The urinary tract is composed of the urethra, bladder, ureters, and kidneys. The urine within the urinary tract is sterile. After an indwelling urinary catheter is placed, if a urinary tract infection occurs, it is considered a catheter-associated urinary tract infection (CAUTI). These infections can be the result of bacteria:
- Being introduced into the urinary tract during insertion
- Entering the urinary tract through the catheter tubing
- Attaching to the catheter's external surface to enter the tract
The overall monetary cost of CAUTI to hospitals is conservatively estimated to be over $400 million dollars per year or $1000 per patient with a CAUTI. Two-thirds of urinary tract infections that are hospital-acquired are directly related to urinary catheter placement and maintenance by healthcare professionals.
Many bundles and toolkits are available to prevent or reduce the occurrence of CAUTI. These resources come from the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the American Nurses Association (ANA), and many others.
Ideas for change, based on such bundles and tool kits, include:
- Avoid placement of indwelling urinary catheters, opting for alternatives
- Ensure the aseptic technique, integrating accountability for hand hygiene and sterile placement
- Promptly remove unnecessary catheters, using nurse-driven protocols
Changing the hospital and nursing culture is essential to changing the practice surrounding catheter-associated urinary tract infections. Interventions to reduce CAUTI occurrence must include the nurses at the bedside as well as nursing leadership.