1 / 21

Preventing Catheter-Associated Urinary Tract Infections

Preventing Catheter-Associated Urinary Tract Infections. Emergency Nursing Education. An 85 year old male with dementia…. Brought to the ED from his skilled nursing facility with a complaint of nonfunctioning PEG tube.

olaf
Télécharger la présentation

Preventing Catheter-Associated Urinary Tract Infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Preventing Catheter-Associated Urinary Tract Infections Emergency Nursing Education

  2. An 85 year old male with dementia… • Brought to the ED from his skilled nursing facility with a complaint of nonfunctioning PEG tube. • In the initial assessment, the nurse notes the patient was incontinent and placed a urinary catheter • The patient is admitted for a PEG change. Overnight the patient becomes more confused and pulls on his catheter leading to severe hematuria and requiring a urology evaluation. • Within 36 hours was febrile, with positive blood cultures, treated for CAUTI and requires a prolonged hospital stay.

  3. Objectives • Describe urinary catheter use with focus on the emergency department (ED) • Identify current evidence on prevention of CAUTIs • Outline nursing assessment of the ED patient who may require urinary catheterization • List criteria for catheter placement • Review communication necessary between nurses and providers to facilitate appropriate clinical decision-making

  4. Urinary Catheter Utilization • About 15 - 25% of patients will have a urinary catheter placed during their hospitalization. • Many are placed in • ED • ICU • OR

  5. Reducing CAUTI • Determine appropriate indication • Avoid use if no indication • Seek alternatives when possible • Use sterile technique for placement • Remove as soon as possible

  6. Why we think putting in a catheter is a good idea – but it’s not

  7. Indications for catheterization • Patient is critically ill and will require accurate output measurement • Urinary retention/obstruction • Bladder scanner or bedside ultrasound first • Immobilization needed for trauma or surgery • Incontinent with open sacral/perineal wounds • End of life/hospice • Chronic or existing catheter use • Re-evaluate need and discuss with provider

  8. “Not” indications for catheterization • Substitute for frequent toileting • To obtain a specimen if the patient can void freely • Patient preference • Dementia • Obesity

  9. Patients at high risk for inappropriate catheterization • Elderly Women • Independent factors: women were twice more likely than men, and very elderly (≥80 years) were 3 times more likely than those 50 or younger, to have urinary catheter placed without indication. Fakih et al, Am J Infect Control 2010;38:683-8 • Incontinent • Obese • Immobile • Non-critically ill cardiac and renal patients • Monitor does not necessitate catheter

  10. Reducing inappropriate placements reduces • Infection rates • Cost • Antibiotics use • Length of stay • Morbidity • Patient discomfort

  11. Communication with providers • Clear understanding of indications • Commitment to nonmaleficence (doing no harm) • Patient focused care

  12. So, how does this affect the care of this patient? • Brought to the ED from his SNF with a complaint of nonfunctioning PEG tube. In the initial assessment, the nurse noted the patient being incontinent and placed a urinary catheter • Incontinence is not an indication by itself for catheter placement

  13. So, how does this affect the care of this patient? • The patient was admitted for a PEG change. Overnight the patient became more confused and pulled on his catheter leading to severe hematuria and requiring a urology evaluation. • The agitated patient (possibly due to dementia) is not a good candidate for catheter placement

  14. So, how does this affect the care of this patient? • Within 36 hours was febrile, with positive blood cultures, treated for CAUTI and required a prolonged hospital stay. • This patient had no indications to place a catheter; the suggestion is that placement of the catheter in the ED was a potential cause of infection. Patient stay is prolonged, patient develops a clinical problem he did not present with initially. This infection is potentially preventable.

  15. Another example… • A 76-year-old woman admitted for congestive heart failure… • Urinary catheter placed and started on diuretics • Condition improved; ready for discharge on 3rd day • No urinary output for 5 hours after catheter removal • Bladder scan showed 500 mL of urine • Straight catheterization • Observed overnight for symptom resolution CAUTI ED slides, Fakih, 2012

  16. So, how does this affect the care of this patient? • Urinary catheter placed and started on diuretics • Accurate I & O measurement can be a valid indication for catheter placement for critically ill patients • Evaluate for need before placement

  17. So, how does this affect the care of this patient? • Condition improved; ready for discharge on 3rd day • No urinary output for 5 hours after catheter removal • Bladder scan showed 500 mL of urine • Not all patients with congestive heart failure require catheterization • Early removal may have prompted evaluation of urinary retention • Additional day of hospitalization • Risk for urosepsis • Explore alternatives for measuring I & O • Removal after initial diuresis to shorten exposure • Frequent toileting • Communicate with inpatient staff indication for placement to assure timely removal

  18. Another example… • A frail 82-year-old woman was admitted for congestive heart failure… • Urinary catheter placed and started on diuretics • Team felt the catheter would make her more comfortable • On day 5 • Chills; fever of 102°F • SBP dropped to 90 mmHg • Blood cultures and urine cultures grew Escherichia coli. • Diagnosed with symptomatic CAUTI and treated with intravenous antibiotics. CAUTI ED slides, Fakih, 2012

  19. So, how does this affect the care of this patient? • Team felt the catheter would make her more comfortable • Comfort is a myth • It may be convenient for the staff and the patient, but does not promote comfort, nor is it a safe indication • Some patients may request a catheter to avoid the need to get up. It is still an inappropriate reason • Consequences • Prolonged, unexpected hospitalization from hospital-acquired CAUTI • Risk for urosepsis

  20. The take home • Review indications for urinary catheter placement • Discuss placement with provider • Communicate indications for placement with inpatient staff for timely removal • Do no harm

  21. Is the patient critically ill and will require accurate output measurement? No Yes • Other indications for urinary catheter: • Urinary retention/obstruction? • Use bladder scanner first • Immobilization needed for trauma or surgery? • Incontinent with open sacral/perineal wounds? • End of life/hospice? • Chronic or existing catheter use? • Re-evaluate need and discuss with provider • Insert catheter and treat signs of shock: • Hypotension • Decreased cardiac output/function • Decreased renal function • Hypovolemia • Hemorrhage • Re-assess after intervention No Yes Do NOT insert Explore alternatives Still critically ill, requiring accurate output measurement? Yes No Insert or maintain catheter Remove catheter prior to admission

More Related