Another hot-topic issue in hospitals is Catheter Acquired Urinary Tract Infections (CAUTI). This post seeks to analyze existing materials and further understand how to address CAUTI’s.
Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals – Lo et al.
EXTRACT
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.
1. Burden of CAUTIs
a. Urinary tract infection is the most common hospital-acquired infection; 80% of these infections are attributable to an indwelling urethral catheter.
b. Twelve to sixteen percent of hospital inpatients will have a urinary catheter at some time during their hospital stay.
c. The daily risk of acquisition of urinary infection varies from 3% to 7% when an indwelling urethral catheter remains in situ.
2. Outcomes associated with CAUTI
a. Urinary tract infection is the most important adverse outcome of urinary catheter use. Bacteremia and sepsis may occur in a small proportion of infected patients.
b. Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means that the cumulative burden of CAUTI is substantial.
c. Catheter use is also associated with negative outcomes other than infection, including nonbacterial urethral inflammation, urethral strictures, and mechanical trauma.
Summary
The article “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals” shares guidelines to reduce catheter-associated urinary tract infections (CAUTIs) in hospital settings and classifies interventions for both standards of care and uncontrolled CAUTI (Lo et al., 2015). The recommendations are categorized into existing best practices, and risk specific approaches for situations when infections are not controlled by standard practices.
Basic Practices Recommended for All Acute Care Hospitals:
- Avoid Unnecessary Catheterization: Limit the use of indwelling urinary catheters to essential medical indications, such as acute urinary retention or accurate urine output monitoring in critically ill patients.
- Prompt Catheter Removal: Implement protocols to ensure timely removal of catheters when they are no longer needed, reducing the duration of catheterization.
- Aseptic Insertion Techniques: Use aseptic techniques and sterile equipment during catheter insertion to minimize the risk of introducing pathogens.
- Proper Catheter Maintenance: Maintain unobstructed urine flow by keeping the catheter and drainage system free from kinks and ensuring the collection bag is positioned below the level of the bladder.
- Staff Education: Educate healthcare personnel involved in catheter insertion and maintenance about proper techniques and infection prevention strategies.
Special Approaches for Hospitals with Uncontrolled CAUTI Rates:
- Use of Antimicrobial/Antiseptic-Impregnated Catheters: Consider using catheters coated with antimicrobial or antiseptic agents in units with persistently high CAUTI rates despite adherence to basic prevention strategies.
Use of Antimicrobial/Antiseptic-Impregnated Catheters: Consider using catheters coated with antimicrobial or antiseptic agents in units with persistently high CAUTI rates despite adherence to basic prevention strategies.
- Bladder Ultrasound: Utilize portable ultrasound devices to assess urine volume and reduce unnecessary catheterizations.
- Alternative Catheterization Methods: Employ alternatives to indwelling catheters, such as intermittent catheterization, when appropriate.
- Surveillance and Feedback: Conduct regular surveillance of CAUTI rates and provide feedback to healthcare staff to promote adherence to prevention protocols.
- Patient and Family Engagement: Involve patients and their families in CAUTI prevention efforts by educating them about catheter care and encouraging them to speak up about catheter removal when it’s no longer necessary.
(Lo et al., 2015 via Open AI, 2025)
This article is straight forward and valuable in defining CAUTI, interventions, and accompanying issues. However, there is no direct mention of cleaning the exposed tubing, nor does it mention the necessary frequency of hygiene. Other considerations are the policies that state who is allowed to empty the in-dwelling catheters related to urine output measurement. Potential contingent interventions could be affected.
Guidelines for Prevention of Hospital-Acquired Infections – Mehta et al.
In Guidelines for Prevention of Hospital-Acquired Infections, Mehta et al. (2014) discuss general infection prevention standards of care:
- Hand Hygiene: Regular and thorough handwashing with alcohol-based hand rubs or soap and water is crucial to preventing HAIs.
- Environmental Hygiene: Regular cleaning and disinfection of hospital surfaces reduce the risk of cross-contamination.
- Surveillance Programs: Implementing active surveillance for HAIs helps in early detection and prevention.
- Standard Precautions: Use of personal protective equipment (PPE) and safe injection practices minimizes infection risks.
- Catheter Care: Proper maintenance and timely removal of urinary catheters reduce the incidence of CAUTIs.
- Ventilator Care: Adhering to ventilator care bundles helps reduce VAP.
- Antimicrobial Stewardship: Judicious use of antibiotics to prevent resistance and reduce infections.
- Staff Training and Education: Regular training programs on infection prevention protocols.
- Patient and Family Engagement: Educating patients and families about infection control practices.
- Monitoring and Feedback: Continuous monitoring of infection rates and providing feedback to healthcare workers.
(Mehta et al., 2014 via Open AI, 2025)
This article is useful for all infections. It also highlights the complexity of infection prevention. Particularly, while a focused set of rules can address direct infection causes, system level rules and interventions can prevent pertinent root causations. For example, resistant bacteria related to the misuse or overuse of antibiotics, or decreased constitution related to immunocompromised illnesses.
DISCUSSION
Determining the most appropriate interventions for an issue is a complex undertaking. CAUTI’s specifically have a long list of factors that directly contribute to infections. Existing standards of care alone may be sufficient in some situations. However, it is important to understand the context.
Was there an upward trend in CAUTI, or are we observing continuous improvement modalities to analyze previous infections? What does the Root Cause Analysis (RCA) show? What did the medication review show? What co-morbidities did the patient have? Was blood sugar under control? Where there pre-existing infections? Was the insertion done correctly? Was the tube always patent? Was there unecessary manipulation of the tube? If the analysis was based on a trend:
- Is there a common factor?
The analysis itself could be very in-depth.
As nurses, we abide by the principle of non-maleficence. CAUTI’s fall in that category. Ultimately, addressing these preventable events is valuable work and can affect the lives of so many.
References
Lo, E., Nicolle, L., Classen, D., Arias, K. M., Podgorny, K., Anderson, D. J., Burstin, H., Calfee, D. P., Coffin, S. E., Dubberke, E. R., Fraser, V., Gerding, D. N., Griffin, F. A., Gross, P., Kaye, K. S., Klompas, M., Marschall, J., Mermel, L. A., Pegues, D. A., … & Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5), 464–479. https://doi.org/10.1086/675718
Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V., Bhattacharya, P. K., & Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian Journal of Critical Care Medicine, 18(3), 149–163. https://doi.org/10.4103/0972-5229.128705
OpenAI. (2025). ChatGPT (March 15 Version) [Large language model]. Retrieved from https://chat.openai.com/