Why are we revising our process?
1.
Joint Commission requirements
 National Patient Safety Goal – 2013
 Goal 7
 Reduce the risk of health care-associated infections.
 Implement evidence-based practices to prevent indwelling catheterassociated urinary tract infections (CAUTI).
2.
CDC guidelines
3.
Catheter Associated Urinary Tract Infections (CAUTIs)
• Are the most common healthcare acquired infections
• UTI causes approximately 36% of all hospital infections per year
•
80% of those are catheter related
• Increases hospital stay
• Increases healthcare cost
• It is highly preventable
You can make a difference by doing a few simple things!!
APIC Guide 2008: Guide to Elimination of Catheter-Associated Urinary Tract Infections.
Klevens RM, et al. 2002. Public Health Rep. 2007; 122:160–167
“Getting to Zero”
• Committee developed in 2012 to get to “O” CAUTIs
• CAUTIs recorded at Aultman
• 2010: 106
• 2011: 92
• 2012 YTD: 17
• Our Goal
• NO CAUTIs from this point forward in 2012
• Zero “O” CAUTIs in 2013!
16
Mar
14
2012 –
“O”
12
10
2010
8
2011
6
2012
4
2
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Prevention Strategies
 Eliminate unnecessary insertion of catheters
 Review physician orders to ensure a valid Foley catheter
insertion order was entered
 Educate your patient about CAUTI (use FAQ sheet) prior to
insertion
 Currently available on Policy Tech - type “SHEA CAUTI”
 Insert Foley catheter using sterile technique
 Secure the catheter as to prevent urethral trauma, migration
of organisms, and kinking/bending of the catheter
 Keep catheter below the level of bladder
 Perform catheter care per policy
 Maintain a closed system
 Discuss daily with physician potential removal of
unnecessary catheters
NEW catheter kits available to assist us
to meet 2013 NPSG!
• Kits Include:
• Castile soap wipes
• Betadine swabs
• Pre-connected, sealed catheter
tubing
• Securement Device
• Insertion labels for patient chart;
apply to front of chart, and
catheter tubing (from BARD ®)
* Your unit director will communicate with you
when the new kits are available on your unit
Insertion of Catheter: Policy Revisions
Steps removed
Steps added
 Testing urinary catheter balloon
 Use of castile soap
 Already performed by
manufacturer
 Use of cotton balls to cleanse
urinary meatus
 Product changed to swab
sticks
 Use of betadine swab sticks
 Use green sheeting clip to secure
catheter drainage tube to the
sheet
 Apply insertion labels to the
front of the chart and to the
catheter drainage tube
Catheter 101
Proper Techniques for Urinary Catheter Insertion
 Perform hand hygiene immediately before and after insertion
 Remember: Wash hands after cleansing patient and before donning
sterile gloves
 Insert urinary catheter using aseptic technique and sterile equipment
 Use the smallest Foley catheter possible, consistent with good drainage
(18 French or larger not recommended for routine use)
 Document date and time of catheter insertion, individual who inserted
catheter, size of catheter , and date and time of catheter removal along
with who removed it in the patient record
Catheter 101
Proper Techniques for Urinary Catheter Maintenance
 Secure the Foley catheter
 Maintain a closed drainage system by utilizing pre-connected, sealed
catheter-tubing junctions
 Maintain unobstructed urine flow and keep the catheter and collection
tube free from kinking
 Keep the collection bag below the level of the bladder or hips at all
times
 Empty the collection bag a minimum of every shift and prn or per
physician’s order using a clean collection container
 Rinse the collection container after each use
Catheter Care
 Revised process for catheter care
 Castile soap & water only

Products must be thoroughly rinsed
 No emollients or residue producing products


Bath-in-a bag
Perineal cleansers
 Catheter Care is different than Perineal Care:


Skin protectants & emollient products OK for perineum, but not at the insertion
site of a catheter (urethral area)
Skin protectants & emollient products intensify formation of biofilm* & provide a
breeding ground for organisms
*Biofilm is a very thin layer of microscopic organisms that covers the surface of an object.
http://medical-dictionary.thefreedictionary.com/Biofilms
Catheter Care Product Update
 Why Castile Soap?
 Safe, very mild & effective cleanser
 Contains no emollients
 Why not just use the bath-in-a-bag or current perineal cleanser?
 Both contain emollients
 Should not be used on the catheter (urethral) area because it can
increase biofilm formation
Product Update Continued…
 Why a closed drainage system?
 Using a pre-connected, sealed catheter tubing junction prevents CAUTIs
 Why StatLock ® securement device?
 Minimizes accidental catheter dislodgements
 Firmly holds catheter in place at the “Y”
 Allows complete freedom of movement
 Latex free
 StatLock ® Application and Care
 Use skin prep before application
 Apply with “click it before you stick it” method
 Initial and date securement device upon application
 Assess adherement and skin around device daily
 Move device every 7 days
 Remove with alcohol
Pre-connected tubing & securement device
Catheter Care Procedure
1.
2.
3.
Perform at least every 24 hours
and prn for soiling.
Identify patient using two
patient identifiers.
9. Cleanse, thoroughly rinse, and gently
pat dry urethral meatus. (Pericare
bottle may be used.)
10. Remove gloves and discard.
Perform hand hygiene.
11. Perform hand hygiene.
4.
Don clean gloves.
5.
Place the patient in supine
position and expose the perineal
area to easily visualize the
meatus.
6.
7.
8.
Release the catheter from
securement device to prevent
urethral trauma.
Remove gloves and perform hand
hygiene.
Don clean gloves.
12. Resecure the catheter with securement
device.
13. Position the patient for comfort.
14. Perform hand hygiene.
15. Document activity in the medical
record, including education provided
to patient/family
Catheter Care Procedure
Female:
 Using castile soap and water, cleanse the urethral area using circular
motions moving outward with washcloth, thoroughly rinse with water,
and then gently pat dry.
 Using a separate washcloth, cleanse the catheter beginning at the
insertion site moving away from the body, using castile soap and water
and then rinse and dry with clean towel.
Catheter Care Procedure
Male:
Circumcised
 Cleanse around the meatus using
washcloth, castile soap and water.
Rinse and then dry the area with a
towel.
 Using a separate washcloth, cleanse
the area between the scrotum and
rectal area, rinse and dry.
 Using a separate washcloth, cleanse
the catheter beginning at the
insertion site moving away from the
body, using castile soap and water
and then rinse and dry with clean
towel.
Uncircumcised
 Retract the foreskin from the
catheter.
 Cleanse around the meatus using a
washcloth, castile soap and water.
Rinse and dry with clean towel.
 Replace the foreskin around the
catheter.
 Using a separate washcloth, cleanse
the area between the scrotum and
rectal area, rinse dry.
 Using a separate washcloth, cleanse
the catheter beginning at the
insertion site moving away from the
body, using castile soap and water
and then rinse and dry with clean
towel.
Removal of Catheter: Policy Revisions
Revisions
 Use of castile soap to cleanse
urinary meatus prior to removal
 To prevent migration of
organisms
Reminders
 Cleanse urinary meatus prior to
catheter removal - rinse, gently
pat dry after cleansing
 Deflate catheter balloon prior to
catheter removal
 Document catheter removal in
medical record
Documentation – Urinary Catheter
 Document Patient
Education task
(fires BID)
 Select “Education
Provided” from navigator
bar
 Click box for “Infection
Prevention”
Documentation Continued…
 Document education provided
 CAUTI/FAQ
 Hand Hygiene
 Catheter secure education
 Avoid twisting/kinking
catheter
 Collection bag lower than
bladder
Resources
 Smith, S., Duell, D., Martin, B. 2008. Clinical Nursing Skills: Basic to
Advanced Skills. 7th EditionPrentice Hall.
 Clinical Care Improvement Strategies: Preventing Catheter-Associated
Urinary Tract Infections. 2011. The Joint Commission Resources.
 Urinary Catheterization of a Male of Female Patient: Insertion, Care of
Patient, and Removal of Catheter. 2012. Aultman Polices and
Procedures.
 BARD ® Foley and Urethral Catheterization tray insert documents.
Online Education
 You have completed the Learning Module entitled Urinary
Catheterization: Insertion, Maintenance, Catheter Care & Removal
 Please go to the quiz section in QUIA and complete the quiz Urinary
Catheterization: Insertion, Maintenance, Catheter Care, & Removal
 Deadline for completion: October 15, 2012
Questions?
Patty Russell, BSN, RN
Ext. 35435
UD Main 5 (Chair – CAUTI Task Force)
Kerri Samblanet, BSN, RN, CRRN
Ext. 34243
Step-Down Staff Educator (Co-Chair CAUTI Task Force)