CAUTI InformationWhat is CAUTI?CAUTI is an infection of the urinary tract caused by a tube (urinary catheter) that has been placed to drain urine from the bladder. The urinary tract consists of the kidneys, ureters (tubes joining the kidneys to the bladder), bladder, and urethra (tube leading from the bladder to the outside of the body). Show
Urinary catheters are used to drain urine in patients who are not able to urinate on their own, to measure the amount of urine produced during intensive care, or during and after surgery or tests of the kidneys and bladder. Germs can travel along the urinary catheter and cause an infection in your bladder or your kidney; this type of infection is called a catheter-associated urinary tract infection (or "CAUTI"). The definition of CAUTI falls into two groups:
CAUTI includes those infections in which a patient had an indwelling urinary catheter at the time or within 48 hours before onset of the event. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated. CAUTI is the most common type of HAI and causes 1of 3 HAIs in patients in hospitals. Among urinary tract infections acquired in the hospital, approximately 75% area associated with a urinary catheter. There are an estimated 13,000 annual death attributed to CAUTI. CAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible. Core Prevention Strategies:
Resources:
Guidelines for CAUTI prevention:
ContentsExecutive Summary Executive SummaryInfections that develop in health care settings are known as healthcare-associated infections (HAIs). HAIs are especially significant in long-term care (LTC) settings, and have been estimated to account for 1.6 to 3.8 million infections and 388,000 deaths annually.1 Additionally, infections have very high costs to LTC facilities: $38 to $137 million annually for antimicrobial therapy and $673 million to $2 billion for hospitalizations.2 Catheter-associated urinary tract infection (CAUTI) is a common, costly, and potentially life-threatening HAI for LTC residents. An estimated 7 to 10 percent3 of all LTC residents have urinary catheters, including 12 percent4 of all new admissions at the time of transfer from acute care facilities to LTC facilities. Research suggests CAUTIs are highly preventable and that perhaps as many as 50 to 70 percent of these episodes can be prevented.5,6 Moreover, failures in infection control was the most common type of deficiency cited in LTC surveys in 2014, demonstrating a need for greater focus on preventing CAUTIs and other HAIs.7 The AHRQ Safety Program for Long-Term Care: HAIs/CAUTI was developed and refined over a 3-year period through a national quality improvement collaborative designed to reduce CAUTIs and enhance LTC resident safety culture. Through the adaptation of evidence-based practices including the Comprehensive Unit-Based Safety Program (CUSP), tools and resources were developed to eliminate HAIs/CAUTI and enhance safety practices in the LTC setting. This guide provides information, tools, and resources, including educational bundles, to support LTC facilities that are interested in developing a quality improvement program to reduce CAUTIs and other HAIs, and to improve the resident safety culture. This program was funded by the Agency for Healthcare Research and Quality (AHRQ), and was part of the U.S. Department of Health & Human Services (HHS) National Action Plan to Prevent Healthcare-Associated Infections.8 Return to Contents OverviewThe purpose of this guide and the appended tools is to provide long-term care (LTC) facilities with an approach to implement elements of the AHRQ Safety Program for Long-Term Care: HAIs/CAUTI—reducing catheter-associated urinary tract infections (CAUTIs) and other healthcare-associated infections (HAIs). To achieve CAUTI reduction and sustain these improvements, a strategy to address both culture and clinical practice in your LTC setting is necessary. Culture consists of the team's values, attitudes, and beliefs, which all have an impact on the team's ability to improve clinical practice. The Comprehensive Unit-Based Safety Program (CUSP) is a change model designed to improve resident safety in the LTC setting by providing educational videos, tools, and resources to understand the science of safety and integrate evidence-based practices into daily care. CUSP draws on the wisdom of frontline providers who have practical knowledge regarding resident safety risks and provides a mechanism to analyze and reduce the risks of those hazards. This guide also presents strategies to eliminate the primary risk factor for CAUTI—unnecessary use of indwelling urinary catheters. Many of these catheters are placed without indications. The guide's section on clinical indications contains the appropriate and inappropriate indications for catheter placement as well as alternatives to indwelling urinary catheter use. The guide also includes strategies for encouraging removal of catheters and for fostering appropriate insertion and maintenance of catheters. Other critical factors for reducing CAUTIs include appropriate use of urine cultures and non-treatment of asymptomatic bacteriuria. These evidenced-based practices are addressed in this guide to the extent that they directly relate to CAUTI prevention and surveillance efforts. This guide also presents steps a LTC facility can take to evaluate the effectiveness of a CAUTI reduction strategy, and finally, strategies for sustaining and spreading improvements. Return to Contents How To Use This GuideThis guide highlights the main program elements and necessary steps to plan for and implement a quality improvement program—focused on reducing CAUTI and other HAIs and improving safety culture. We recommend that in order to achieve successful implementation, your plan should be inclusive of both clinical and cultural interventions. This guide provides educational bundles, tools, and resources to integrate these elements into your quality improvement plan. Each section of this guide is further described:
Return to Contents Program ElementsEvidence-based clinical practices and strategies to enhance infection prevention skills and improve the use of—and care for—catheters in the LTC setting provide facilities with tools and resources to improve outcomes (e.g., reduce the number of CAUTIs and other HAIs). The culture change model for this program is CUSP. This model has been used successfully by physicians, nurses, frontline team members, and support team members who were committed to working together to improve resident safety, clinical outcomes, and safety culture in the LTC environment. The CUSP principles include: understanding the science of safety, assembling the team, engaging senior leadership, identifying defects, and implementing teamwork and communication. CUSP provides strategies to help team members create a culture of safety that supports the implementation and success of quality improvement programs. Return to Contents Long-Term Care Safety Toolkit ModulesThe CUSP model was adapted for this program to help LTC facilities improve resident safety, clinical outcomes, and safety culture. The Comprehensive Long-Term Care Safety Toolkit Modules are designed specifically to help leaders and staff apply CUSP principles in the LTC environment. The Long-Term Care Safety Toolkit Modules emphasize the importance of a diverse team, focuses on the input of frontline staff, discusses the importance of a common goal, identifies issues that the team can successfully solve, and integrates these elements as part of the team's routine work. The modules are available on the AHRQ Web site and include training tools to make care safer by improving the foundation of how physicians, nurses, and other frontline staff work together. They build the capacity to address safety issues by combining clinical best practices and the science of safety. The Long-Term Care Safety Toolkit Modules are modular and modifiable to meet individual LTC facility needs. The Long-Term Care Safety Toolkit Modules are—
Return to Contents T.E.A.M.S. InterventionThe T.E.A.M.S. mnemonic, available as an infographic, provides specific cultural interventions that promote a culture of safety. This tool provides a visual guide for the key elements in the Long-Term Care Safety Toolkit Modules and is designed to assist you in developing skills and strategies to improve all aspects of resident safety, not just infection prevention.
Guidance on elements of the T.E.A.M.S. mnemonic can be found in the remainder of the guide and is included in the Long-Term Care Safety Toolkit Modules. Return to Contents C.A.U.T.I. InterventionThe C.A.U.T.I. mnemonic, available as an infographic, provides evidence-based clinical interventions to reduce CAUTI. This infographic provides a visual reminder for caregivers in LTC settings to focus on how to reduce unnecessary catheter use and improve care of residents who have a catheter in place.
Guidance on elements of the C.A.U.T.I. mnemonic can be found in the remainder of the guide and is included in the Long-Term Care Safety Toolkit Modules. Return to Contents PlanLong-term care facilities may have a variety of reasons to implement quality improvement programs. Transparency of care has increased to consumers of health care as well as to other health care organizations over time. The Centers for Medicare & Medicaid Services is now enforcing how LTC facilities establish and maintain quality assurance and performance improvement processes in an effort to sustain quality care and improve resident safety for nursing home residents.9 However, before an LTC facility team can begin implementing clinical interventions, it is important to determine if the facility is ready to take actions that lead to measureable improvements in preventing CAUTIs and other HAIs, and improving safety culture. To achieve results and improve the quality of care, a LTC facility needs to understand what resources are available, what processes and policies are currently in place, how care is currently provided, and how these elements impact CAUTI and other HAI rates, and safety culture. More importantly, research has identified six critical success factors for successfully improving health care in organizations that are important to consider as an LTC facility initiates the planning process:10,11
The Long-Term Care Safety Toolkit Modules include training materials to implement a successful program, and the following guidance provides recommendations to ensure that the success factors for improving and sustaining an HAIs/CAUTI reduction program are established. Utilize the Facility Action Plan to document your ideas and what steps to take to achieve your goals. Return to Contents Identify Improvement OpportunitiesBefore beginning the implementation of an intervention, leadership and staff should reflect on what they want the LTC facility to improve and how to accomplish the work. One way to determine improvement opportunities is to complete the Staff Safety Assessment found in Module 2 of the Long-Term Care Safety Toolkit Modules, with frontline staff. To reduce CAUTIs and other HAIs and improve patient safety, it is critical to follow clinical guidelines. Once a facility identifies the gaps in care, then it can identify evidence-based practices to implement into care. The first task is to focus on one improvement area. A few questions to reflect on as a team include—
Return to Contents Engage the TeamImproving resident safety by reducing CAUTIs and other HAIs, and improving the culture of safety, are team efforts. Leaders, clinicians, frontline staff, and residents and families should be included in the process in order to sustain the improvement made. Utilize the
Team Roster in Appendix A to develop your team. Return to Contents Leadership Buy-In A key component to implementing interventions that improve resident safety is leadership. Prior to implementing clinical and cultural interventions to improve resident safety, leaders need to be committed to the goals of reducing HAIs and improving safety culture. Leaders can demonstrate this commitment by ensuring facility staff have the time and resources to achieve the goals. Module 2: Senior Leadership Engagement in the Long-Term Care Safety Modules provides tools and resources that further explain the role and responsibilities of senior leaders in addressing an LTC facility’s safety goals. Return to Contents Core Team Members It is recommended that a facility select a core team of individuals to implement improvement opportunities to meet a facility's goal. In small facilities, individuals on the core team may be assigned more than one role. At a minimum, the core team should include—
Long-term care facilities are most successful when other influential individuals are integrated into the implementation team. Influencers, or informal leaders, are respected members of the staff that should be highly encouraged to join the team, as their ability to engage other staff will be important to reaching an LTC facility's goal(s). These champions include a physician, nurse, and nursing assistant. Once the core team identifies these champions, invite each person individually to participate in this program that contributes to improving the safety of the residents and staff. Highlight that each team member has been selected based on their expertise in a particular area and their distinctive skills, and provide an explanation as to how he/she influences peers. Assure team members that work assignments will be covered when participating in trainings and meetings. Return to Contents Facility Staff All staff in an LTC facility should understand why changes are being made and what their role is in supporting the changes to improve quality in the LTC facility. Each individual's knowledge, skills, experience, and perspective helps inform the current state (i.e., what is happening now) and future state (i.e., what improvements are in place over time). When an LTC facility is seeking to remove unnecessary catheters or improve hand hygiene practices, for example, the team—the individuals implementing the changes—is critical to achieving results that can be sustained over time. Return to Contents Residents and Families Improving resident safety and reducing HAIs requires a team effort and should include the resident and family as part of the safety improvement team. Module 5: Resident and Family Engagement in the Long-Term Care Safety Toolkit Modules explains why it is important to engage residents and families and their role as partners in facilities' safety teams, and provides a resident and family engagement checklist. Additional tools and resources to engage residents and families in the program to reduce CAUTIs and other HAIs can be found in the Resources section of the Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities. Return to Contents Utilize DataAs part of the strategy to implement improvements, data to monitor progress toward achieving set goals should be determined. Measuring results provides the LTC facility team and leadership with a way to determine if the intervention is working. Objective information allows the team to begin asking the right questions to understand the problem, instead of basing practices on outdated policies or preferences of the way it has always been done. As resident outcomes change, an LTC facility wants to know that the interventions or changes applied make improvements. Performance measures the LTC facility chooses to track should reflect the care targeted for improvement. The LTC facility can use existing data to track improvement or decide to track other data relevant to the intervention. Once the performance measures are determined, a data collection system needs to be developed. The following sections outline performance measures to consider. Return to Contents Qualitative Measures Regardless of the improvement the LTC facility is trying to make, the root of improvement lies in the safety culture within the facility. Qualitative measures can provide valuable subjective data that can be used to assess safety culture. Leadership and staff perceptions of resident harms such as CAUTIs or falls, and staff harm such as a punitive response to errors, can influence culture. One way to measure if an LTC facility's safety culture is improving is to use a safety survey. AHRQ has a survey available for nursing homes that helps facilities assess staff perceptions of resident safety culture and track changes over time. The AHRQ Nursing Home Survey on Patient Safety Culture should be completed by all staff (whether employed or contracted) working at least eight hours per week on an annual or biannual basis to assess progress over time. For more information and resources to promote the survey, review Appendix B. Once the results are in, review the data with staff to engage them in a discussion about the domains the facility scored well in, and the domains where there are opportunities for improvement. Consider sharing the results in staff meetings, “town hall” meetings with residents and families, and other councils to begin developing action plans. To change the way facilities do their work and provide care, refer to the Long-Term Care Safety Toolkit Modules to discuss safety concepts including senior leadership engagement, staff empowerment, teamwork and communication, resident and family engagement, and sustainability. AHRQ also provides a list of initiatives related to the survey areas titled Improving Patient Safety in Nursing Homes: A Resource List for Users of the AHRQ Nursing Home Survey on Patient Safety Culture. Return to Contents Quantitative Measures Quantitative measures provide objective data to assess progress toward meeting goals. Process measures, such as device utilization ratio or urine culture collection rate, can help to determine how well interventions are being implemented. A select set of measures are outlined to consider when measuring performance to reduce CAUTIs, and a sample of these measures along with tips about what and how to collect this data can be found in Appendix C, as well as a spreadsheet to calculate rates in Appendix D. Consider enrolling in the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) tracking system. Enrollment training and guidance documents for NHSN can be found in the Long-Term Care Facility Component drop-down of the NHSN Web site. From there, scroll down to Other Enrollment Resources to gain access to the enrollment and set-up checklist, suggested weekly task list, and other useful enrollment resources. Indwelling Urinary Catheter Utilization Ratio Invasive devices, such as an indwelling urinary catheter, increase the likelihood of an infection. By measuring how often an indwelling urinary catheter is utilized in the LTC facility, staff can see if the process of reducing the use of catheters that are not clinically indicated is impacting infection rates. Urine Culture Collection Rate Asymptomatic bacteriuria (ASB), or a positive urine culture in the absence of symptoms specific to the urinary tract, is extremely common in residents in long-term care. Unfortunately, ASB is often confused with urinary tract infection, particularly in catheterized adults, who almost always have bacteria in their urine.12,13 Due to this confusion, urine cultures from residents with asymptomatic bacteriuria might be included in the surveillance for symptomatic and catheter-associated UTIs, potentially increasing the reported urinary tract infection rate for a LTC facility. By measuring how often urine cultures are collected for all residents with or without an indwelling urinary catheters, staff can monitor for appropriate assessment and treatment of symptomatic and catheter-associated UTIs. Appropriate antibiotic treatment of urinary tract infections is a key element of antibiotic stewardship; measuring the rate of urine cultures collected and appropriate prescribing patterns can assist in this effort.14-16 Refer to more information on urine culturing and antibiotic stewardship in the Urine Culturing and Antibiotic Stewardship section. CAUTI Rate Because improvement takes place over time, it is important to see whether or not changes implemented make a difference in reducing rates over time. CAUTI rates are one of the most important indicators of how changes in practices and processes are impacting the infection rates. Return to Contents ImplementOnce the LTC facility identifies opportunities for improvement, changes can be implemented by focusing on evidence-based practices and other effective strategies to improve resident safety. One approach to manage change and train staff to institute improvement is through the use of the Plan-Do-Study-Act (PDSA) cycle.17 See Appendix D to develop and document each PDSA cycle. In order to effectively make changes, it is recommended that an LTC facility keep the changes small and involve the frontline staff and leadership who are interested in improving care. Overall, this AHRQ Safety Program for Long-Term Care: HAIs/CAUTI promotes implementation of specific cultural and clinical interventions and CAUTI surveillance practices. Educational bundles, listed in Appendix E, are designed to help the LTC facility educator train facility staff, and when appropriate, residents and families, on infection prevention and safety culture topics. The educational materials that accompany this guide are designed to be customizable and adaptable to your facility's needs. Slide sets and 10- to 20-minute videos describe evidence-based HAIs/CAUTI prevention practices and resident safety culture improvement practices, and highlight strategies to overcome barriers to implementation in the LTC setting. Supplemental activities may also be available, and are intended to reinforce learning. Return to Contents Cultural InterventionsThis section promotes implementation of cultural interventions referred to in the T.E.A.M.S. mnemonic and the Long-Term Care Safety Toolkit Modules that are designed to improve all aspects of resident safety. Return to Contents Communication and Engagement To enhance communication skills, AHRQ's TeamSTEPPS Long-Term Care version provides strategies and tools to engage leadership, staff, and residents and families in communicating and sharing strategies to reduce barriers to safe, quality care. Evaluating team engagement and communication with one another, residents, and families is an ongoing process. Meet regularly during existing safety or quality committee meetings to discuss team successes and barriers and to review data trends. Assess what is currently working by reviewing cases of resident safety issues (e.g., CAUTI) each month to find causes and solutions. Physician Engagement Lack of physician engagement can be a barrier for some LTC facilities, especially for facilities where physicians are not regularly on site. However, support for improving performance from clinical decision makers is key to helping your facility reduce harm. Consider asking for a few minutes to speak at medical staff meetings to improve buy-in to support evidence-based practices and clinical guidelines. Lastly, one-on-one conversations with the medical director and other physicians can often be the most effective strategy to explain their important role in an LTC facility’s program. Resident and Family Engagement To enhance communication skills, the TeamSTEPPS Long-Term Care version provides strategies and tools to engage leadership, staff, and residents and families in communicating and sharing strategies to reduce barriers to safe, quality care. The brochure, “Resident and Family Engagement: What is my role as a leader?” gives a detailed definition of resident and family engagement and describes the role of leaders in carrying out the following strategies:
Tools and resources to engage residents and family members as partners in clinical decision-making include Module 5 of the Long-Term Care Safety Toolkit Modules and the Resident and Family Engagement brochure for residents. Additional materials are available on The National Consumer Voice for Quality Long-Term Care (Consumer Voice) Web site to train local ombudsmen to educate and engage residents and families in CAUTI and other infection prevention efforts. Return to Contents Assess What's Working Communication tools and strategies, as well as safety assessment tools, may be piloted to see what contributes to improving safety culture to sustain or modify your approach to culture change. The Learn From Defects tool in module 2 of the Long-Term Care Safety Toolkit Modules provides a team-based approach to identifying factors that contributed to resident harm and opportunities for improvement, whereas the Nursing Home Survey on Patient Safety Culture assesses staff perceptions of resident safety culture. This survey can be re-administered to all staff to complete at an LTC facility's discretion, but it is recommended to administer it at least six months apart to assess culture change over time.13 Communicate ResultsEngaging not only leadership, but nursing staff, frontline staff, and residents and families in monitoring progress promotes team accountability. It also garners buy-in for improvements being implemented and gives the staff a voice to identify workable solutions to improve resident safety. Assess and share program data to encourage, inspire, and motivate the facility staff, residents, and family members. Reinforce the positive changes being made or identify where more or different interventions are needed to optimize safe care for residents who require a catheter. Strategies to share data include newsletters, posters, staff meetings, huddles, safety committee meetings, board meetings, resident/family council meetings, and one-on-one conversations. Celebrate SuccessesWhen goals are reached, celebrations and LTC facility leadership's recognition of the efforts made by all staff can help sustain the gains made to improve resident safety culture and outcomes to reduce CAUTIs and other HAIs. Return to Contents Clinical InterventionsImprovements in clinical care of residents begin with understanding the appropriate clinical indications for indwelling urinary catheter use. A summary of this guidance as it relates to the LTC setting and recommended strategies, beginning with fundamental infection prevention knowledge and skills, are included in this section. Refer to the C.A.U.T.I. mnemonic and Clinical FAQs in Appendix F for more information. Return to Contents Infection Prevention Failures in infection control was the most common type of deficiency cited in LTC surveys in 2014, demonstrating a need for greater focus on infection prevention skills and practices.7 When caring for a resident with an indwelling urinary catheter, it is paramount that the facility staff demonstrate proper hand hygiene and personal protective equipment use, and maintain a clean and disinfected environment. Leadership may use the “Take the Pledge…” handout to communicate basic infection prevention skills and ask staff to commit, or pledge, to consistently practice these skills. For staff training materials, review the infection prevention educational bundles found in Appendix E and A Unit Guide to Infection Prevention for Long-Term Care Staff. Urine Culturing and Antibiotic Stewardship Asymptomatic bacteriuria (ASB), or a positive urine culture in the absence of symptoms specific to the urinary tract, is extremely common in residents in long-term care. Unfortunately, ASB is often confused with urinary tract infection, particularly in catheterized adults, who almost always have bacteria in their urine. Treatment of ASB with antibiotics is one of the leading causes for antibiotic overuse in long-term care.12,13 Moreover, antibiotics can lead to resident harm, such as nausea, diarrhea, allergic reactions, and antibiotic-related infections.14 Antibiotics can also wipe out healthy bacteria that can lead to secondary infections like yeast and Clostridium difficileinfections.15,18 Furthermore, it can lead to bacterial resistance—especially in LTC facilities—as noted in the statement about the National Action Plan for Combating Antibiotic-Resistant Bacteria released in March 2015 by the U.S. White House Office of the Press Secretary.13,19 Appropriate antibiotic treatment of urinary tract infections is a key element of antibiotic stewardship. Decreasing inappropriate use of urine testing (urine cultures) is one strategy that can be used to decrease the inappropriate use of antibiotics in residents with asymptomatic bacteriuria (ASB). Refer to more information on collecting urine culture collection rate data as a proxy measure for antibiotic stewardship in the Utilize Data section. For staff training materials, review the urine culturing and antibiotic stewardship educational bundles found in Appendix E, the Antibiotic Stewardship educational video, and the “4 Things You Should Know About Urine Cultures” infographic. Return to Contents Catheter Removal The CDC's Healthcare Infection Control and Practices Advisory Committee (HICPAC) 2009 CAUTI Prevention Guidelines outline when it is appropriate to use an indwelling urinary catheter, alternatives to using an indwelling urinary catheter, and proper techniques for urinary catheter insertion and maintenance.13 Many catheters are placed without appropriate indications. It is important to remove an indwelling urinary catheter if it is not clinically indicated or if there is an alternative option. Unless an indwelling urinary catheter is clinically indicated, then it should be removed immediately if currently in place. Refinements of the HICPAC guidelines based on the Ann Arbor Criteria are listed.20 Appropriate indications for indwelling urinary catheters in LTC settings include—
Examples of inappropriate uses of an indwelling urinary catheter in LTC settings include—
Use Regular Assessments Review the clinical indications for an indwelling urinary catheter, remove it as is soon as it is no longer clinically indicated, and do not insert an indwelling urinary catheter if it is not clinically indicated. Regular walking rounds on the unit to review indications for an indwelling urinary catheter can provide staff with the opportunity to review cases together and determine appropriate next steps. Aseptic Insertion Insert new urinary catheters only when there is a good indication for it. If it is necessary to insert a catheter, then it is critical that only trained staff insert indwelling urinary catheters and, if possible, have a two-person team to observe and support aseptic technique. Go to Appendix G, Indwelling Urinary Catheter Insertion Checklist, and the educational bundle, Catheter Insertion and Maintenance, in Appendix E for more information. Return to Contents Alternatives to Catheter Use If there is not a clinical indication for an indwelling urinary catheter and a medical provider, frontline staff, or resident or family member requests that an indwelling urinary catheter be inserted, it is important to consider alternatives to using a urinary catheter when developing individual resident care plans and behavior interventions. Alternative options may include—
For staff training materials, see the educational bundles on alternatives to indwelling urinary catheter use in Appendix E. Return to Contents Training for Catheter Care Only trained staff should care for the catheter—maintaining a closed drainage system and an unobstructed urine flow. Include residents and families in the education of proper catheter care as they can also help with proper maintenance. The Indwelling Urinary Catheter Maintenance Checklist, available as Appendix H, includes common questions and answers to the care and maintenance of catheters, leg bags, and bath basins. For staff training materials, see the educational bundle on indwelling urinary catheter use and care available in Appendix E, “Leg Bag Frequently Asked Questions,” and the “Do's and Don'ts of Catheter Care” infographic. Return to Contents CAUTI Surveillance CAUTI surveillance is a process by which an infection preventionist or someone in a similar role reviews residents' charts for a suspected symptomatic CAUTI to determine whether it is a CAUTI. While there are different definitions of a CAUTI for the purposes of diagnosis or coding for medical claims, surveillance should consider the CDC's NHSN definition. Per the NHSN definition, a CAUTI is identified if the following indications are met: (1) an indwelling urinary catheter connected to a drainage bag is in place; (2) the resident has one or more CAUTI signs or symptoms; and (3) the resident has a urine culture that fits the CAUTI criteria.21 Consult the CDC NHSN Web page and the NHSN Definition CAUTI Criteria pocket card available as Appendix I for further details. Utilize the Long-Term Care CAUTI Surveillance Worksheet available in Appendix J that combines the resident’s health assessment and laboratory findings to give direction on whether an infection episode meets NHSN criteria. Identify a safety issue for your team to tackle and create an action plan to address root causes of that issue. The CAUTI Case Review Form found in Appendix K provides an approach to specifically identify reasons why a CAUTI occurred and find opportunities for improvement, which can be discussed as a team. Return to Contents SustainImprovement strategies can only be sustained if the strategies are embedded into the culture and norms of a facility, so the best time to begin thinking about sustaining program gains is at the beginning of your program implementation. Consider what processes can be integrated into the normal workflow. The Long-Term Care Safety Toolkit Modules sustainability module provides information on essential elements to sustain a quality improvement program and spread it to other areas of your LTC facility or affiliated organization. Return to Contents Assess Capacity for Sustaining the GainsOnce the program is underway, it is recommended that your team understand what program elements and other factors may influence sustainability by completing the Sustainability Assessment Tool. Results from completing this tool can be used to develop a sustainability action plan to maintain, as well as build, your team's capacity for sustainability. Return to Contents Engage Residents and FamiliesConsider including evidence-based practices to prevent CAUTIs and other HAIs into the policies and procedures related to the care of residents' needs. Moreover, include evidence-based information, such as the “When Do You Need An Antibiotic?” brochure, the Antibiotic Stewardship educational video, and the resources found on the Consumer Voice Web site in care plan meetings with residents and families to promote shared decision making in a resident's day-to-day care. Resident and Family Council meetings are another great opportunity to provide information to residents and families. Return to Contents Maintain Staff Competency
Return to Contents References
Return to Contents AppendixesAppendix A. Team Roster Appendix B. Guide to Administering the AHRQ Nursing Home Survey on Patient Safety Culture and Reviewing Results Appendix C. CAUTI-Related Data Definitions Appendix D. PDSA Worksheet Appendix E. Educational Bundles Appendix F. Prevent Catheter-Associated Urinary Tract Infection Appendix G. Indwelling Urinary Catheter Insertion Checklist Appendix H. Indwelling Urinary Catheter Maintenance Checklist Appendix I. NHSN Definition CAUTI Criteria Pocket Card Appendix J. Long-Term Care CAUTI Surveillance Worksheet Appendix K. CAUTI Case Review Form Prepared by Health Research & Educational Trust with contract funding provided by the Agency for Healthcare Research and Quality through Contract No. HHSA 290201000025I. Disclaimer: The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or HHS. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this document. This document may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. What is most important in preventing CAUTI?There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (1) prevention of inappropriate short-term catheter use, (2) nurse-driven timely removal of urinary catheters, and (3) urinary catheter care during placement.
What is most important in preventing a catheterCAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible.
What is the best intervention to prevent a CAUTI catheterCatheter-associated urinary tract infections (CAUTI) are preventable by reducing unnecessary catheter use, length of catheter use, and improving insertion technique [3].
What is the most important risk factor for developing CAUTI?The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
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