What are the guidelines for preventing Catheter-Associated Urinary Tract Infections (CAUTI)?

Guidelines for Preventing Catheter-Associated Urinary Tract Infections (CAUTI)

The most effective strategy for preventing CAUTI is to avoid unnecessary catheterization and remove catheters as soon as possible when no longer needed. 1, 2

Core Prevention Strategies

Catheter Insertion and Maintenance

• Use aseptic technique for catheter insertion, including proper hand hygiene, sterile equipment, and site preparation 1, 3
• Maintain a closed drainage system at all times to prevent bacterial entry 1, 4
• Secure the catheter properly to prevent movement and urethral trauma 2, 5
• Keep the collection bag below the level of the bladder to prevent backflow of urine 1
• Do not add antimicrobials or antiseptics to drainage bags as this does not reduce CA-bacteriuria or CA-UTI 1

Appropriate Catheter Use

• Insert urinary catheters only for appropriate indications and remove them as soon as they are no longer needed 1, 4
• Consider alternatives to indwelling catheters when appropriate (e.g., external catheters, intermittent catheterization) 4
• Implement reminder systems or stop orders to prompt catheter removal when no longer indicated 6, 2
• For patients with short-term urinary retention, consider intermittent catheterization to monitor residuals, performing catheterization every 6 hours initially 6

Antimicrobial Considerations

• Do not administer prophylactic antimicrobials routinely at the time of:
  • Catheter placement (Grade A-I recommendation) 1, 2
  • Catheter removal (Grade B-I recommendation) 1, 2
  • Catheter replacement (Grade A-III recommendation) 1, 2
• Do not routinely screen for or treat catheter-associated asymptomatic bacteriuria (CA-ASB) 2
• If a catheter has been in place for ≥2 weeks at the onset of CA-UTI and is still indicated, replace the catheter before starting antimicrobial therapy 2

Special Considerations

Catheter Care and Replacement

• Data are insufficient to recommend routine catheter changes (e.g., every 2-4 weeks) to reduce the risk of CA-ASB or CA-UTI, even in patients with repeated early catheter blockage 1
• Do not use topical antibiotic ointment or creams on catheter insertion sites due to potential for promoting fungal infections and antimicrobial resistance 1
• Monitor catheter sites regularly for signs of infection or other complications 1

Monitoring for Success

• Consider a trial of void successful if residual volumes are consistently less than 30 ml on the majority of catheterizations for 3 consecutive days 6
• Monitor for signs of UTI recurrence (fever, dysuria, frequency, urgency) after catheter removal 6

Common Pitfalls to Avoid

• Leaving catheters in place longer than necessary 1, 4
• Breaking the closed drainage system 1
• Failing to maintain proper aseptic technique during insertion 3
• Administering prophylactic antimicrobials routinely, which can promote antimicrobial resistance 2
• Treating asymptomatic bacteriuria in catheterized patients (except in specific circumstances like pregnancy) 2
• Not replacing catheters that have been in place for ≥2 weeks prior to antibiotic treatment for symptomatic infection 6, 2

By following these evidence-based guidelines, healthcare facilities can significantly reduce the incidence of CAUTI and improve patient outcomes.