No catheter, No CAUTI (catheter associated urine No catheter, No CAUTI (catheter associated urine infection)infection)
Reducing avoidable harm in patients with catheters
January 2015
Faculty: <insert faculty>
No Catheter, No CAUTI - Background
• GSTT/ Health Innovation Network for South London– Project lead – Dr Adrian Hopper
• Reduce patient harm from catheterisation specifically catheter associated urinary tract infections (UTI’s)
• Catheter associated UTI’s are a major cause of hospital acquired bacteriemia– devastating impact on patients
© SaIL Centre 2015
No Catheter, No CAUTI - The facts
• CAUTI– significant financial burden– extended hospital stay – can contribute to delirium & falls
• 26% of catheters inserted in A&E are inappropriate
• 1/3 of urinary catheter-days have been shown to be unnecessary
• Risk of CAUTI begins to increase after 48 hours of insertion
Source: xxxxx
© SaIL Centre 2015
No Catheter, No CAUTI - The facts
Examples of Serious Harm Caused by CAUTIs...
1. Patient JC - 13 emergency admissions, 2 months period in hospital over 18 months due to CAUTI or blocked catheter
2. Patient CR - dementia diagnosis: died from severe sepsis despite critical care treatment following a CAUTI
Source: KHP 2014
© SaIL Centre 2015
No Catheter, No CAUTI-The background
© SaIL Centre 2015
No Catheter, No CAUTI Group work
Group 1Indications & contraindications of catheters. Why insert a catheter & why not?
Group 2Risks & complications of catheters. List & discuss implications inc to patients & services
Catheters - appropriate use
• Acute urinary retention or chronic urinary retention only if associated with renal impairment
• Clinical need to monitor urine output
• Severe sacral pressure ulcers
• Measurement of post void residual urine volume-if bladder scanner is unavailable
• Instillation of medication-e.g.. Chemotherapy
• Urethral stricture therapy
• Urological investigations
• Management of intractable urinary incontinence
© SaIL Centre 2015
Catheters-inappropriate use
• Urinary incontinence (NB complete continence assessment - inc patient choice in provision of pads & products)
• Advanced age
• Immobility
• Urinary tract infection
• Signs of urethral trauma
• Patient refusal
© SaIL Centre 2015
Risks/ Complications
•Injury/ trauma - urethra / bladder wall punctured
•Perforation of prostate gland
•Catheter associated urine infections
•Narrowing of urethra - secondary to scar tissue caused by repeated use of a catheter
•Bladder stones (usually develop after years of catheterisation)
•Psychological effect
•Pain/ Bladder spasm
© SaIL Centre 2015
Anatomy and catheter placement
© SaIL Centre 2015
Keeping our patients safe- what can we do
• Consider risk/ benefits before insertion
– Use clinical guidance to support decision making
• Review catheters every shift
– Are they needed? Can they be removed?
• Ensure documentation complete
– EPR insertion & continuing care forms to support decision making
• Daily clinical reviews
• Catheter passport
– Empowering & educating patients
Keeping our patients safe- what we can do?
References
© SaIL Centre 2015
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