1. Patient had an indwelling urinary catheter for > 2 days AND catheter was still present on the date of event OR removed the day before the date of event
2. Patient has at least one of the following signs or symptoms:
• fever (>38.0°C)
• suprapubic tenderness
• costovertebral angle pain or tenderness
• urinary urgency, urinary frequency, dysuria (only in pts whose catheter has been removed in the last 24 hours)
3. Patient has a urine culture with no more than two organisms, at least one of which is ≥100,000 CFU/ml (excludes yeast)
• Management of acute urinary retention and urinary obstruction• Perioperative use for selected surgical procedures• Accurate measurement of urine output in critically ill patients• Assistance in wound healing for incontinent patients• Required immobilization for trauma or surgery• End-of-Life care
HICPAC CAUTI Guideline, 2009
Daily needs assessment
• Documentation of need assessment a required row in nursing flow sheet
Objectives Strategies Strategy of choice How to make it happen
CAUTI BUNDLE messages
Nursing/Unit education ICU educational tour Unit A will lead All
Alternatives Improve knowledge and use of alternatives
Alternatives available during ordering UCI – Nycole Hansen
Work on mobilization / UCO Increase use of bed pans / urinals Include alternatives in Nursing
education
TBD TBD CONSIDER alternatives
Securement Ensure catheter is properly secured and remains secured
xxxx as available product xxxx education by Bard Audit
xxxx availability and education
Unit A has made xxxx the available product; xxxx will provide education
CONNECT with a securement device
BathingPeri-careCatheter care Diarrhea/incontinence
Improve bathing, peri- and catheter care
Offer product options for peri-care
Baby wipes for perineal cleansing Peri-care+ catheter care w/ bath Peri-care and catheter care prn Assessments every 4 hours Xxxx product in skin folds Different wash cloth per area Education – video
Product availability and expectation of use
Will trial baby wipes on Unit A for peri-careUnit B will work with PAR stock to put xxxxnext to wipe (may package for pilot);Consider bathing kit via MICC?
Keep it CLEAN
Ensure catheter and peri area is cleaned post-diarrhea/ incontinence
xxxx product for incontinence xxxx
Breaking closed system Decrease inappropriate irrigations Maintain aseptic technique with
• 105 CAUTIs in 2012-13, fever was the primary indication for obtaining culture (97%).
• 51% had an alternative infection to explain the fever: pneumonia, BSI
• 18% had fever due to noninfectious cause
• 32% had no alternative explanation. Of these, 66% received appropriate empiric antimicrobial therapy, but no targeted therapy changes were made based on urine culture results.
• The other 34% did not receive antimicrobial therapy at all.
• Only 6% of all CAUTIs resulted in blood cultures positive for the same organism within 2 days. The urinary tract was not definitely established as the source of bloodstream infection.
• Urine culture was not useful in evaluation of the febrile hospitalized, catheterized patient.
Infect. Control Hosp. Epidemiol. 2015;36(11) :1330–1334
Providers: Do not order irrigation if bladder scan does not show urine in the bladderDo not ask nurses to irrigate Foley – this should be done by Urology techs
