CAUTIs and hand hygiene in aged care

To see out our focus on hand hygiene this month, we thought it might be helpful to look at how hand hygiene compliance can improve rates of catheter-associated urinary tract infections (CAUTIs) in our care facilities. 

Urinary catheters are useful devices with a long history. There are accounts of them being used medically since 3,000 BC, and while they have earnt their place, catheters remain a leading cause of hospital-acquired infections (HAI) worldwide. CAUTIs can occur by bacteria entering the body via an indwelling catheter device and through the disruption of normal urinary flow and function, resulting in a build-up of bacteria at the balloon site.

Urinary tract infections are the most common source of bloodstream infections in older adults, increasing the need for hospital-level care, resulting in reduced quality of life and an increased risk of injury and morbidity.

Hand Hygiene and CAUTIs

Hand hygiene compliance rates are reported as having a direct impact on the development of CAUTIs with the CDC estimating up to 69% of catheter-associated urinary tract infections may be preventable with infection prevention and control measures such as hand hygiene and aseptic technique.

Unclean hands are a well understood source of infection and while it is not difficult to understand how CAUTIs occur, the literature suggests that hand hygiene and infection control methods are often overlooked during routine care of indwelling devices.

Reducing CAUTIs supports other key IPC initiatives such as the reduction of HAIs and the development and transmission of MROs (multi–drug resistant organisms).

Urinary catheters should only be used when medically indicated, maintained with strict infection control measures and removed as soon as no longer clinically required. Early removal is strongly advocated for. Catheterisation is an aseptic procedure and only provided by health professionals who are trained to undertake the procedure.  

“Guidelines for the prevention of CAUTI recommend appropriate catheter use, aseptic insertion, use of closed drainage systems, proper maintenance and timely removal of indwelling urinary catheters, as well as the use of established practices such as hand hygiene.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387977/

Simple ways to reduce the risk of CAUTI

  • Ensure catheterisation is clinically indicated.
  • Ensure hand hygiene is performed before and after all catheter management and bag drainage actions.
  • Keep the drainage bag off the floor and ensure it is never raised higher than the bladder, to avoid reflux of contents back up the catheter.  
  • Empty the drainage bag before or once it is 2/3–3/4 full.
  • Ensure leg bags are changed every 7 days, when contaminated or when disconnected from catheter. Overnight bags are to be changed daily.
  • Catheter bags are single-use items and should not be reused.
  • Urinary catheters are to be changed in strict accordance with manufacturer’s instructions and policy.
  • Ensure the peri-urethral area is clean and dry, particularly after episodes of faecal incontinence.
  • Clean the meatus (area of entry) with soap and water once daily, during routine showering or bathing.
  • The early removal of catheters is highlighted as key to reducing infection.

This Five Moments of Hand Hygiene Poster outlines the recommended hand hygiene points for urinary catheter care.

Urinary catheter education and care are an IPC priority and require Standard Precautions at all times. While we cannot fix the risks inherent with indwelling devices, by being aware of those risks we can encourage ourselves and others to be more diligent in their hand hygiene.

Here at Bug Control, we cover urinary catheter care within our IPC Policy and Procedures Manual, which is available in print or as a digital platform that is regularly updated. Find out how you can improve your facility's processes with Bug Control's IPC Manual today.

References

https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf

https://www.who.int/gpsc/5may/hh-urinary-catheter_poster.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387977/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700699/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871665/

https://www.sciencedirect.com/science/article/pii/S2221169116309509

https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/lam.13144

https://www.urotoday.com/urinary-catheters-home/history-of-urinary-catheters.html

Recommended Reading

https://www.cec.health.nsw.gov.au/keep-patients-safe/infection-prevention-and-control/cauti-prevention/catheter-insertion

https://www.healthnavigator.org.nz/health-a-z/u/urinary-catheters/