We used to think it was inevitable that patients got urinary tract infections from Foley catheters. We used to keep catheters in any incontinent patient and for days or weeks longer than necessary.
Now hospital acquired urinary tract infections are never events. The Centers for Medicare and Medicaid Services will not pay for care associated with these infections after they develop in a hospitalized patient. Suddenly, we’ve got an incentive to prevent these infections.
Guidelines on How to Prevent Urinary Tract Infections
The Centers for Disease Control and Prevention published guidelines for the prevention of catheter-associated infections. Here is one of their key concepts: avoid using a catheter if at all possible. If catheters must be used, remove them as soon as these devices are no longer necessary. The CDC defines when catheters are and are not necessary.
Lengthy use of indwelling catheters increases the likelihood of infections with over 20 percent of catheterized patients acquiring a catheter-associated infection.
One hundred percent of patients will get a UTI if a catheter is left in place for a month.
The recommended prevention methods require healthcare providers to:
- use sterile aseptic technique during catheter insertion;
- maintain a closed sterile drainage system;
- avoid routine catheter irrigation as this requires opening the system which leads to likely microbial contamination and the possibility that the irrigant solution may be contaminated;
- maintain unobstructed urinary flow;
- keep the catheter drainage system lower than the level of the patient’s bladder to prevent backflow of urine from the drainage bag;
- collect specimen through needle aspiration to avoid opening the catheter-tubing juncture; and
- change the catheter only as indicated and not on a routine arbitrary schedule.
The standard of care requires healthcare providers responsible for the care of patients with catheters to follow the above recommended methods. Nurses and physicians have to be aware of overall patient conditions, as this affects the likelihood that patients may get a UTI. Proper fluid intake is important for cellular metabolism and maintenance of urine flow through the bladder.
However, staff are to be mindful of conditions in which fluid intake needs to be restricted, avoiding procedures that have been shown to be ineffective in preventing UTI, such as treating bacteria collecting at the opening of the urethra or using antibiotics for patients who do not have symptoms from the bacteria in their urine.
Research on catheters
Joanna Briggs Institute performs researches and condenses the latest findings for the establishment of evidenced based practice (EBP). According to the Joanna Briggs Institute (JBI), the use of silver alloy-coated or antibiotic impregnated catheters decreases the risk of short-term urinary catheter use.
Prophylactic antibiotics also help to prevent urinary tract infections in short-term catheter use. JBI also reports that daily hygiene with normal tap water is sufficient in perineal care. Staff must review culture results and report unusual microorganisms including if these are resistant to antibiotics. However, the single most effective deterrent of UTIs is mandatory staff education.
In determining possible negligence, the attorney or legal nurse consultant should review the documentation include changes in urine color, odor, etc. Did the facility follow their own policy and procedure for catheterization and care?
Modified from “Infections in Hospitals and Nursing Homes” by Ginny Lee, MBA/HCM, MSN, RN, Luke Curtis, MD, MS, CIH, Jacqueline Vance RNC, CDONA/LTC and Lorraine M. Harkavy RN, MS in Patricia Iyer, Barbara Levin, Kathleen Ashton and Victoria Powell, Nursing Malpractice, Fourth Edition
Check out our webinar on hospital acquired infections. Learn more about how to prove the liability or defend the staff accused of liability associated with urinary tract infections infections.
Get details about this webinar at this link. Learn more about how to evaluate liability for urinary tract infections. If a patient gets a urinary tract infection, has someone been negligent? Learn the intriguing answer to this question when you get the digital download to watch at your convenience.