21.3 Preventing CAUTI

A catheter-associated urinary tract infection (CAUTI) is a common, life-threatening complication caused by indwelling urinary catheters. The development of a CAUTI is associated with patients’ increased length of stay in the hospital, resulting in additional hospital costs and a higher risk of death. It is estimated that 17% to 69% of CAUTI cases are preventable, meaning that up to 380,000 infections and 9,000 patient deaths per year related to CAUTI can be prevented with appropriate nursing measures.^[1]

Nurses can save lives, prevent harm, and lower health care costs by following interventions outlined in the document created by the American Nurses Association titled Streamlined Evidence-Based RN Tool: Catheter Associated Urinary Tract Infection (CAUTI) Prevention. Review the entire tool in the box provided below. Key interventions include the following:

• Ensure the patient meets CDC-approved indications prior to inserting an indwelling catheter. If the patient does not meet the approved indications, contact the provider and advocate for an alternative method to facilitate elimination.
  • According to the Centers for Disease Control and Prevention (CDC), appropriate indications for inserting an indwelling urinary catheter include the following^[2]:
    • Urinary retention or bladder outlet obstruction
    • Hourly monitoring of urinary output in critically ill patients
    • Perioperative use for selected surgeries
    • Healing of open sacral and perineal wounds in patients with urinary incontinence
    • Prolonged immobilization
    • End-of-life care^[3]
  • Inappropriate reasons for inserting an indwelling urinary catheter include the following:
    • Substitution of nursing care for a patient or resident with incontinence
    • A means for obtaining a urine culture when a patient can voluntarily void
    • Prolonged postoperative care without appropriate indications^[4]
• After an indwelling urinary catheter is inserted, assess the patient daily to determine if the patient still meets the CDC criteria for an indwelling catheter and document the findings. If the patient no longer meets the approved criteria, follow agency policy for removal.
• When an indwelling catheter is in place, prevent CAUTI by following the maintenance steps outlined by the CDC.
• Continually monitor for signs of a CAUTI and report concerns to the health care provider.^[5]
  • Signs and symptoms of CAUTI to urgently report to the health care provider include fever greater than 38 degrees Celsius, change in mental status such as confusion or lethargy, chills, malodorous urine, and suprapubic or flank pain. Flank pain can be assessed by assisting the patient to a sitting or side-lying position and percussing the costovertebral areas.^[6]