Catheter-associated urinary tract infection prevention
Healthcare associated infections are a major cause of poor outcomes for patients. Approximately one fifth of healthcare associated infections are urinary tract infections, with the majority being catheter associated. Catheter-associated urinary tract infection (CAUTI) results in increased patient morbidity and mortality. Complications associated with CAUTI include: cystitis, pyelonephritis, bacteremia, and, in males, prostatitis, epididymitis and orchitis. Less common complications include: endocarditis, osteomyelitis, septic arthritis and meningitis.
Prevention of CAUTI is a high priority patient safety issue covered under Standard 3 of the National Safety and Quality Health Service Standards.
Risk of CAUTI is associated with the insertion process and duration of catheterisation, patient susceptibility to CAUTI and quality of catheter care.
Minimising the risk of CAUTI
Key recommendations are:
- ensure that the urinary catheterisation is absolutely necessary for the patient
- remove the urinary catheter as soon as it is no longer needed
- perform hand hygiene and wear appropriate personal protective equipment (PPE) before catheter insertion or manipulation
- document (in the patient’s records) all procedures involving the catheter or drainage system.
Insertion of a urinary catheter should only be undertaken by persons trained and competent in the technique.
Key points include:
- use aseptic technique when inserting urinary catheters
- use the smallest bore catheter possible that will not be associated with leakage
- insert the urinary catheter using sterilised equipment (including a sterile drape) with an aseptic technique
- clean the urethral meatus with sterile normal saline before insertion of the catheter
- use an appropriate sterile, single-use lubricant or anaesthetic gel
- properly secure the catheter after insertion to prevent movement and urethral traction.
- maintain an aseptic continuously closed urinary drainage system i.e. minimise unnecessary opening of the system, but empty catheter bags frequently enough to maintain urine flow and prevent reflux
- position drainage bag to prevent back-flow of urine i.e. below the level of the bladder or contact of the bag with the floor
- do not add an antiseptic or antimicrobial solutions to the bag
- avoid catheter irrigation if possible; however, if obstruction is anticipated, closed continuous irrigation may be used
- chronic antibiotic suppressive therapy is generally not recommended
- routine hygiene i.e. bathing or showering is adequate
- do not apply topical antiseptics or antibiotics applied to the catheter, urethra or meatus.
For further information on prevention of catheter-associated urinary tract infection contact the SA Health’s Infection Control Service on (08) 7425 7161.