CAUTIs in Critical Care

[silverbelle]

My hospital is trying to reduce Critical Care Cather Associated UTIs. We are doing better but still have more than our goal. We are told that hospitals across the country have 0 in a year. I simply don't see how this is possible. If a patient is on a vent, sedated, incontinent and has multiple infectious processes going on.... how is it possible to keep them from getting a UTI? Very frustrated, we are trying but just not getting where we want to go....

What do these hospital do...do they not use Foleys in anybody???

[Nalon1 RN/EMT-P, BSN, RN]

I don't know the exact number at my facility, but I heard we had like 4 CAUTI's last year (mid size suburban hospital, ~ 110 floor beds plus surgical and L&D beds)

We have mandatory annual training on foley insertion for all nurses, minimal twice daily foley care and strict guidelines for both putting them in and when they come out. Surgical patients have 2 day maximum unless the order is renewed. Generally if a patient can walk, foley should come out. Conscious males rarely have them.

[meandragonbrett]

Strict cath care

Frequent reeducation

Post-op day 1 at 5am they come out

Condom Caths for incontinent makes

We have had a cauti in two years in our unit.

[Lennonninja, MSN, APRN, NP]

We've been trialing a product Clorpactin as a foley irrigation, along with daily chlorhexadine baths and TID foley care. Our CAUTIs have definitely decreased. We've also been using more condom caths.

[Here.I.Stand, BSN, RN]

Fewer foleys--discretion with who really needs strict I&O, condom caths for males who don't have obstructions; incontinence isn't a rationale for having one

TID foley care. We use barrier cream wipes for stool incontinence but have begun keeping them away from the urinary meatus, since the oily substance can trap bacteria

Dual insertion for every single Foley. The second RN can help hold skin on females and verify that sterile technique is maintained

Adhesive anchoring device, vs. the elastic Velcro leg band

UCs only if pt is symptomatic of a UTI (subjective sx or VS changes). They can't come back positive if they're not done, and if the pt is not symptomatic they don't need to be treated. We treat infections, not colonizations.

Daily chlorhexidine washes

Simple stuff like always emptying the bag before repositioning to the other side of the bed, rinsing the graduate after emptying, changing the graduate weekly

[silverbelle]

Great information....thanks everyone!...