St. Mark's Hospital - July 06, 2019
by Debra Widmer, Dir Quality

St. Mark’s is committed to preventing infections, including catheter-associated urinary tract infections (CAUTIs). UTI are one of the most common hospital-acquired infections; 70-80 percent of these infections are attributable to an indwelling urinary catheter. Daily risk of acquisition of bacteriuria varies from 3-7 percent when an indwelling urethral catheter remains in place. Catheter use is associated with negative outcomes including infection, nonbacterial urethral inflammation, urethral strictures, mechanical trauma, and mobility impairment. Inappropriate treatment of catheter-associated asymptomatic bacteriuria promotes antimicrobial resistance and Clostridium difficile infection in acute care facilities.

A prevention initiative to address CAUTIs has begun at St. Mark’s. Nursing leadership, the Infection Prevention team, and Administrative leaders are working to decrease the use of urinary catheters.

The best effort for prevention of a CAUTI is to minimize insertion or remove the indwelling device as soon as possible. Consider external devices for delivery of treatment and return the patient to ambulatory toileting practices as soon as possible to promote functional recovery.

CAUTI reduction includes the following:

  • Hand Hygiene remains the number one prevention for HAIs
  • Avoid unnecessary urinary catheters
  • Insert urinary catheters using strict aseptic technique
  • Maintain urinary catheters based on evidence based guidelines
  • Determine urinary catheter necessity on a daily basis and remove as soon as possible (Our nurse driven protocol for catheter removal is an essential component)

Appropriate Urinary Catheter Use:

  • Insert catheters only for appropriate indications and leave in place only as long as needed
  • Avoid use of urinary catheters for management of incontinence
  • Use urinary catheters in operative patients only as necessary, rather than routinely
  • Consider using alternatives to indwelling urethral catheterization in selected patients when appropriate

Medical Staff, thank you for your assistance to reduce patient harm with your support of these key elements for CAUTI prevention:

  • Eliminate unnecessary use of Foley catheters
  • Remove the indwelling device as soon as possible
  • Consider use of the Nurse Driven Foley Protocol
  • Consider external devices for delivery of treatment and return the patient to ambulatory toileting practices as soon as possible

The descending dotted line represents the Standardized Utilization Ratio (SUR), which is a ratio calculated as actual number of catheter days / number of predicted catheter days. St. Mark’s Hospital has a goal to remain below 1.000.

Each person icon on the graph represents a patient that developed a CAUTI while receiving care at St. Mark’s. This graph depicts 3 CAUTI events from January through May. The number represents the Standardized Infection Ratio (SIR), which is a ratio of the actual number of CAUTIs to the predicted number. This value is based upon data reported to NHSN (National Healthcare Safety Network).

For more information, please visit the CDC "Guideline for Prevention of Catheter-Associated Urinary Tract Infections."