Urinary tract infections (UTIs) account for almost half of all hospital-acquired infections annually and between 70 and 80 percent of those UTIs are attributable to an indwelling urethral catheter.
“Catheter-associated urinary tract infections (CAUTI) develop either during or after placement of a urinary catheter. CAUTI has been shown to increase patient morbidity and mortality, increase length of stay, and add to the cost of care,” says the Association for Professionals in Infection Control and Epidemiology.
The National Healthcare Safety Network (NHSM) reports that UTIs – an infection involving any part of the urinary system, including the urethra, bladder, ureters, and kidney – are the most common type of healthcare-associated infection.
“Among UTIs acquired in the hospital, approximately 75 percent are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25 percent of hospitalized patients receive urinary catheters during their hospital stay,” explains the Centers for Disease Control and Prevention (CDC).
Catheter-Related UTIs Are a High Priority Hospital-Acquired Condition
The Institute for Healthcare Improvement (IHI) says that among the 10 hospital-acquired conditions selected by the Centers for Medicare & Medicaid Services, catheter-associated UTI received a high priority due to its high cost and high volume and because it can be reasonably prevented through the application of accepted evidence-based prevention guidelines.
“The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed,” says the CDC.
The IHI agrees and says that “it is well established that the duration of catheterization is directly related to risk for developing a urinary tract infection (UTI). With a catheter in place, the daily risk of developing a UTI ranges from 3 percent to 7 percent.”
What is a CAUTI and How Did I Get It?
The CDC says that a urinary tract infection (also called “UTI”) is an infection in the urinary system, which includes the bladder (which stores the urine) and the kidneys (which filter the blood to make urine). Germs (for example, bacteria or yeasts) do not normally live in these areas; but if germs are introduced, an infection can occur.
If you have a urinary catheter – a thin tube placed in the bladder to drain urine into a bag -- germs can travel along the catheter and cause an infection in your bladder or your kidney. This is called a catheter-related urinary tract infection or catheter-associated urinary tract infection (CAUTI).
The CDC says that many of the germs that cause CAUTI are common germs found in your intestines that do not usually cause an infection there but can enter the urinary tract when the catheter is being placed or while the catheter remains in the bladder.
Symptoms you might have a UTI include:
- Burning or pain in the lower abdomen (that is, below the stomach)
- Fever
- Bloody urine may be a sign of infection (but is also caused by other problems)
- Burning during urination or an increase in the frequency of urination after the catheter is removed
Most catheter-associated urinary tract infections can be treated with antibiotics and removal or change of the catheter.
How to Prevent Getting a CAUTI While Hospitalized
Fortunately, catheter-associated urinary tract infections are preventable if the proper precautions are taken.
The CDC advises healthcare providers and staff to take the following actions to prevent patients from acquiring CAUTI:
Catheter Insertion
- Catheters are put in only when necessary and they are removed as soon as possible.
- Only properly trained persons insert catheters using a sterile (“clean”) technique.
- The skin in the area where the catheter will be inserted is cleaned before inserting the catheter.
- Other methods to drain the urine are sometimes used, such as:
o External catheters in men (these look like condoms and are placed over the penis rather than into the penis)
o Putting a temporary catheter in to drain the urine and removing it right away. This is called intermittent urethral catheterization.
Catheter Care
- Healthcare providers clean their hands by washing them with soap and water or using an alcohol-based hand rub before and after touching your catheter.
- Avoid disconnecting the catheter and drain tube. This helps to prevent germs from getting into the catheter tube.
- The catheter is secured to the leg to prevent pulling on the catheter.
- Avoid twisting or kinking the catheter.
- Keep the bag lower than the bladder to prevent urine from back flowing to the bladder.
- Empty the bag regularly. The drainage spout should not touch anything while emptying the bag.
What Patients Can Do to Stop the Spread of CAUTI
The No. 1 thing a patient can do for themselves to prevent a UTI while in the hospital is to ask healthcare providers to clean their hands if they do not see them do so before handling your catheter. Other things patients can do to prevent CAUTI include:
- Always clean your hands before and after doing catheter care.
- Always keep your urine bag below the level of your bladder.
- Do not tug or pull on the tubing.
- Do not twist or kink the catheter tubing.
- Ask your healthcare provider each day if you still need the catheter.
Patients should contact their doctor, nurse, or another healthcare provider immediately if they develop symptoms of a UTI such as burning or pain in the lower abdomen, fever, or an increase in the frequency of urination.
“Right now, about one in five hospital patients has a catheter collecting urine, increasing the risk of a painful and potentially dangerous urinary tract infection, or UTI,” wrote Kara Gavin for University of Michigan’s “Michigan Medicine Health Lab”. “Many of these patients may not actually need a catheter. And none need an infection. But both catheter use and UTI rates have stayed high despite years of national attention on the issue.”
The good news is that catheter-associated urinary tract infections drop in general hospital populations after teams get training, checklists and data, according to a massive study across 603 hospitals.
