Catheters, both central venous and urinary, are medical devices that save lives, but they also can contribute to significant patient morbidity and mortality if the proper techniques for insertion, maintenance and removal are not followed. We review the basics of interventions related to infection prevention and control.
Catheter-Associated Urinary Tract Infections (CAUTIs)
More than 30 million urinary catheters are inserted annually in the United States, accounting for as many as 1 million CAUTIs. Saint (2000) reports that as much as one-quarter of patients are catheterized, and many are due to increased acuity of their illness, the complexity of care and decreased staffing levels. Klevens, et al. (2007) report that CAUTIs comprised more than one-third of the total number of healthcare-acquired infections (HAIs) which include bloodstream infections, surgical site infections and hospital-acquired pneumonia. It has also been documented that the presence of indwelling urinary catheters for two to 10 days can trigger bacteriuria (Saint, 2000).
Particularly germane to infection preventionists are the risk factors associated with the development of a CAUTI, including the duration of catheterization and breaches in catheter-care protocol. (Salgado et al., 2003), as well as the recognition of the complications and adverse outcomes associated with indwelling catheters, including urinary tract infection (UTI), secondary bacteremia/sepsis, the creation of a reservoir for multidrug-resistant organisms (MDROs), prolonged hospital stay and even mortality. An estimated 17 percent to 69 percent of CAUTIs may be preventable with recommended infection control measures, which means that up to 380,000 infections and 9000 deaths related to CAUTIs per year could be prevented. (Umscheid, 2008)
To help infection preventionists navigate CAUTI prevention and control, the Association for Professionals in Infection Control and Epidemiology (APIC) in 2008 issued its Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs), part of the organization’s ongoing series of HAI elimination guides. One of the CAUTI guide’s three co-authors, Linda Greene, RN, MS, CIC, director of infection prevention for Rochester General Health System in Rochester, N.Y., explains the impetus for the creation of the guide: “In keeping with APIC’s 30-plus year mission of delivering science to the bedside, the APIC CAUTI guideline was developed to serve as a definitive, comprehensive tool to questions raised by more than 13,000 infection preventionists worldwide. As such, APIC continues to update such vital documents in sync with guidelines released by HICPAC, thereby translating evidence into clinical practice and sharing strategies and tools for the successful implementation of evidence-based practices.”