hhc - foley -cauti education 2015.pptx

8/16/2019 HHC - Foley -CAUTI Education 2015.pptx

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Catheter AssociatedUrinary Tract Infections

(CAUTIs) & Urethral

Catheterizations


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Outline

• Introduction

• Insertion

• Maintenance/Sampling

• Removal

• Orders and Documentation


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Introduction

Catheter AssociatedUrinary Tract

Infections (CAUTIs) &Urethral

Catheterizations


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Catheter-Associated Urinary Tract InfecCAUTI

A urinary tract infection (UTI) will be dened as an infection in part of the urinary system, including urethra, bladder, ureters,

Here are some important facts and statistics relating to UTIs

• UTI’s are the most common type of healthcareassociated in

• !"# of hospital ac$uired UTIs are associated %ith a urinary c

• &'&(# of patients receive urinary catheters during their ho

•)rolonged use of a urinary catheter is the the most importanfor developing a +,UTI

atheters should only be used for appropriate indications andremoved as soon as they are no longer needed


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Why all the fuss about the CAUTIs /fo

• +,UTIs are reporta-le to +MS• +,UTIs are tied to reim-ursement

– .inancial penalties are -ased upon• High infection rates

• Inaccurate documentation of !oley "evice "ays – 0-ased o1 of R2 documentation3

• )u-lic perception – )u-licly reported

• +ommercial Insurers

– 45 ,etna/,nthem as* for this data


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!atient safety

•

6e %ant to avoid giving our )atients a H,I/H,+0Hospital ,c$uired Infection/ +ondition3• +,UTI’s increase #ength of $tay 07OS3

– 4stimated 8' additional days for a +,UTI

• +ostly

– ,verage to treat a +,UTI is 9:;( / infection

It is a goal on %%&s balanced scorecard to decrease AUTI rates


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"artford "ealthcare: Current state a"artford "os#ital

•HH has -een performing +-$. T%A/ .01.T." fo+,UTIs<

• HH reports =&"'8# higher .oley Device Days than units nationally<

• +,UTI Rates at HH are %ell a-ove those reported frounits nationally


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HHC CAUTI Analysis by Facility

Calendar Years 2013 - 2014Confidential and Proprietary Information


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$A% 'oley insertion a# analysis

• HH – Only in * insertions +ere co,#leted ase#tically

• +ommon areas noted for improvement

– 7ac* of )eri+are prior to insertion

– 2ot maintaining a sterile >eld

• ?aps in drapes• Turning -ac* to patient

• Use of dirty glove to manipulate catheter prior to inse

• Trash -eing thro%n in sterile >eld


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Insertion



Catheterizations


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Instructional ideo

)rior to continuing in this learning module@ pleasevie% the AardB ,dvance .oley +atheter Selection@Insertion@ +are@ and Maintenance

in your online learning system 0separate module3< The video %ill provide a detailed revie% of .oley

+atheter Insertion

Once video portion completed@ please return here tocomplete the remainder of this learning module


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Indications for catheterization

In '88;@ the +D+ recommended a list of appropriate andinappropriate indications for urinary catheter placement -ased oncritical revie% of literature<

A##ro#riate Indications

&< +ritically ill / unsta-le re$uiring strict ICOs'< Urologic/gyn/perineal/ lo% rectal surgery< Eidney transplantF< 7um-ar/lo% thoracic epidural"< Urinary retention / neurogenic -ladder

(< ?ross Hematuria!< +hronic ind%elling catheter:< +omfort care / hospice;< Orthopedic fracture prior to sta-iliGation or planned return to OR&8< Incontinent patient %ith stage or F perineal / sacral %ound&&< )rolonged immo-iliGation&'< 4nrolled in clinical trial necessitating strict ICO monitoring

http://!c"rr


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Ina##ro#riate indications

Ina##ro#riate Indications

&< Urine output monitoring outside the I+U for noncriticalpatients

'< Incontinence %ithout a sacral or perineal pressure sore

< )rolonged postoperative use

F< Mor-id o-esity or immo-ility

"< +onfusion or dementia

(< )atient re$uest

!< .re$uent urination


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Contraindications

The only absolute contraindication to urethral catheteri2ation is a consuspected urethral in3ury

' These are rare inuries' Most commonly associated %ith a pelvic

fracture' Alood at meatus or gross hematuria may -e

%arning signs of urethral inury

If any .uestion of urethral inury0do not #lace catheter1

Rectal e5am -y an MD and retrogradeurethrography should -e considered


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Indications for uroloy consultation:

The urethra cannot -e entered due to severeparaphimosis (the glans develops venous andlymphatic congestion and then cannot be returned toit&s normal position) or meatal stenosis 0narrowingor stenosis of the opening of the urethra3<

The patient has an arti>cial urinary sphincter

The patient has had recent urethral@ prostate@or -ladder surgery

The patient has documented history of dicultanatomy re$uiring urology catheter placement

There is resistance during passage of thecatheter

The catheter *in*s in the urethra and -loodydischarge is noted@ urethral perforation may

have occurred< 6ithdra% catheter< 2o furtherattempt should -e made<


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Alternaties to ind+ellin urinary cathet

Hourly rounding %ith proactive toileting

45ternal condom catheter or urinary pouch

$ladder scanner: con>rm urinary retention -efore placing catheteJshould not -e performed on a patient %ith ascites scanner cannot di1erentiate the

Straight catheter for onetime@ intermittent@ or chronic voiding need-esearch has shown that having a constant direct route allowing bacteria to enter ttract, such as with a indwelling catheter, has a much higher risk for UTI than intermicatheteri2ation< ,ssociation for )rofessionals in Infection C 4pidemiology 0'88:3

Aedside commode@ urinal and disposa-le underpads

S*in -arrier spray/cream for protection


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Catheter insertion best #ractices:

• +leaning periurethral area prior to start of procedure

+astile soap %ipes are included in Aard Eits

,s Supported -y – +D+ HI+),+ +,UTI ?uidelines@ '88;

– The Loint +ommission +linical +are Improvement ?uideline for +,UTIs@ '

• )erform hand hygiene immediately before and after insertion

• Insert urinary catheters using aseptic techni4ue and sterile e4uipm


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Choose the #ro#er size and ty#e of cathe

A 16 F catheter should be us

initially unless the provider oindicates a larger size


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Coud2 catheter

'or a coud20 insert the catheter+ith the ti# facin u#3

+onsider using coud catheter

' Male patients N ("yrs' History of A)H' Dicult catheteriGations


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4ale #atient catheterization 5ey #oints:

•

Retract fores*in@ pull penis using light traction – Maintain taut and perpendicular during insertion

• 7u-ricate catheter generously prior to insertion

– MD order needed if using 7idocaine elly

• Hold catheter close to meatus

– ,-out an & inch from the tip

– Inserting slo%ly@ one inch at a time• Reduce fores*in 0if applica-le3 to avoid paraphimosis

(


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!ro#er #osition facilitates catheterizatio

Ay holding penis taut and perpendicular@ the urethris straightened thus minimiGing it’s S shape curve<

Sshaped curve


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6ey #oints to re,e,ber

7eer in8ate balloon unless there is a #ositie urine return

•

In males – Insert catheter to the -ifurcation

– To ensure the -alloon is securely %ithin the -ladder

• In females

– ,dvance the catheter another ' inches after urine is returned

If the patient complains of any pain during inKation of -alloon@

9TO!111DeKate -alloon completely and advance the catheter -efore reattempting to

inKate -alloon<


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If on insertion@ there is no urine return@

do not in5ate balloon

The catheter may -e o-structed -ylu-ricating elly@ attempt aspiratingthrough sample port or gently palpatethe -ladder area

!ree return of urine helps to conrmthat the catheter is properly positioned

6ey #oints to re,e,ber


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!retestin balloon in8ation is not reco,

Research has sho%n that creases orridgesP remain after deKation %hen the-alloon %as preinKated< This can causeirritation to the urethra during insertionand an increase chance of UTI<

HH+ uses A,RD M4DI+,7 catheters

These should not be pre-infated


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7eer force the catheter throuh theurethra

• If there is resistance during catheter insertion

– Have the patient ta*e slo%@ deep -reaths to promote rela5atio

the catheter is inserted slo%ly

• If resistance persists

– The patient may have enlarged prostate or urinary a-normalit

– +onsider a coud catheter<

• If resistance persists@ preventing catheter insertion – Stop the insertion and notify the MD or 7I) 0licensed independe

practitioners3<


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!ost insertion

• In8ation of $alloon:

• .ollo% manufacturer’s instructions

– a " ml -alloon re$uires &8 ml of Kuidfor symmetrical inKation

• Use sterile %ater only

– 2ormal saline can lead to crystalformation causing diculty %ithdeKation

• ocu,entation:

• )lease enter the color and amount ofurine drained upon initial insertion in thepatients MR

*#l ball""n in%lated ith 10#l "% %l+

*#l ball""n in%lated ith * #l "% %l+id


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4aintenance and 9a,#lin



Catheterizations


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4aintenance of urinary catheters

$est #ractices include:

• MinimiGe manipulation of system

– Use a >5ation device to secure the catheter0Stat loc* or leg strap3 according tomanufacturers recommendation andconsidering patient’s lo%er e5tremities ROM0range of motion3

)lease revie% a -rief video on ST,T loc* application -yclic*ing on the lin* -elo% and scrolling to video inservicehttp//%%%


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• Maintain uno-structed Ko% and dependent drainage

– Eeep -ag -elo% the level of -ladder at all times

• .ocus during transport 0do not place on -ed3 – Hang drainage -ag at the foot of the -ed

• Eeep a continuous Do%nhillP Ko% of urine

• ,voiding looping the tu-ing

• ,void resting -ag on the dirty Koor

• Use green clipP to position the tu-ing


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Maintain closed system of drainage

• Use preconnected catheters

– ,void using separately pac*aged items• Don’t -rea* the R4D sealQ

If -rea*s in aseptic techni$ue@ disconnection@ or lea*age occur@ replace the

catheter and collecting system using aseptic techni$ue and sterile e$uipment<,ssn< for )rofessionals in Infection C 4pidem< 0'8&F3

• ,void irrigationQ

– If necessary@ use aseptic techni$ue


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– Daily and )R2 pericare 0including after a Ao%elmovement3

•Use patient premoistened -ath %ipes

• Distinct C separate from the daily -ath<

• 6ipe front to -ac* -eginning at the insertion sitemoving do%n the catheter<

– )revent contamination of drainage spout

• Drainage -ag emptied at least once each shift

• Use a container designated or that patientonly.


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Ase#tic s#eci,en collection

• Do not use hats/-ed pans to collect specimens

• Disinfect the sampling port %ith an alcohol %ipescru-’ prior to collection or remove +uros cap

• +ollect %ith the approved collection device<

• )lace urine sample in the sterile and la-eledcontainer Transport specimens to the la- ,S,)Q

– 4nsure specimen is received in the la- %ithin one

hour of collection or sooner<

+ i Q


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+oming soonQ

• 2e% sampling *its are -eing ordered and %ill -eavaila-le through the storeroom

•7uer loc* 0attaches to catheter collection port3vacutainer collection device

• Includes a yello%/red spec*led top tu-e0contains preservative3 for U, %ith reKe5 toculture

• ?rey top tu-e 0contains a preservative3 forcultures

• , specimen cup %ill also -e availa-le it has avacutainer top that is sealed@ once the seal isremoved it can -e accessed aseptically tominimiGe contamination for those patients %hocan void into the cup< It is a needle in the top so

do not put your >ngers in as it is a signi>cant

Ch i ' l C h C id i


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Chronic 'oley Catheters Considerations

• Do not change on a routine -asis

• +hange only %hen indicated such as – Suspected UTI – Mechanical pro-lems 0lea*ing or o-struction3

• If concerned for possi-le UTI –

+hange catheter prior to sending urine specimen – Send the specimen from the ne% catheter


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%e,oal



Catheterizations

! t th t l


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!ro,#t catheter re,oal

The best way to prevent complications is

to avoid catheterization whenever possible

• If catheteriGation is necessary@

– igilant assessment for continued needshould -e performed on a daily basis and

documented – Removal of catheter should -e done as

early as clinically possi-le<


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Orders and ocu,entation



Catheterizations

'oley re,oal


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'oley re,oal%7 rien !rotocol

• )roviders need to identify patients appropriate for catheter remov• 2urses %ill evaluate C document daily

– If meets clinical criteria to maintain .oley catheter

• .ollo% the post removal instructions as indicated in the orders• ,fter .oley catheter removal

– If patient is una-le to void perform -ladder scan %ithin ( hour

For patients that no longer meetclinical criteria the nurse may

discontinue the Foley

And lastly


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And lastly;#ro#er docu,entation

• MD order is re$uired for the placement of routine orspecialty catheters 0coud@ %ay@ temp3

• MD order re$uired for use of 7idocaine elly

• Documentation recorded -y R2 should include

– Date/Time of insertion

– Reason for insertion 0appropriate indication3

– SiGe and type of catheter

– +haracteristics of urine Urine color/clarity and initialvolume %hen placed odor if present

– Ho% patient tolerated the procedure

– ,ny complications %ith insertion

ocu,entation dries data


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ocu,entation dries data

• .or trac*ing +,UTIs – 6e need accurate !oley "evice "ays to

calculate our rates

• Missing data

– +an arti>cially inKate our infection rates

• 4lectronic reports

– ?enerated from R2 documentation

6ee#in our #atients safe


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6ee#in our #atients safe

• 6e can

– Insert for appropriate indications

–Insert aseptically

– /ever force in a catheter

– 4nsure daily care is performed

– Eeep the drainage -ag -elo% the -ladder

– "ocument a daily needs assessment

– Use the /urse "riven 1rotocol 0if your facility has one3

– .ollo% proper collection of urine specimens

Remove catheters as soon as clinically possible!

What


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What s ne=t;3Co,#letin the co,#etency alidation

•

This healthstream module and A,RD video completion ful>lls one of the prelearning re$uirements +O2?R,TU7,TIO2SQQQ

)lease complete the follo%ing ne5t steps

• +omplete the short test attached to this program

• )rint out certi>cates of completion for both programs 0Aard In

ideo and this program3• +omplete the HandsonP +ompetency alidation session dat

-egin in May '8&"@ stay tunedQ

hhc - foley -cauti education 2015.pptx

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