CAUTI– Preventing the Most Common HAI

Posted on by CDC's Safe Healthcare Blog

Dr. Carolyn Gould

The other day, I was watching my colleague Dr. Sanjay Saint on Medscape and began thinking, “How can we better communicate that urinary tract infections (UTIs) are more than just nuisance infections, and that they are preventable?” So, I want to focus this blog post on one of the most common, yet most preventable, of the healthcare-associated infections catheter-associated urinary tract infections (CAUTIs).

In looking at the overall number of healthcare-associated UTIs, I am overwhelmed by both the burden and the myths associated with catheter use. Today, UTIs account for more than 30 percent of HAIs in acute care hospitals, and most of these are caused by urinary catheters. Perhaps the fact that many providers out there still believe that certain conditions, such as incontinence, are best managed with catheters is contributing to the CAUTI burden. The reality is that because infection control measures – including removing catheters as soon as possible – aren’t always followed, CAUTIs are causing illness among patients, longer hospital stays, and unnecessary antibiotic use. And more antibiotic exposure puts patients at greater risk for developing multidrug-resistant organisms and Clostridium difficile infection.

The 2009 Guideline for Prevention of CAUTIs, developed and released by CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), is an excellent resource for healthcare facilities – both acute and non-acute care settings (e.g., long-term care, home healthcare). The recommendations in the CAUTI Guideline should be followed by any facility that cares for patients requiring urinary catheterization and should be the starting point for facilities to prevent UTIs.

Does your facility have a comprehensive prevention program for preventing CAUTIs? Are you confident that measures are in place to prevent CAUTIs for patients requiring catheterization? Are you and your facility doing everything possible to “prevent the preventable” CAUTI?

Posted on by CDC's Safe Healthcare Blog

25 comments on “CAUTI– Preventing the Most Common HAI”

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    Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I’ll be subscribing to your feed and I hope you post again soon.

    Thank you for your recent inquiry regarding strategies for Foley catheter use when surgery is scheduled for the patient. Catheter placement must be ordered if its use is clinically necessary. Similarly, catheter removal is also subject to MD order, the primary reason for removal being the catheter is no longer a clinical necessity. As an example, if a Foley catheter is inserted on day 1 to obtain a urinary specimen, then an OR visit planned for day 2, during which a urinary catheter will be inserted—there does not appear to be a clinical necessity during that <24 hour period for keeping a catheter in place. When a catheter is no longer clinically necessary, it is always better to remove the catheter and thereby reduce the risk for a urinary tract infection (UTI). There is less risk for infection with insertion compared to keeping a catheter in place for longer than is necessary.

    CDC – Blogs – Safe Healthcare – CAUTI “ Preventing the Most Common HAI I was recommended this web site by my cousin. I’m not sure whether this post is written by him as nobody else know such detailed about my problem. You are amazing! Thanks! your article about CDC – Blogs – Safe Healthcare – CAUTI “ Preventing the Most Common HAIBest Regards Craig

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    CDC – Blogs – Safe Healthcare – CAUTI “ Preventing the Most Common HAI I was recommended this website by my cousin. I am not sure whether this post is written by him as nobody else know such detailed about my problem. You’re incredible! Thanks! your article about CDC – Blogs – Safe Healthcare – CAUTI“ Preventing the Most Common HAIBest Regards Rolf

    Excellent blog post, I have been reading into this a bit recently. Good to hear some more info on this. Keep up the good work!

    The best way for hospitals to prevent CAUTIs is to avoid reusing catheter products. Even professionally reprocessed single use devices are 90% likely to test positive for the presence residual tissue, significantly heightening one’s chance of infection.

    Can you give me any more information regarding the part of the NHSN definition ” with no other recognzied cause”? Does this require a positive culture from another site to be a recognized cause? For instance, if you have a patient with a neurogenic bladder requiring long term foley use with a sacral wound getting long term antibiotics (i.e 6 weeks of Vancomycin) and the patient gets a positive culture for Candida albicans. Does this constitute a recognized cause?


    Normally I wouldn’t comment on posts but I felt that I had to as your writing style is really good. You have broken down a difficult area so that it easy to understand.

    This is such a great resource that you are providing and you give it away for free. I enjoy seeing websites that understand the value of providing a prime resource for free. I truly loved reading your post. Thanks!

    The hospital I work for recently switched vendors. At first we were a bit skeptical , however, like the above poster rates are now down from 5-10 per quarter to near zero.

    I have seen many variations in catheter use and care in my years of nursing. In school I was taught that one used the port on the catheter tube to withdraw urine or irrigate the catheter. This policy continued in the small community hospital in which I worked for 5 years.

    When I moved to long term care, I found that one disconnected catheter and bag for these tasks and changed them as well as the container into which the bag was emptied monthly. In another LTC facility, I found that catheter and bag and container were changed every 90 days, whether they needed it or not!

    Another changed catheter monthly and bag and container weekly. That facility had almost no Cautis. When the facility was purchased by a Corporation, it became “too expensive” to continue the frequent changes. At that point catheter use increased due to a shortage of staff and increases in Stage III pressure ulcers and UTIs. When a State Inspection cited us for these increases, a phenomenal Infection Control Nurse was able to change the policies and the thinking. Incontinence was no longer a reason for a catheter, our residents who were incontinent were started on cranberry tablets, one twice daily and given a lengthy trial at bladder retraining and those with pressure ulcers were faithfully turned every two hours. In addition the Infection Control Nurse was able to convince the local MDs that it was not necessary for people with catheters to be “colonized” with multiple bacteria at subclinical levels. The next years State Inspection revealed almost no Cautis and minimal pressure ulcers.

    It was ownership of catheter care and of frequent turning/changes plus education at all levels of care that enabled us to end the cycle.

    Back in June 2007, I had a seizure and fell. In the process I hit my back on something and broke a bone. I was in the hospital a while and then transferred to a nursing home for another while before I could go back home. But while I was in the hospital, I was hooked up to a catheter for mostof my stay. In the process, I developed a urinary tract infection. I had burning every time I had to go to the bathroom. When I was transfered to the nursing home, the hospital took the catheter out and when I got to the nursing home, they gave me a urine bottle and told me use that. The infection stayed on. I had it when I went home. And when I had another seizure in August 2007 and had to go back to the hospital for 3 days, I still had the infection. I told the hospital resident treating me about it and his first thought was that I must have a venerial diesease of some kind. So they tested for that and found nothing. The hospital started me on antibiotics which finally killed the infection about a week after I went home from the August stay. One thing that could be done to eliminate catheter related urinary tract infections would be to change, clean, and steralize well the catheter line and sack on a regular basis. The two most critical things are the cleaning and the steralizing. It may sound elementary, but it is important that people at the hospitals assigned to taking care of catheters should be given training on how to clean and steralize them and how much time is necessary for a good cleaning and steralizing to take place. And then the staff should be monitored on a periodic basis to make sure they are following the guidelines and follow-up training be given as needed and up-dated information becomes available. We also need a test of some kind so before the catheter is reused in a patient, it is tested for the presence of infectious organizisms. If any are found, the catheter would be taken out of service for recleaning and retesting. Best wishes, Michael E. Bailey.

    Poor patient staff ratios necessitate the need for urinary catheters. Incontinence contributes to skin breakdown when patients are not frequently attended. Complete skin care after incontinence which takes time and effort is not a desired patient care activity by staff. With proper supplies it need not take an inordinate amount of time. Most all assisted living homes manage incontinence without skin breakdown, indicating that it is possible. Urinary catheters should only be used with output measurements are critical, and/or that there is an existence of Stage III and IV decutibus ulcers. This seems to be a staffing issue as it does increase the amount of time spent by staff giving direct patient care. This lowest paying staff level is often shortchanged in numbers, while the salary of the executives raise inordinately. Could be bottom causative factor be greed?

    Perhaps, we in healthcare, reflect the population at large. There is a gap between cause and effect. Look at most health issues from drugs & alcohol to self care for diabetes and CHF. The result of our behavior is not immediately linked to a negative result so the stimulus to change is low or non-existent.

    In healthcare, if we don’t see an immediate effect (infection) from a cause (our actions or inactions) we don’t easily change. An infection does not result immediately from most of what we do so the association to our actions is lost or blurred. If I don’t swab the ports of the IV line nothing observable happens so why do it? I don’t have the time. I need the catheter for accurate I & O or because the person is incontinent or because it takes so long to get the patient up to void. Hardly anyone with catheter gets a CAUTI so for the most part it must be alright.

    We are working very hard on these issues including CAUTI. I think one of the biggest hurdles is getting people to understand that they can not decide to base their behaviors on their perceptions of whether not or their action will lead to a specific result. Actions must occur (or not occur) without personal perception of effect.

    We have had more than an entire quarter without a CAUTI and I believe the most important reason for this success is because a nurse driven/nurse empowered team, took ownership of this issue with the help of myself (ICP) – A crucial foundation was creating strict criteria for placement of a Foley and incorporating this into a protocol. This protocol empowered nurses to discontinue the Foley if it no longer met criteria and they created their own system for auditing. Also unit nurses continue to lead this process. Along the way another group reviewed the products in the hospital and changed our vendor and reduced the inventory which saved a significant amount of costs. This has been a wonderful example and success story of teamwork and performance improvement

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Page last reviewed: September 28, 2020
Page last updated: September 28, 2020