Catheter Associated Urinary Tract Infection Prevention

Catheter-associated urinary tract infections (CAUTIs) are a significant problem. These infections are substantial sources of patient morbidity, extended hospital stays, and increased healthcare costs to our hospital and our patients. We recently audited Foley catheters and found that many were not placed for acceptable reasons. Our quality department, nursing, and others are focusing on preventing CAUTIs. We ask physicians to participate in these efforts as our orders dictate when Foleys are placed and discontinued.

Here are some essential points:

• Patient convenience is not a reason to keep a Foley in place.
• Providers often select urinary retention as a reason for placing a Foley catheter without any evidence of urinary retention. We have a protocol for determining if a patient has urinary retention, and if they do not meet that criteria, do not place the Foley.
• Nursing may request a Foley catheter without a viable indication to remain in place. Nursing convenience is not a reason to keep a Foley in place.

Regarding patients asking to keep a Foley catheter for convenience, we know why Foleys must come out, but patients do not. Bacteriuria in patients with indwelling bladder catheters occurs at a rate of approximately 3 to 10 percent per day of catheterization. Of those with bacteriuria, 10 to 25 percent develop symptoms of urinary tract infection (UTI). Patients do not know the danger, so you should educate them on why their catheter needs to be removed. For them, it’s a convenience, but we know they may have to be in the hospital for extra days being in the hospital; it can cost them additional money, and pyelonephritis is not worth keeping the little tube in place.

We are improving our tracking and attribution to staff and providers who are increasing the risk for these infections. CAUTIs will happen, but they should be rare events. As stated before, many are making significant efforts to prevent CAUTIs. Your assistance is greatly appreciated.