SYMPOSIUM


of CAUTIs range from $896 to $1,500, as some CAUTIs may be associated with bacteremia.16


Organisms that


most commonly cause CAUTI in- clude Escherichia coli, Enterococcus spp, Pseudomonas aeruginosa, Klebsi- ella pneumoniae, and rarely Candida or other staphylococcal species.14 Many noninfectious complications associated with urinary catheters fur- ther escalate the costs associated with patient care. They include reduced mobility (and this has been referred by some as a form of restraint) and risk of falls, deep vein thrombosis, and in- creased incidence of pressure ulcers.17 In addition, urethral strictures, risk of hematuria, and urethral tears from demented patients trying to remove the catheter in a confused state can


result in acute trauma to the bladder and urethra.18 The primary risk factor for a


CAUTI is the presence of an indwell- ing urinary catheter. Duration of the catheter, age of the patient, underly- ing immunosuppression, position of the drainage bag, insertion errors, and gaps in care are other risk factors not- ed in the literature.14


Proper education


of staff on best practices for insertion, maintenance, and removal can result in prevention of CAUTI.19 Hospitals can implement evidence-


based, detailed strategies to prevent CAUTI. (See Table 1.)14


These guide-


lines include information on strategies that do not prevent infections such as antimicrobial impregnated catheter usage, instillation of antibiotics in the


drainage bag, or changing catheters at regular intervals.14


CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS


Great emphasis has been placed on the prevention of CLABSIs. There are 75,000 to 80,000 CLABSIs per year in United States.20


The majority


of CLABSIs happen outside the in- tensive care unit.21


On a per-case basis,


CLABSIs are the most expensive HAI at $45,000 to $65,000.16 A central venous line is an intra-


vascular catheter that terminates at or close to the heart or in one of the great vessels and is used for infusion of large volumes of fluid and also serves the purpose of blood draw as well as hemodynamic monitoring in an in-


TABLE 1. CATHETER-ASSOCIATED URINARY TRACT INFECTION PREVENTION STRATEGIES


Insertion • Proper assessment for medical necessity and appropriateness of the catheter • Rigorous performance and compliance of hand hygiene • Appropriate perineal care prior to applying antiseptic solution • Usage of aseptic insertion technique using sterile supplies • Securing the device to prevent movement and traction • Bladder scanner usage to assess urinary retention instead of insertion • Consideration of other alternative urinary devices, e.g., condom catheters when possible


Maintenance


• Hand hygiene before and after catheter or bag manipulation • Keeping catheter area clean by regular perineal and incontinence care • Maintaining a sterile and continuous closed system with unobstructed flow and minimization of any dependent loops or kinks


• Ensuring the bag is below bladder all the time even during transport of the patient • Always collecting urine from the port, not directly from the drainage tubing • Emptying the urine drain bag regularly using a patient-dedicated collection container • Daily assessment of device for medical necessity and appropriateness • Timely replacement of device upon breakage or leakage


Removal


• Removal of catheter when no longer medically necessary • Implementation of catheter removal protocols (nurse-driven or otherwise)


Source: Table adapted and modified from Septimus EJ, Moody J. Prevention of Device-Related Healthcare-Associated Infections [version 1; referees: 2 approved]. F1000Research 2016 Jan 14; 5. (doi:#10.12688/f1000research.7493.1)


February 2017 TEXAS MEDICINE 43


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