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Issue link: https://eguideline.guidelinecentral.com/i/1524011
Table 1. Recommendations to Prevent CAUTI 6. Maintain unobstructed urine flow. (L) a. Remind bedside caregivers, patients, and transport personnel to always keep the collecting bag below the level of the bladder. b. Do not place the bag on floor. c. Keep the catheter and collecting tube free from kinking, which can impair urinary flow and increase stasis within the bladder, increasing infection risk. d. Empty the collecting bag regularly using a separate collecting container for each patient. Avoid touching the draining spigot to the collecting container. 7. Employ routine hygiene. Cleaning the meatal area with antiseptic solutions is an unresolved issue, though emerging literature supports chlorhexidine use prior to catheter insertion. Alcohol-based products should be avoided given concerns about the alcohol causing drying of the mucosal tissues. (L) Additional Approaches 1. Develop a protocol for standardizing diagnosis and management of postoperative urinary retention, including nurse-directed use of intermittent catheterization and use of bladder scanners when appropriate as alternatives to indwelling urethral catheterization. (M) a. If bladder scanners are used, clearly state indications, train nursing staff in their use, and disinfect between patients according to the manufacturer's instructions. 2. Establish a system for analyzing and reporting data on catheter use and adverse events from catheter use. (L) a. Use cumulative attributable difference to identify high-risk units or hospitals. b. Measure process and outcomes measures (eg, standardized utilization ratio and standardized infection ratio). c. Define and monitor catheter harm in addition to CAUTI, including catheter obstruction, unintended removal, catheter trauma, or reinsertion within 24 hours of removal. 3. Establish a system for defining, analyzing, and reporting data on non-catheter- associated urinary tract infections (UTIs), particularly UTIs associated with the use of devices being used as alternatives to indwelling urethral catheters. (L) a. Non-catheter-associated UTIs are defined as UTIs that occur in hospitalized patients without an indwelling urethral catheter. These include but are not limited to patients that have had no urinary device at all, as well as those with EUCs, urinary stents, or urostomies, or who undergo intermittent catheterization, that are not captured by the National Healthcare Safety Network (NHSN) CAUTI definition. b. As the incidence of CAUTI continues to decline, the proportion of non-catheter- associated UTIs is increasing in some hospitals. However, the national incidence of non-catheter-associated UTIs is not known, as surveillance and reporting of these UTIs are not required by US federal agencies. c. As non-catheter-associated UTIs are a common indication for antibiotics in hospitalized patients, this metric could provide important information as healthcare facilities consider the risks and benefits of newer alternatives to urinary catheters with currently limited published data on adverse events (eg, EUCs for women) to help inform when the benefit outweighs the potential risk for specific patient populations. (cont'd)