Catheter Associated UTI

Remove That Foley!

Objectives

Review evidence that foley catheters cause infection

Employ algorithm to determine if foley catheter is appropriate

Apply guidelines for when to remove foley catheter

Foley Catheters Cause

Infections Length of stay Cost $$$ Patient Discomfort Antibiotic Usage Risk of falls (tethered to bed/1 point

restraint) Risk of skin breakdown, DVT and

pneumonia due to immobility

Urinary Tract Infection (UTI) and Indwelling Catheters

UTIs: THE most common Hospital Acquired Infection (HAI) and are directly associated with the use of indwelling foley catheters

40% of all HAI are caused by UTI 80% are secondary to foley catheters Risk of infection

5% each day 25% at 1 week 100% at one month

Duration

SCIP INF-9* recommends that post-operative foley catheters are removed by the end of post op day 2

Use urinary catheter in operative patients only as long as necessary

SCIP INF-9 requires physician documentation for foley catheter continuation

*SCIP = SURGICAL CARE IMPROVEMENT PROJECT *INF-9 = Infection Module # 9

When to Discontinue Foley Catheters?

Decreasing the duration of an indwelling urinary catheter will reduce the risk of a catheter-associated UTI

The time frame for foley catheter removal is dependant on clinical judgment and findings

Indwelling catheters should not be changed at arbitrary intervals

No action necessary. Avoid catheter

placement.

Does the patient meet

criteria for a Foley?

Continue to monitor

Foley need on a daily basis

YES

YES

NO

NOYES

Foley Catheter Decision-Making Algorithm

Foley Indicators Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus Diuresis / Mass hydration Comfort Care/Palliative Care Other__________________

ObtainRemove Foley

order

Is there a Foley Catheter

in place?

Foley Catheter Checklist*Date Post Op Day #_____________

Foley Day #_______________

Room #

Does your patient have a foley catheter? Y N

Is there an order for the catheter? Y N

Which service is your patient on? Medical Surgical Trauma

Which criteria for appropriate use of foley catheter does your patient meet:

Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus Diuresis / Mass hydration Comfort Care Other

If none of the above criteria are met, was a D/C foley order obtained? Y N

*Used in ICUs that do not document nursing assessment in IDX/GECE

Foley Catheter Sticker*: Doctor’s Order Documentation of catheter criteria FOLEY CATHETER ORDER

Date/Time Doctor__________

This patient has a Foley Catheter, inserted __________(date)

Please indicate criteria for continuation of foley catheter:

IF NO CRITERIA APPLY PLEASE CONSIDER DISCONTINUATION OF FOLEY CATHETER

□ Continue Foley Catheter □ D/C Foley Catheter Physician/NP/PA Signature __________________#________Date/Time__________ Cat # 86604

Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus

Diuresis / Mass hydration Comfort Care/Palliative Care Other_____________________________________________

*Place dated sticker on physician order sheet

Sticker for Chart Front to Alert MD

Place on front of chartFoley Catheter in place…… See Doctor’s Order SheetDate__________ Cat # 86605

Date and place this sticker on the front of the chart to alert MD that the foley catheter order sticker has been placed on the physician order sheet.

Unit Flyer

Nurses must advocate for the removal of unnecessary indwelling catheters.

Use the criteria-based guidelines to determine need for foley catheter.

Document foley criteria, insertion date, and discontinuation date.

How does this apply to nursing?

Use the decision-making algorithm Use the Criteria-Based Foley Catheter Checklist

daily for areas that do not chart in GECE/IDX If no criteria on the checklist are met, obtain a

physician’s order to discontinue the foley catheter Foley Catheter Days will be collected on each unit,

every day There is no evidence to support a set time of day

that foley catheters are to be discontinued.

Nursing Guidelines

GECE Screenshot

2 Documentation Changes as of January 1, 2010:#1 Discontinue date of foley#2 Foley Catheter Criteria IF patient has a foley

Maintain catheters based on recommended guidelines Maintain a sterile, continuously closed drainage system. Keep catheter properly secured to prevent movement

and urethral traction. Keep collection bag below the level of the bladder at all

times (even during transport). Maintain unobstructed urine flow. Empty collection bag regularly, using a separate

collecting container for each patient, and avoid allowing the draining spigot to touch the collecting container.

Maintain meatal care with routine hygiene (bathing) using soap and water.

Questions

Foley Catheters cause:

A. Increased infections

B. Increased length of stay

C. Increased risk of falls

D. Increased cost

E. All of the above

Criteria for Foley Catheter includes:A.   Neurogenic bladder

B.   Strict I&O

C.   GU related Surgery/Procedure

D.   Stage III/IV decubitus

E.   Comfort Care/ Palliative Care

F. All of the above

Discontinuation of foley catheters is based on all of the below except:A. Physician Order-sets

B. Research based criteria

C. Gut feeling

D. Pathways

E. MD/PA/NP order

Maintaining foley catheters includes all of the following except:A. Maintain a sterile, continuously closed drainage

system.

B. Keep catheter properly secured to prevent movement and urethral traction.

C. Keep collection bag on top of the bed covers at all times.

D. Maintain unobstructed urine flow.

E. Maintain meatal care with routine hygiene (bathing) using soap and water.