Preventing Catheter-Associated Urinary Tract Infections

Laura A. Stokowski, RN, MS

Disclosures

February 03, 2009

Practices That Are Not Recommended

The SHEA/IDSA guidelines suggest that some common practices should not be used routinely in the prevention of CAUTI.[1] Some of these interventions can temporarily suppress bacteriuria but will eventually lead to the appearance of resistant flora.[6]

The following are not recommended:

  • Routine use of silver-coated or antibacterial urinary catheters;

  • Routine screening for asymptomatic bacteriuria in catheterized patients;

  • Treating asymptomatic bacteriuria except before invasive urologic procedures or in pregnancy;

  • Irrigating catheters;

  • Administering prophylactic antibiotics;

  • Changing catheters routinely; and

  • Cleaning the meatus with antiseptics (perform routine hygiene only).

Dr. Gray explains the rationale for abandoning some of these outdated practices. "Cleaning the meatus with antiseptics has no effect on infection rate. Instead, a routine perineal cleansing solution should be used, and perineal hygiene must be scrupulous if fecal incontinence is present. Bladder irrigation," he continues, "has a very limited role with indwelling catheters, and does not prevent bacteriuria or CAUTI."

The Society of Urological Nurses and Associates (SUNA) clinical practice guideline, "Care of the Patient with an Indwelling Catheter,"[11] reinforces the evidence-based recommendations of SHEA/IDSA. In addition, SUNA emphasizes educating patients about urinary catheter care. An adequate fluid intake in catheterized patients, to achieve a daily urine output of approximately 1500 to 2000 mL (depending on individual patient requirements), should be maintained. This usually requires an intake of about 30 mL/kg per day. Adequate urine output is important to appropriately dilute the urine and decrease the risk for urinary encrustations in the catheter.[11] Drainage bags should be emptied when half to two-thirds full (or about every 3-6 hours) to prevent excessive traction on the urethra from the weight of collected urine. Drainage bags should be cleansed by filling with a diluted (1:10) bleach solution, agitating, and then air drying the bag.

SUNA's guidelines for nursing management of urinary catheters address topics such as catheter changes, insertion, and securing of the catheter.[11] The indications for catheter change are encrustations (blockages), leaking, bleeding, and symptomatic urinary tract infection. SUNA recommends that after insertion of the catheter, a 5- mL balloon should be filled with 10 mL of sterile water (not saline or air) for symmetrical inflation, according to the manufacturer's instructions. Balloon volume should be assessed routinely, and sterile water added if necessary. Urinary catheters should be secured to the patient's thigh or abdomen to reduce traction and movement, which can cause bleeding, trauma, or bladder spasm. When switching between overnight and leg bags, the connection sites should be cleansed with alcohol and capped when not in use.[47] Patients should not be instructed to routinely irrigate their urinary catheters, and catheter changes should be individualized according to patient need.[47]

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