Does the use of Foley Catheters Increase the Occurrence of
Urinary Tract Infection? Presented are four evidence based nursing
studies showing the risks of UTIs and catheter use. Ways to
decrease patients risks. Medicare and Medicaid involvement with
CAUTIs And supporting data
Slide 3
Catheter-associated urinary tract infections and the Medicare
rule change was written by Jennifer A. Meddings, Sanjay Saint,
David Calfee, Christine P. Kowalski, and Sarah L. Krein in June of
2009. The article discusses the risks and percentage of catheter
associated urinary tract infections and why Medicare and medicaide
have chosen to eliminate additional payments.
Slide 4
The Facts multidisciplinary approaches can prevent between 25%
and 75% of CAUTI. CMS believes that if payment is halted for
improper care, then the quality of hospital care would
improve.
Slide 5
Medicare and Medicaid Medicare and Medicaid have chosen to
eliminate additional payment if infections occur due to the use of
catheters the new CMS rule change would increase focus on CAUTIs,
and increase focus on catheter care and early removal. The downside
would be more expenses to the patient as a urinalysis may be
ordered on admit to rule out any infections prior to being admitted
to the hospital.
Slide 6
Medicare/Medicaid and cost The CMS rule change was brought on
by linking payment with health care out-comes by paying more for
better health care and less for inferior care(Saint, 2009, pg. 878)
CMS believes that if payment is halted for improper care, then the
quality of hospital care would improve. CMS uses a system call
present-on-admission
Slide 7
Engineering Out the Risk of Infection with Urinary Catheters
was written by Dennis G. Maki from the University of Wisconsin
Medical School, Madison Wisconsin and Paul A. Tambyah from the
National University of Singapore Medical School, Singapore in
2001.
Slide 8
The Facts Catheter-associated urinary tract infection (CAUTI)
is the most common nosocomial infection (p.1). With the cause of
bacteremia and candiduria causing more than 25% of the infections
for those with a catheter for a week or more and at a rate of 5%
daily risk on average (Maki, 2001,p.1).
Slide 9
What can we do to decrease our patients risks ? First and
foremost avoid the use of catheters if and when possible, use
alternatives to bladder catheterization (such as suprapubic
catheterization or condom catheters), practice sterile technique,
maintain a closed dependent drainage system, and use as little
handling of the device as possible (Maki and Tambyah 2001,
p.4).
Slide 10
What can we do to decrease patients risks? Catheters
impregnated with anti-infective solutions have been studied in
randomized trials, one impregnated with the urinary antiseptic
nitrofurazone and the other with a new broad spectrum
antimicrobial-drug combination minocycline and rifampin. Both
catheters showed a significant reduction in bacterial CAUTIs Use of
a silver hydrogel coated catheter not only showed that its use
decreased CAUTI but dropped it by 26% (Maki and Tambyah, 2001,
p.5).
Slide 11
Systematic Review and Meta-Analysis: Reminder Systems to Reduce
Catheter-Associated Urinary Tract Infections and Urinary Catheter
Use in hospitalized Patients was written by Jennifer Meddings, Mary
A. M. Rogers, Michele Macy, and Sanjay Saint in 2009. The article
focuses on statistical analysis related to catheter-associated
urinary tract infections (CAUTI).
Slide 12
The Facts The greatest risk factor for CAUTI is prolonged
catheterization (Meddings et al. pp.550) Catheters not only cause
infection but promote other challenges such as patient discomfort,
and difficulty in mobility.
Slide 13
Interventions Two interventions that the article focused on
included a reminder system and a stop order system The reminder
system is simply to remind either a physician or a nurse that the
catheter was still in place and that removal was recommended if no
longer necessary a stop order is a prompt to the physician to
remove the catheter by default after either a certain time period
or a set of clinical conditions occurred
Slide 14
The article Preventing Catheter-Related Bacteriuria was written
by Sanjay Saint and Benjamin Lipsky in 1999. The article focuses on
clinical definitions of catheter- related infection and rate of
occurrence. This article also examines risk factors associated with
catheter use and methods of prevention and interventions.
Slide 15
Facts Clinical definition of catheter-related infection (UTI)
growth of 10CFU/mL or greater of a predominant pathogen from a
catheterized urine specimen, especially when associated with
pyuria, represents catheter-related UTI (Saint, 1999, p. 801). Risk
Factors included length of foley catheter use, female gender, older
than 50 years old, lack of systemic antibiotics, and underlying
illness Prevention focused on abstaining from foley catheter use
when not necessary, use of alternative devices such as condom
catheters, suprapubic catheters, and intermittent catheterizations
when necessary to meet patient needs Interventions included
systemic antibiotic use but not prophylactic, closed drainage
system, and silver coated catheters
Slide 16
Data The available data suggest that urinary
catheter-associated bacteriuria may be preventable for the short
term (less than a few weeks) but is only postponed at best if the
device is needed long term. Furthermore, the complications of
catheter-associated bacteriuria, including symptomatic UTI and
bacteriuria, may be largely not preventable (Saint, 1999, p.
806)
Slide 17
Conclusion Is there a direct correlation between using foley
catheters and occurrence of urinary tract infection, the answer is
yes The available data suggest that catheter- associated urinary
tract infections can be preventable. RNs need to be aware of foley
catheter use, prevention strategies, alternative devices, and
reason to avoid use of foley catheters in the hospitalized patient
if possible.