Catheter-associated urinary tract infections are costly and potentially life-threatening for long-term-care residents, and were identified as one of five priority areas in Phase Three of the United States Department of Health and Human Services (HHS) National Action Plan to Prevent Health Care-Associated Infections. An estimated 7 percent to 10 percent of all long-term-care residents have urinary catheters, including 12 percent of all new admissions at the time of transfer from acute care facilities to LTC facilities.
The Agency for Healthcare Research and Quality’s “Safety Program for LTC: HAIs/CAUTI” promotes the use of bundles or combinations of interventions to reduce CAUTIs, prevent infections, and improve the safety culture in long-term-care facilities. Here is AHRQ’s recommended intervention, using the letters of “CAUTI” as a memory device:
- Catheters in newly admitted (and readmitted) residents should be removed to assess if still needed; every resident deserves a chance to be “catheter free.”
- Aseptic insertion of indwelling catheters is essential, with hand hygiene before and after every resident contact and barrier precautions during intimate (e.g., toileting, bathing) assistance with activities of daily living.
- Use catheters only if indicated. Routine assessments of catheter need (daily for short-term residents, monthly for long-term residents) should be conducted, and alternatives should be considered (such as intermittent catheterization, use of bladder scanner protocols to decrease need for catheterization, and other noncatheter solutions for incontinence).
- Training and mentorship of staff and family regarding catheter care are important, emphasizing the following points: Keep the drainage bag below the bladder, no violations of “closed” drainage system, and learn the appropriate use of leg bags.
- Incontinence care planning to address individual resident challenges and solutions is important, including behavioral interventions such as timed and prompted voiding and appropriate medical management.
Source: AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs, Agency for Healthcare Research and Quality, May 2017, https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/final-report.pdf