Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH

While working as the Quality Manager for a LTACH (Long Term Acute Care Hospital) one of my responsibilities was Infection Control. As with most facilities our highest number of infections were FRUTI (Foley Related Urinary Tract Infections). There were a number of factors to consider. Nurses Announcements Archive Article

The biggest was NOT getting catheters out as soon as possible. If the doctor doesn't address it then the nurse should ask if there are any reasons the patient still needs the catheter. If not ask for an order to remove it. However, if the foley is needed then it is of the utmost importance that foley care is done at least once per shift.

Our policy was revised to include clear guidelines for care.

Along with q shift peri care, staff was educated on importance of having a leg strap in place below the Y port to prevent tension on it, proper placement of the bag, never opening the closed sterile system and close observation of patient for any symptoms of a UTI. One of the most difficult issues was that many of out patients were placed into Low Boy beds due to high risk for falls. These beds had no place to hang the bag that did not have it touching the floor.

To keep it off the floor it ended up being higher than the bladder.

I called the manufacturer of the beds and the catheters to see if they had any suggestions. They were both completely baffled. I realized it was going to be up to me to figure this one out.

I considered blue pads but felt this would be a fall risk and would easily be kicked aside. I came up with a temporary plan until we could come up with something more permanent.

The foley bag was placed into the small plastic disposable bath tubs. They were less than 50 cents each, much less than the cost to treat an infection. I then set out on my quest to find a fluid impermeable cover for the bags.

Since they would touch the floor no matter where it was placed, the only solution was to protect it from allowing any contamination from the floors. It took a great deal of searching but I finally found just what we needed. The last step was that after each time the bag was emptied the spout was to be cleansed with alcohol wipe then placed back into the holder.

With a clear plan it was now time to not only educate but to get staff "buy in". I asked for volunteers and since the CNA's performed most of the foley care the majority of the team was made up of them with a few LPN's and RN's.

We decided that staff along with myself would police each other. To keep it positive, we decided that when one of the staff observed another correctly performing foley care they were given "tickets" to issue to the person "caught" doing a good job.

Once a staff member acquired a predetermined amount of tickets they were able to turn them in for a small "prize". From start to finish it took about 6 months for our infection rate to drop. We had a Pizza Party to celebrate our accomplishment. Even after we discontinued the prizes staff continued to be vigilent about the foley care and in the end it was the patients who were the real "WINNERS".:yeah:

Im not saying that only the floor is causing the infections, however I was taught to clean the port after emptying it from residual urine. If the port is not clean then yes it is possible that bacteria will grow, we know bacteria love moist and warm environments. So it is possible that the floor could cause infection. My patient has BPH and a catheter must be in place for long periods of time. And since I am working under my instructors liscense, it is my responsibility and my obligation to report any wrong doing to the nurse on the floor. If I dont tell them , I am just as wrong. I will always do what is right, and if that means telling them how to do their job when it is obvious that something is wrong, then that is what I will do. I think about the patients safety first!! Remember the oath my dear.

I understand what your saying and I also understand that the floor is not necessarily the cleanest place. Believe me, I understand where you are coming from and understand your concern, however I believe you are probably barking up the wrong tree. If they are turning their pt. from side to side how do you propose they get the bag over to the other side of the bed? And whether or not your pt. has BPH or needs the catheter to protect his skin, the fact of the matter remains that the catheter is there. Those catheter drainage systems are closed drainage systems, which are suppose to prevent the very thing your talking about. Now, having said that, are they 100% effective? My guess would be 99 point something, something, something that they are. I have not seen any evidence where it says they are not effective. The point I am trying to get across to you is that the chances of getting a UTI form having the bag touch the floor are very very very low (probably 0) compared to all the other ways that are probably at play here. And I seriously doubt it is because the way they are turning the pt.

I have worked on a surgery floor for 7 years and I have seen and dealt with catheters many, many times. I could probably put one in with my eyes closed. Instead of spinning your wheels about the bag touching the floor I think I would be more concerned about how long the catheter has been in place first, and probably the next area I would lean towards would be the hygeine care that the pt. is getting (or not getting in this case), and also the aseptic technique that they are using when putting the catheter in.

I certainly do not disagree with you "cleaning the port off," as I feel it surely could not hurt. Personally, I have never seen that done in the many years I have been in this profession, but if you feel that helps, then go for it. Fact of the matter remains is that if your saying the bag touching the floor causes infections, then you need to go ahead and say that if the bag touches the IV pole, bed frame, or chair then that will also cause infection. Although the floor is dirty, I don't know how you can say it has any more bacteria than anything else the bag touches. This whole post started with an "educator" saying she was on some crusade to stop UTI's caused by the bag touching the floor. I'm sorry, but I have major concerns with people that are trying to fix something that they think is the cause, but yet they are overlooking the most obvious causes of all. Probably because it's just the easier path to take. Especailly when they are supposedly educators in the first place. I have seen many people over the years in this profession that make up stupid and senseless policys when they have never stepped foot on a nursing floor and done direct pt. care.

One last point, when your emptying the bag, your not emptying "residual" urine. Residual urine is urine that is still left in the bladder after the pt. has voided.

I applaud troc for being so observant instead of turning a blind eye to what is going on around her. If nurses have seen improper handlimg of catheters for years and apparently not done anything about it means that they are part of the problem. EVERYONE knows foleys in place too long sharply increase the risk of infection. In a perfect society no one would have a catheter and if they did someone would design a completely sterile way to hang the bag but it is not a perfect society and thus any thing that can be done in an effort to eliminate any possible causes of bacteria should be done. Let's say the floor is a fine place to lay the foley bag what does it hurt to put it into a protective barrier? Take a culture of a floor and see what it grows then do the same to an IV pole and I bet you'll find the floor wins hands down for more possible contaminate.

The CDC has published best practice guidelines to prevent CAUTI Cath Acquired UTI that you can look up with those keywords. They do recommend not having the collection bag on the floor, no routine bag changes unless clinically indicated (contaminated), recommend against irrigation, single unit foley and bag tubes, there is continuing research about other issues. Clinical research and scientific method are our best allies. Give it a lookup!

That website sounds interesting, I will check it out. Our instructors are always encouraging us to do research, this looks to me like a good topic for a newbie. Preventing HAIs are always top of my list.:loveya:

Specializes in Vents, Telemetry, Home Care, Home infusion.