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Intermittent Catheterization Related to UTI in the Health Care System


Julie Arsenault
Norquest College
NFDN 2003
Assignment 1 Research and Application to Nursing Care
Jasmine Guanlao Sagun
September 2015

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM

Urinary tract infections (UTIs), to some, may seem no more than a nuisance when
suffered at home. In the health care system, particularly in certain populations, urinary tract
infections are more common and can have detrimental consequences. Even worse, urinary tract
infections are most frequently acquired because of staff error in the health care system.
Catheterizations are a common cause of UTIs because of the technique used in the hospitals.
Because it is so highly preventable, some governments have stopped paying hospitals for the
associated costs of UTI treatment and care. Consequently, catheter use has been changing in an
attempt to minimize these catheter associated urinary tract infections (CAUTIs). In order to fully
understand this issue and to foster prevention, one must first understand the pathology behind
UTI, what has already been changing and also how we can empower people to take an active role
in the prevention of these infections.
Catheter-Associated Urinary Tract Infections, or CAUTI, are extremely prevalent in
todays health care system. Urinary tract infections are responsible for more than 500,000 visits
to Canadian doctors every year (Potter and Perry, 2009, p. 1077). They are also one of the most
common hospital acquired infections today. According to Potter and Perry (2009), a urinary tract
infection exists when bacteria enters the urinary tract, ascends the urethra, and takes residence in
the urinary system (p. 1078). An educational brochure released from the University of
Washington states the signs and symptoms often include cloudy urine, malodourous urine,
burning on urination, fever, malaise, urinary frequency and urgency, nausea, headache, chills
and/or mild back pain. Not only can urinary tract infections cause uncomfortable signs and
symptoms but they can also lead to more serious consequences in severe cases and in certain
populations. UTIs can lead to prostatitis, epididymitis, and orchitis in males, and cystitis,
pyelonephritis, gram-negative bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis,
endophthalmitis, and meningitis in all patients (Centre for Disease Control and Prevention,
2015). A catheter associated UTI occurs with the use of a urinary catheter where bacteria can
more easily travel along the catheter and higher into the urinary system. According to Meddings,
Krein, and Fakih (2013) catheters are often used in health care systems in patients who are not
able to urinate on their own, to carefully monitor urine output, during and after some types of
surgeries, for diagnostics and sometimes to aide in the wound healing process. CAUTIs have
been granted increased attention in the last few years because of their high prevalence and their
highly preventable nature.

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM

According to a recent study at the National Centre for Biotechnology Information


(NCBI), catheter-associated urinary tract infection (CAUTI) had been relatively neglected in
clinical research until recently. However, external forces, such as mandated public reporting of
nosocomial infections and the climate of zero tolerance for hospital-acquired infections have
led to an increased interest in this infection (Trautner, 2010). Previously, indwelling catheters
were used more commonly than intermittent catheters and there were no specific, consistent and
enforced guidelines surrounding their use in the health care setting. There are vast amounts of
research and evidence arguing the pros versus the cons of indwelling catheters. In this research,
intermittent catheterization (rather than the use of indwelling catheters) is a commonly
recommended alternative; however, UTIs related to intermittent catheter use are still prevalent in
society and must be reduced in the same way as that of indwelling catheters. In order to reduce
illness and infection in those that are receiving intermittent catheterizations, attention must be
paid to why it is being performed and whether sterile or clean technique will be required.
Hygiene measures must be enforced to ensure the risk of a CAUTI will be minimized and the use
of the catheter itself must be regularly assessed to determine the patients need. The goal is that
with increased knowledge of best practice and improved patient education CAUTI will be vastly
reduced, even eliminated.
Education of both staff and patients in the health care system is crucial in order to
minimize the prevalence of CAUTI. Both must be aware of the best and most recent evidence
that will promote the health of the medical-surgical client whether in the hospital or in a home
setting. Education must be provided in order to ensure the learner has an understanding of the
pathology behind CAUTI. That is, that catheters impede most of the natural defenses of the
lower urinary tract by providing an artificial route for organisms to enter the bladder (Day,
Paul, Williams, Smeltzer, & Bare, 2010, p. 1497). Patients who are higher risk should be notified
in order to ensure they take extra precautions against CAUTI and UTI in general. According to
Day et al. (2010), these patients include women, older adults, patients who are debilitated,
malnourished, immunosuppressed, and those with diabetes (p. 1498). Health care professionals
must be made to use sterile technique when performing catheterizations in order to decrease
bacteria available to the perineal area and to the catheter upon insertion. This is especially
important in a health care setting where bacteria is numerous and accessible enough without
allowing for an extra point of entry in which to infect patients. A nurse must use aseptic

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM

technique to minimize the risk of cross-contamination; however, a patient [performing selfcatheterization] may use a clean, nonsterile, technique at home, where the risk of crosscontamination is reduced (Day et al., 2010, p. 1499). Staff and patients must also be aware of
other ways to decrease spread of microorganisms leading to UTIs. These include, but are not
limited to only using a catheter when required and to discontinue its use as soon as possible.
Always perform hand hygiene before and after catheterization. Always provide perineal care
before catheterization in order to minimize bacteria, primarily E. Coli, available at the urethral
orifice. Do not tug, pull, or twist the tubing as this may cause bacteria to travel further up the
catheter and into the urethra. A patient who will be performing self-catheterizations must be
taught the signs and symptoms of an infection and when to seek medical attention. Education is
such a crucial step in prevention as it enables people to take responsibility for their own health
and for others safety as well.
Urinary tract infections can have serious consequences for not only medical-surgical
patients but also those in a home-care setting. By remaining aware of the most recent research
and following best practice, everyone can play a part in reducing the prevalence of catheter
associated urinary tract infections.

CARE PLAN 1
PRIORITY NURSING
D IAGNOSIS

Risk of UTI related to intermittent catheterization.

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM
CLIENT GOAL
CLIENT -CENTRED
O UTCOME

IDENTIFY 3 NURSING
INTERVENTIONS

RATIONALE FOR
INTERVENTIONS

Patient will remain free of infection as evidenced by normal temperature, normal WB

Patient will not show signs of UTI (fever, increase in WBCs, or dysuria) during my 1
1) Clean

technique will be
performed during catheterization.

2) Encourage water

intake of 2000-

3) Encou

Clean technique will prevent


infection and control the spread of
bacteria.
(Potter and Perry, 2009, P. 649)

An increased fluid intake keeps


urine diluted and the flow of urine
high to prevent stasis and infection.
(Gulanick and Myers, 2011, P. 817)

urine wi
each day
glasses o
day.
Acidic u
of patho
juice yie
metaboli

3000 mL each day.

(Gulanick

EVALUATION

Monitor WBC count and


temperature, which will indicate
if an infection is present.

urineIncreased
pH. A pH that is
Monitor urineTest
output.
greater
than 6 is more
urine flow means
decreased
susceptible
stasis; therefore,
bacteriatoisinfection
being than a
flushed out. pH less than 6.

CARE PLAN 2
NURSING D IAGNOSIS

CLIENT G OAL

CLIENT -CENTRED
O UTCOME

IDENTIFY 3 NURSING
INTERVENTIONS

Readiness for enhanced knowledge related to self-catheterization as evidenced by pat


want to hurt or infect myself.
Patient will be knowledgeable about CAUTI.

By the end of two teaching sessions, patient will be able to state the required steps to
catheterization.
1) Educate

patient on the need for


good perineal care and hand
hygiene before and after
catheterization.

2) Teach

patient the structure of the


urinary tract and required
positioning for correct insertion.

3) Teach

every thr

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM

RATIONALE FOR
INTERVENTIONS

EVALUATION

Perineal and hand hygiene will


decrease the number of
microorganisms around the urethra
and help to maintain skin integrity.
(Potter and Perry, 2009, P. 1098)
Patient will demonstrate
proper hand hygiene on self
and pericare on a mannequin.

The patient must be able to


physically manipulate equipment
and assume a position for
catheterization in which the urethra
is straight and easily accessible.
(Potter and Perry, 2009, P. 1114)

Catheter
decrease
bladder w
decrease

(Gulanick

Patient will tell the


nursewill repeat back to
Patient
which position they
the must
nurse how often she
catheterize in in order
toself-catheterizing.
will be
safely insert the catheter
into their own urethra.

CARE PLAN 3
NURSING D IAGNOSIS
CLIENT G OAL

CLIENT -CENTRED
O UTCOME

IDENTIFY 3 NURSING
INTERVENTIONS

RATIONALE FOR
INTERVENTIONS

Risk of injury related to self-catheterization as evidenced by lack of sensation below L


spinal cord injury.
Client will be knowledgeable on safe self-catheterization.

Client will demonstrate safe self-catheterization after two teaching sessions.


1) Educate

patient on the need for


good perineal care and hand
hygiene before and after
catheterization.

2) Teach

patient the structure of the


urinary tract and required
positioning for correct insertion.

3) Provid

Perineal and hand hygiene will


decrease the number of
microorganisms around the urethra
and help to maintain skin integrity.
(Potter and Perry, 2009, P. 1098)

The patient must be able to


physically manipulate equipment
and assume a position for
catheterization in which the urethra
is straight and easily accessible.
(Potter and Perry, 2009, P. 1114)

This wil
visualiza
as a diffe
Videos a
desirable
they acc
of the ac
(Potter a

a same s
self-cath

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM

Patient will demonstrate


proper hand hygiene on self
and pericare on a mannequin.

EVALUATION

Patient will Patient


tell the will
nurse
teach/demonstrate
to the
which position
they must
nurse
how to properly selfcatheterize in
in order
in a safe manner.
safely insertcatheterize
the catheter
into their own urethra.

References
Centre for Disease Control and Prevention. January 2015. Retrieved from:
http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf
Centre for Disease Control and Prevention. FAQs about Catheter-Associated Urinary Tract
Infections. Retrieved from: http://www.cdc.gov/hai/pdfs/uti/CA-UTI_tagged-BW.pdf
Fakih, M. G., Watson, S. R., Greene, M. T., Kennedy, E. H., Olmsted, R. N., Krein, S. L., &
Saint, S. (2012). Reducing Inappropriate Urinary Catheter Use: A Statewide
Effort. Archives of Internal Medicine, 172(3), 255260. Retrieved from:
http://doi.org/10.1001/archinternmed.2011.627
Gulanick, M., & Myers, J. L. (2011) Nursing care plans, diagnoses, interventions, and outcomes
(7th ed.). St. Louis, MI: Mosby Elsevier.
Meddings J, Krein SL, Fakih MG, et al. Reducing Unnecessary Urinary Catheter Use and Other
Strategies To Prevent Catheter-Associated Urinary Tract Infections: Brief Update
Review. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence
for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and
Quality (US); 2013 Mar. (Evidence Reports/Technology Assessments, No. 211.)
Chapter

9. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK133354/

Potter, P. A., & Perry, A. G. (2009) Canadian fundamentals of nursing (4th ed.). Toronto, ON:
Mosby Elsevier

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PREVENTION
OF CAUTI IN THE HEALTH CARE SYSTEM

Trautner, B. W. (2010). Management of Catheter-Associated Urinary Tract Infection


(CAUTI). Current Opinion in Infectious Diseases, 23(1), 7682. Retrieved from:
http://doi.org/10.1097/QCO.0b013e328334dda8
University of Washington. Northwest Regional Spinal Cord Injury System. Intermittent
Catheterizations

Pamphlet. Retrieved from: http://sci.washington.edu/info/

pamphlets/uti_1.asp