Reducing Catheter Associated Urinary Tract Infections

Aim

To improve clinical practices associated with urinary catheter insertion, maintenance and removal in acute care settings.

Benefits

Improved practice will:

  • Ensure that urinary catheterisations are undertaken only when appropriately indicated; 
  • Reduce the risk of insertion site and drainage device contamination; 
  • Reduce the dwell time of catheterisation; and 
  • Reduce the risk of acquiring a urinary tract infection due to catheterisation.

It is anticipated that reducing the incidence of catheter-associated urinary tract infections will reduce the risk of acquiring an infection caused by a multi-resistant organism and reduces the likelihood of needing complex antimicrobial therapy and prolonged hospitalisation.

Other benefits anticipated from this project include: 

  • Improved decision-making regarding catheter insertion and urinary specimen collection; 
  • Reduction in pathology waste associated with inappropriately collected or contaminated urine specimens for culture; and 
  • Standardisation of catheter insertion and maintenance practices across clinical speciality areas.

Summary

The project supports NSW local health districts and networks by developing resources and governance structures to support process modifications to improve the entire process of urinary catheterisation. The project provides tools to encourage clinicians to:

1. Check if an indwelling catheter is clinically indicated. 2. Insert the catheter using aseptic technique. 3. Document catheter insertion and indication. 4. Maintain asepsis and closed system while the catheter is in place. 5. Only collect urine specimens for culture if clinically indicated. 6. Remove the catheter as soon as it is no longer needed. 7. Review CAUTIs incidents

The Healthcare Associated Infections (HAI) program has worked closely with a multidisciplinary team of frontline clinicians to develop the project resources to ensure that resources align with the needs and workflows of the various acute settings.

Background

This project is an initiative of the CEC’s Healthcare Associated Infections (HAI) program, which has been involved in reducing the risk of HAIs in NSW public hospitals since 2011. Catheter associated urinary tract infections (CAUTIs) account for at least 24% of all HAIs, making them one of the most common HAIs.

Patients have indwelling urinary catheters (IUC) inserted for a variety of reasons, most commonly to relieve urinary retention and obstruction and to assist in the management of injury or surgery.

In Australia, over 25% of patients have an IUC during a hospital admission. Recent research suggests that patients who have IUC in place however are over five times more likely to acquire a urinary tract infection than patients without an IUC.  

This project is particularly focused on ensuring that:

  • A pre-insertion discourse is undertaken to check for appropriate insertion indications and catheterisation alternatives;
  • Aseptic technique is used for catheter insertion and handling;
  • Catheter insertion, maintenance and removal is adequately documented;
  • Urine specimens are collected only when clinically indicated;
  • Thorough catheter care and review is undertaken daily;
  • The need for catheterisation is continually assessed and catheters are removed when appropriate; and
  • Lessons are learnt from any CAUTIs events.

The following resources are now available

Decision support tools
Quick guides
Educator presentations
Assessment, audit and investigation tools
Patient information material
Promotional material

If you have implemented, or are considering implementation of any of these tools at your facility, the HAI Program is available to provide advice and support. Please direct all correspondence to CEC-HAI@health.nsw.gov.au.

Partnerships

  • ACI - Urology Network
  • eHealth
  • NSW Health Pathology

Key Dates

Pilot Sites

Implementation Sites

Evaluation

The pre-insertion decision support tool (n=7 pilot sites), urine specimen collection decision support tool (n=4 pilot sites) and the criteria-initiated urinary catheter removal protocol (n=8 pilot sites) were evaluated for the practicality and effectiveness. This evaluation took the form of a 20 week pilot before and after pilot study. Reliability testing of the pre-insertion decision support tool has also been undertaken.

Related Initiatives

  • This project is an initiative of the HAI program.
  • This project promotes the adoption of Hand Hygiene
  • This project promotes the adoption of In Safe Hands for patient rounding and handover.

Further Details

Contact

Jan Gralton
HAI Project Officer
jan.gralton@health.nsw.gov.au
02 9269 5582

Dr Paul Curtis
Director, Clinical Governance
paul.curtis@health.nsw.gov.au
02 9269 5569

Page Top | Added: 3 September 2014 | Last modified: 15 March 2016

CEC
Status:
Contact:
Jan Gralton
HAI Project Officer
Email
02 9269 5582
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