Updated June 08, 2015.

According to the Centers for Disease Control and Prevention (CDC), catheter-associated urinary tract infections (CAUTI) are the most prevalent hospital-acquired infection (HAI). CAUTI accounts for over 30 percent of the HAIs in acute-care hospitals. Almost all of the incidences of healthcare-acquired urinary tract infections are due to the insertion of catheters. Fortunately, the CDC, medical supply manufacturers, and hospital staff are each doing their part to help reduce CAUTI.

CAUTI Reduction Benefits

• Hospital Length-of-Stay reduction
• Morbidity and Mortality reduction
• Hospital HAI Treatment Cost reduction

The CDC's Contribution

The CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) has published an extensively researched document titled, Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009.

The Guideline provides evidence-based recommendations for the care of patients requiring short and long-term catheterization in not only acute-care hospitals, but also for patients in long-term care and home-care settings who require chronic urinary drainage.

The Guideline is the first time the CDC HICPAC has issued a standardized methodology for reducing CAUTI. Following this methodology will standardize care and quality improvement strategies so that healthcare staff can measure the impact of their efforts.

The CDC HICPAC has organized its Summary of Recommendations as follows:

• recommendations for who should receive indwelling urinary catheters

• recommendations for catheter insertion;
• recommendations for catheter maintenance;
• quality improvement programs to achieve appropriate placement, care, and removal of catheters;
• administrative infrastructure required;
• surveillance strategies.

The Hospital Staff's Contribution

Key Points in the CDC's "Strong Recommendations" that Hospital Staff follow:

• Catheters should be inserted only when appropriate and should remain in use no longer than necessary.
• Consider alternatives to indwelling catheters where appropriate.
• Perform proper hand hygiene before and after inserting the catheter or handling any part of the device or site of insertion.
• Ensure that only properly trained people, including staff, the patient, or the patient's family member, who have been taught and are skilled in the proper technique of aseptic catheter insertion are allowed to do so
• Hospital staff should insert urinary catheters using aseptic technique and sterile equipment.
• In the long-term care and home-care environments, clean technique is more acceptable and practical than sterile technique for chronic intermittent urinary catheterization.
• Secure the indwelling catheter after insertion so that it doesn't move or cause any friction within the patient.
• Use the smallest bore catheter possible, barring any contraindications.
• When intermittent catheterization is necessary, the CDC recommends performing it at regular intervals to prevent the patient's bladder from becoming unfavorably stretched.
• Consider using a portable ultrasound device. These devices can help to assess urine volume in patients undergoing intermittent catheterization and thus reduce unnecessary catheter insertions.

The Medical Supplier's Contribution

Medical equipment and supply manufacturers have responded to the call to reduce and prevent CAUTI incidence by introducing new technologies that help healthcare providers implement the CDC's evidence-based recommendations.

• Portable ultrasound devices that can asses urine volume without the need to insert a urinary catheter in some patients.
• Antiseptic or antimicrobial-impregnated catheters, such as silver-alloy coated catheters, theoretically should be helpful in preventing urinary tract infection. The CDC recommends these devices could be used if the incidence rate fails to fall despite adherence to the strongly recommended guidelines. More research is needed to prove without a doubt that antiseptic or antimicrobial-impregnated catheters will prevent CAUTI.
• The CDC even suggests that electronic medical record (EMR) systems can also assist in CAUTI prevention efforts. EMR systems can be used by hospital staff to document if a patient is indicated for catheter insertion. The EMR system can also monitor dates and times of catheter insertions and removals. The CDC states that electronic alerts or reminders can also be used to prompt clinicians to remove unnecessary catheters.
• Pre-packaged CAUTI Prevention Kits. Some manufacturers have created kits that include a tray with all of the items needed for a sterile insertion of a urinary catheter, including a larger CSR wrap to provide a larger sterile field.

Source: Carolyn V. Gould, MD, MSCR; Craig A. Umscheid, MD, MSCE ; Rajender K. Agarwal, MD, MPH; Gretchen Kuntz, MSW, MSLIS; David A. Pegues, MD and the Healthcare Infection Control Practices Advisory Committee (HICPAC), Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009