Healthcare-Associated Infections _ ______________________________________________________________
SUMMARY OF LEVEL I RECOMMENDATIONS FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) FOR THE PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTION a
Appropriate Urinary Catheter Use Insert catheters only for appropriate indications, and leave in place only as long as needed.
Minimize urinary catheter use and duration of use in all patients, particularly those at higher risk for infection or mortality from catheterization, such as women, individuals older than 65 years of age, and patients with impaired immunity. Avoid use of urinary catheters in patients and nursing home residents for management of incontinence. Use urinary catheters in operative patients only as necessary, rather than routinely. For operative patients who have an indication for an indwelling catheter, remove the catheter as soon as possible postoperatively, preferably within 24 hours, unless there are appropriate indications for continued use. Proper Techniques for Urinary Catheter Insertion Perform hand hygiene immediately before and after insertion or any manipulation of the catheter device or site. Ensure that only properly trained persons (e.g., hospital personnel, family members, or patients themselves) who know the correct technique of aseptic catheter insertion and maintenance are given this responsibility. In the acute care hospital setting, insert urinary catheters using aseptic technique and sterile equipment. Use sterile gloves, drape, sponges, an appropriate antiseptic or sterile solution for periurethral cleaning, and a single-use packet of lubricant jelly for insertion. Properly secure indwelling catheters after insertion to prevent movement and urethral traction. If intermittent catheterization is used, perform it at regular intervals to prevent bladder overdistension. Proper Techniques for Urinary Catheter Maintenance Following aseptic insertion of the urinary catheter, maintain a closed drainage system. If breaks in aseptic technique, disconnection, or leakage occur, replace the catheter and collecting system using aseptic technique and sterile equipment. Maintain unobstructed urine flow. Keep the catheter and collecting tube free from kinking. Keep the collecting bag below the level of the bladder at all times. Do not rest the bag on the floor. Empty the collecting bag regularly using a separate, clean collecting container for each patient; avoid splashing, and prevent contact of the drainage spigot with the nonsterile collecting container. Use Standard Precautions, including the use of gloves and gown as appropriate, during any manipulation of the catheter or collecting system. Unless clinical indications exist (e.g., presence of bacteriuria when catheter is removed after urologic surgery), do not use systemic antimicrobial agents routinely to prevent catheter-associated urinary tract infection for patients requiring either short-term or long-term catheterization. Do not clean the periurethral area with antiseptics to prevent infection while the catheter is in place. Routine hygiene (e.g., cleansing of the meatal surface during daily bathing or showering) is appropriate. Quality Improvement Programs Implement quality improvement programs or strategies to enhance appropriate use of indwelling catheters and to reduce the risk of catheter-associated urinary tract infections based on a facility risk assessment. The purposes of quality improvement programs should be to: ensure appropriate utilization of catheters; identify and remove catheters that are no longer needed (e.g., daily review of their continued need); and ensure adherence to hand hygiene and proper care of catheters. Administrative Infrastructure Provide and implement evidence-based guidelines that address catheter use, insertion, and maintenance. Ensure that healthcare personnel and others who take care of catheters are given periodic in-service training regarding techniques and procedures for urinary catheter insertion, maintenance, and removal. Provide education about catheter- associated urinary tract infections, other complications of urinary catheterization, and alternatives to indwelling catheters. a Level I recommendations are supported by high-to-moderate quality evidence suggesting net clinical benefits or harms, or by low-quality evidence suggesting net clinical benefits or harms, or an accepted practices supported by low-to-very low quality evidence. Source: [23] Table 8
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