such as antiseptic solutions and sterile saline for meatal and perineal cleaning before catheter insertion 1.
- Consider using urinary antiseptics, such as methenamine, for the prevention of UTIs, and separating patients with indwelling catheters to prevent the transmission of pathogens 1.
From the Research
Guidelines for Preventing CAUTI
The guidelines for preventing Catheter-Associated Urinary Tract Infections (CAUTI) include:
- Minimizing the use of indwelling urinary catheters and removing them as soon as medically possible 2
- Implementing infection control guidelines in healthcare institutions, including monitoring device use and suitability of device justifications 2
- Adhering to hand hygiene and using aseptic technique for catheter insertion 3
- Maintaining a closed drainage system and proper catheter care 3, 4
- Considering alternatives to indwelling catheters, such as intermittent catheterization or condom catheters 5
- Using antimicrobial-coated catheters, although the clinical efficacy of these devices is not well established 6
Key Risk Factors
The key risk factors for developing CAUTI include:
- Duration of catheterization, with longer durations increasing the risk of infection 3, 5
- Use of indwelling urinary catheters, which can introduce bacteria into the urinary tract 2, 3
- Poor catheter care and maintenance, including failure to maintain a closed drainage system 3, 4
Prevention Strategies
Prevention strategies for CAUTI include:
- Implementing bundles of interventions, such as the use of aseptic technique, proper catheter care, and removal of catheters as soon as medically possible 5
- Using collaboratives to implement and monitor CAUTI prevention measures 5
- Developing and implementing guidelines for the prevention of CAUTI, including recommendations for limited use of urinary catheters and proper catheter care 4