Catheter-associated urinary tract infections (CAUTIs) are a significant problem for hospitals, and the feds are taking notice. In fact, the Joint Commission recently revised its hospital guidelines for prevention of CAUTIs, which means facilities will have to change their approach to the infections in the new year.
According to information from the Joint Commission, CAUTIs are the most common hospital-acquired infections found in patients. And anywhere from 70% to 80% of CAUTIs are caused by indwelling urinary catheters.
Urinary catheters can cause other problems in patients, such as urethral inflammation and impaired mobility. So to boost patient safety, it’s critical for hospitals to monitor their use closely.
As part of the Joint Commission’s revised National Patient Safety Goal for hospitals, facilities must implement evidence-based practices to prevent CAUTIs and other harm caused by indwelling catheters.
The new 2017 guidance for this measure requires hospitals to:
- educate clinical staff who place urinary catheters in patients, or who care for patients with catheters, about the importance of preventing CAUTIs
- educate patients and their families about the steps they can take to prevent CAUTIs and how they can recognize a urinary tract infection, and
- develop specific written criteria for when patients should have a urinary catheter (e.g., critically ill patients who need accurate measurements of their urinary output, patients who will be immobilized for most of their hospital stay, end-of-life patients).
Safe catheter use
Per the Joint Commission, hospitals must also develop and follow written procedures for inserting and maintaining urinary catheters. Procedures should include language that specifically limit their use and duration, except for patients with medical conditions where the benefits of prolonged use of a urinary catheter may outweigh the risks (such as spinal cord injuries or Parkinson’s disease).
Facilities’ internal guidelines should emphasize the importance of practicing proper hand hygiene before catheter insertion or maintenance care. Issues with hand hygiene can contribute to infections in patients, including CAUTIs, so staff must be diligent about washing and sanitizing their hands.
Besides hand hygiene, staff must make sure that supplies and equipment for urinary catheters are kept sterile, and that site preparation is done using techniques to keep the area clean and free of germs. The urine collection system must remain sterile through all points of the process, and it must be replaced quickly when required.
In addition, there should be specific guidelines for the collection of urine samples that prioritize patient safety by keeping equipment free of contamination.
Tracking prevention efforts
Along with implementing these procedures and guidelines, hospitals should have a process in place to monitor progress toward CAUTI prevention, including patient outcomes.
The Joint Commission says hospitals should do this by:
- selecting evaluation metrics that align with evidence-based guidelines and best practices
- having a consistent method to document urinary catheter use, insertion and maintenance for each patient
- monitoring staff compliance with guidelines for CAUTI prevention, and
- evaluating the effectiveness of infection prevention efforts.