Curos caps for foleys?

The purpose of Curos caps is to remove some of the variation that occurs in cleansing a leur-lock port prior to accessing, it essentially makes the port continuously aseptic so that inadequate cleansing of the port is no longer an issue. So unless you're frequently accessing the sampling port there wouldn't be much benefit to a Curos cap. If the port is being accessed excessively then it might make more sense to address that issue than moving to Curos caps for all.

Changing the Foley catheter routinely is not recommended, and may actually increase the risk of CAUTI. It should also be noted that routine "Foley care" which suggests cleansing of the urethral meatus is also not recommended by the CDC to reduce CAUTI, and in two studies increased the incidence of CAUTI, routine hygiene should be limited regular peri-care.

We never use them in foleys.we do ha d CAUTI. But now we are at zero.

we encourage each other to use hand wash before and after procedures.We use whatsapp ,the code to remind staff to do it, a polite one.

Always make sure that culture is done whenever we get new cases to ICU, may be of has an infection( only with foleys pts).

We have done root analysis to find out the causes.

Proper clean but non touch technique to collect sample and transport it to the sterile container, also it reaches lab without any delay.

Removal of catheter and putting diaper if no need of catheter.

Good personal care

Applying flexitrack to secure it in proper way .

Aseptic techniques while inserting catheter and auditing it .

Clamping the tube before shifting it from one to another side

Make sure no kink, to prevent stagnation and uti.

Always keeping bag below the bladder level.

Changing urometer if discoloration, with pus, if u feel .

Single plastic urine bottle .

After and before emptying ,cleaning outlet of bag using 70% isopropyl alcohol.

If recurrent caution use silver catheters

We have audit bundles that starts upon insertion by the one who inserted.

I hope it will help you

Thank u

dawdlingsquid said:

That's interesting. Do you know what the reason is? My cynical side tells me it would be budget related.

We moved to using a wipe that lasts 24 hours after scrubbed. Also, they are 25 cent a cap, so ya, financial.

If you had a "huge problem with CAUTIs" and hired an outside Infection Prevention consultant who said the problem could be fixed with CUROs, it is no wonder he/she is no longer there. Far more likely cause is improper/nonsterile insertion of the Foley, leaving it in past when it is needed, placing a Foley in the first place when there are no indications warranting that invasive procedure, placing Foley's in patients with existing UTI (good way to give them a kidney infection/sepsis), improper or no Foley and peri-care or no Foley awareness (e.g. keep below the level of the patient), breaking the system routinely to irrigate, unnecessary Foley changes, unnecessary UAs (seriously!)--there are many reasons that there are unit problems with CAUTIs and they come down to misinformation, lack of evidence based practice policy and lack of adherence to that policy and accountability (and using those things way more than they should be).

20 hours ago, InfxPrev said:

If you had a "huge problem with CAUTIs" and hired an outside Infection Prevention consultant who said the problem could be fixed with CUROs, it is no wonder he/she is no longer there. Far more likely cause is improper/nonsterile insertion of the Foley, leaving it in past when it is needed, placing a Foley in the first place when there are no indications warranting that invasive procedure, placing Foley's in patients with existing UTI (good way to give them a kidney infection/sepsis), improper or no Foley and peri-care or no Foley awareness (e.g. keep below the level of the patient), breaking the system routinely to irrigate, unnecessary Foley changes, unnecessary UAs (seriously!)--there are many reasons that there are unit problems with CAUTIs and they come down to misinformation, lack of evidence based practice policy and lack of adherence to that policy and accountability (and using those things way more than they should be).

I agree with most of your post, but there's no contraindication to placing a foley in a patient with a UTI. A UTI itself isn't an indication to placing a foley, but there are symptoms of a UTI that may indicate the need for a foley, such as inflammation causing urinary outlet obstruction, in which case it's a lack of an indwelling catheter that may lead a kidney infection/sepsis.

Placing a Foley for retention/obstruction is addressed in the sentence before your bolded quote, "Placing a Foley in the first place when there are no indications warranting that invasive procedure,". Obstruction/retention is a universal reason for placing a Foley.

...as to no contraindications of placing Foleys in someone who has a UTI , you are mistaken, it is not best practice. I am an Infection Preventionist/Epidemiologist, CIC. When the bladder is not its usual sterile self, bacterial slime forms on areas of the urinary catheter (such as the tip where the os is located) and because of this protective matrix many individual organisms may not be affected by antibiotics or only partially so and become resistant. Patient is treated, then returns with a worse infection that may or may not respond as well to antimicrobial treatment. If a Foley has to be inserted into a patient with a UTI, it should be done just as you would for any other time you insert one of these things--for good reason and get it out as soon as you can (before the end of the antimicrobial treatment if at all possible) because removing the catheter can loosen up the matrix and turn organisms loose in the bladder again. (And infection potential aside, from a general comfort standpoint as you said, the urethra tends to be irritated anyways with a UTI, the presence of a Foley doesn't help unless its absolutely needed.

@dawdlingsquid the other, less descriptive term for the bacterial matrix/slime that forms on Foleys is biofilm--in particular there is crystalline biofilm. Do a search on that stuff and you will never want to put a Foley in anyone again! I started working at my present hospital 8 months ago, and you are sooo right--I had to mount an intense blitz to the ED physicians and RNs---they were passing out Foleys on elderly women with unfortunate predictability. Even when a straight cath for a specimen was ordered, they'd pop a Foley in whether or not she was going to be admitted and whether or not the thing was even indicated. Oddly enough, this was not done near as often to elderly men who often do have some retention issues. Elderly women tend to be the opposite--incontinence issues which was the actual reason their Foleys were being placed. It stopped when I clarified that per policy the only actual accepted reasons to place a Foley in our ED was retention/obstruction or pelvic trauma and that any other reason would be individually addressed by the ED doctor and admitting hospitalist. Also that under no circumstances ever is an RN to place a Foley without an order--if you get a verbal order in the heat of an emergency, it is both the physicians' and the nurses' responsibility to get that order entered/documented before the end of the shift. (We had two CAUTIs at that time, both had no physician's order nor even an indication both were even needed). We also use condom caths for males who cannot use urinals and are incontinent (its an art form to attach them but they do work) and a device called Purewick for women. Both protect the patient's skin and avoid bed changes which is pretty much the number one reason staff was so intent on placing the Foleys. There was additional education needed for ED to Inpatient admissions for both doctors and nurses that unless the admitting hospitalist wrote orders for a Foley, any of those things that were placed in the ED needed to come out before transfer to inpatient beds---if a nurse was in doubt, ask to clarify and get an order if you and the doctor feel the thing really is needed). We instituted 24 hour checks by Inpatient units noc shift to catch Foleys present without orders or indications in inpatients and we do daily huddle/rounding where we discuss each inpatient, check if they have a Foley and as the hospitalist is present, ask if the thing can be DC'd and replaced, if even needed, by a noninvasive device or strategy. We place Foleys only when absolutely needed, write a review daily if they are still needed and get rid of the things as fast as possible when they aren't. Our use of Foleys has dropped by two thirds. When placed we do Foley care, documented, at least once a shift---Foley care is a competency now for C.N.A.s and RNs. RNs have the additional competency for insertion and indications for Foleys, and placement of condom caths and the Purewick.

On 7/8/2019 at 3:51 PM, InfxPrev said:

Placing a Foley for retention/obstruction is addressed in the sentence before your bolded quote, "Placing a Foley in the first place when there are no indications warranting that invasive procedure,". Obstruction/retention is a universal reason for placing a Foley.

...as to no contraindications of placing Foleys in someone who has a UTI , you are mistaken, it is not best practice. I am an Infection Preventionist/Epidemiologist, CIC. When the bladder is not its usual sterile self, bacterial slime forms on areas of the urinary catheter (such as the tip where the os is located) and because of this protective matrix many individual organisms may not be affected by antibiotics or only partially so and become resistant. Patient is treated, then returns with a worse infection that may or may not respond as well to antimicrobial treatment. If a Foley has to be inserted into a patient with a UTI, it should be done just as you would for any other time you insert one of these things--for good reason and get it out as soon as you can (before the end of the antimicrobial treatment if at all possible) because removing the catheter can loosen up the matrix and turn organisms loose in the bladder again. (And infection potential aside, from a general comfort standpoint as you said, the urethra tends to be irritated anyways with a UTI, the presence of a Foley doesn't help unless its absolutely needed.

That doesn't make a lot of sense. Foley's should only be placed for appropriate indications, but an existing UTI is not a contraindication to Foley placement. If an indication for placement exists then that is not overridden by the presence of a UTI.