Overcoming “Catheter Apathy” to Prevent Hospital-Acquired UTIs

Do you suffer from catheter apathy? This malady has been all too common among nurses in recent decades and it’s time to make it officially a thing of the past.

If you’ve never heard the term, “catheter apathy” refers to the belief that not much can be done to prevent catheter-associated urinary tract infections (CAUTIs), because colonization by bacteria is inevitable. Well, a new practice alert from the American Association of Critical-Care Nurses (AACN) aims to completely bust this myth. Here’s the scoop:

Urinary tract infections (UTIs) are the most common type of nosocomial infection by far, accounting for up to 40 percent of infections reported by hospitals. And up to 80 percent of these hospital-acquired UTIs are correlated with the use of an indwelling urinary catheter.

It’s a no-brainer that CAUTI increases hospital costs and length of stay. Research also shows that these infections can, in some cases, be deadly. Patient safety concerns alone would be good enough reason to establish protocols to reduce the incidence of CAUTIs, but now there’s a financial incentive as well – as of October 2008, Medicare has deemed these events to be “preventable” and will no longer pay for the cost of care associated with them. Instead, the tab will be picked up by the hospital itself, since the rules don’t allow the costs to be passed on to the patient. Understandably, hospitals and providers are under intense pressure to prevent the vast majority of these infections, and infection control specialists are scrambling to come up with strategies that work.

The new AACN practice alert is the latest in a collection of evidence-based guidelines issued by AACN to standardize practice and update nurses on new advances and trends.

Whether you’re an infection control nurse, nurse manager, or staff nurse, you should be aware of these practice guidelines and the role you play in reducing CAUTIs in your hospital.

Here’s a summary of the recommended actions for nursing practice:

  • Develop written guidelines for urinary catheterization. Include a checklist of indications for indwelling catheters and ensure that only patients who meet these indications actually receive a catheter. This is important because research shows that 25 percent of inpatients and up to 90 percent of ICU patients end up with a catheter, often without an appropriate indication.
  • Design practice standards and training programs that stress aseptic technique for the placement, manipulation, and maintenance of indwelling catheters. Nurses are responsible for most management of indwelling urinary catheters – so always remember that handwashing is the first and most important preventive measure, followed by the use of barrier precautions such as sterile gloves, drape, sponges, antiseptic solution, and single-use packets of sterile lubricant.
  • Every day, conduct a review of all patients with catheters, and remove those that are no longer necessary. Research shows that “forgotten catheters” are often inappropriate catheters.
  • Implement programs to track and monitor rates of catheter use and rates of CAUTIs at the unit level. Develop action plans to make improvements as necessary!

Nursing’s role in infection control

While physicians usually order the insertion and removal of a catheter, don’t ever doubt that nurses can make a difference in reducing CAUTIs. Consider this anecdote, excerpted from a Medscape article:

Fakih and colleagues,[37] used a nurse-led multidisciplinary approach to evaluate the continued need for urinary catheters and found that it significantly reduced unnecessary urinary catheter use. In this study, a specially trained nurse and member of a multidisciplinary team evaluated each hospitalized patient daily for the presence and appropriateness of indwelling urinary catheters. When a catheterized patient was determined to have no continuing indication for the catheter, the nurse requested the attending physician to order removal of the catheter. This intervention reduced by 45% the number of unneeded catheters.

The article also states that some hospitals are now expecting nurses to independently remove catheters in patients that meet established criteria – it will be interesting to see if this becomes a trend.

Still leaning toward catheter apathy? Read this essay, published in the Washington Post, written by a skeptic who became a believer when his hospital embarked on a mission to reduce infection rates in the ICU.

If you’re interested in planning, implementing, and evaluating infection prevention and control measures, consider making this your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in areas like infection control and executive leadership.

Photo credit: Umberto Salvagnin, via Flickr