Prevention of Catheter-Associated Urinary Tract Infections

Guideline Watch |
April 15, 2014

Prevention of Catheter-Associated Urinary Tract Infections

  1. Richard T. Ellison III, MD

This document updates 2008 guidelines on prevention of catheter-associated urinary tract infections in acute care hospitals.

  1. Richard T. Ellison III, MD

Sponsoring Organizations: Society for Healthcare Epidemiology of America (SHEA), Infectious Diseases Society of America, American Hospital Association, Association for Professionals in Infection Control and Epidemiology, and The Joint Commission

Target Population: Clinicians, infection control departments, hospital epidemiologists, acute care hospitals

Key Points or Recommendations

This document updates 2008 SHEA guidelines on the prevention of catheter-associated urinary tract infections (CAUTIs). Following a review of existing guidelines and recommendations and recent relevant literature, it outlines basic practices that should be implemented by all acute care hospitals, special approaches that could be considered for implementation, and strategies that should not be routinely used.

Key recommendations include:

  • Healthcare personnel should be educated about appropriate indications for indwelling urethral catheters and about procedures for the insertion, care, and maintenance of such devices.

  • Indwelling catheters should be properly secured, and unobstructed urine flow maintained.

  • For hospital locations or populations with unacceptably high CAUTI rates, an organization-wide program should be implemented to identify and remove catheters that are no longer necessary; the use of electronic or other types of reminder systems should be considered. A protocol should be developed for managing postoperative urinary retention.

  • Antimicrobial/antiseptic-impregnated catheters should not be routinely used, nor should systemic antimicrobials be routinely administered as prophylaxis.

What's Changed

The guidelines now include specific implementation strategies that institutions can use to improve practices, focusing on ways to engage healthcare providers, improve educational programs, and overcome resistance to practice changes.

Comment

Going forward, hospitals with high rates of catheter-associated urinary tract infections can be penalized by the Centers for Medicare and Medicaid Services — a ruling that has spotlighted the need for effective preventive measures.

A strength of these guidelines is the new section on implementation strategies. The document also highlights concerns with using device-days rather than patient-days as a denominator for determining CAUTI incidence (possibly masking substantial achievements of successful CAUTI-prevention programs), as well as with comparing the effects of prevention strategies among facilities (because the validity of the current CDC/National Healthcare Safety Network definition for CAUTIs has not been established for use in such comparisons).

Editor Disclosures at Time of Publication

  • Disclosures for Richard T. Ellison III, MD at time of publication Grant / research support NIH-NIAID

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