Catheter Acquired Urinary Tract Infection (CAUTI): Prevention (Nursing)

00:04 Hey guys! Let's take a look at how we prevent a Catheter Acquired Urinary Tract Infection.

00:11 So, let's take a moment, and talk about the word CAUTI.

00:14 You're going to hear this a lot. What are we talking about? Well, this shows you hear, what that abbreviation stands for.

00:21 A Catheter Associated Urinary Tract Infection.

00:25 So, the easy thing here, remember the U.

00:28 Anytime you see this word or this abbreviation, we're talking about urinary tract infections.

00:34 Be surprised though with some patient populations, this can cause serious complications and issues in your patient.

00:41 So, this can result in complications such as increased morbidity and mortality, actually.

00:46 Especially in certain populations that are at risk.

00:49 So this actual infection, this UTI, this can spread to other organs of the body, and really cause complete system failure, if we don't get a handle on it.

01:00 And not only that this can cause an increase in hospital stay for your patient, and more healthcare costs of the facility.

01:08 Now, let's take a look. How does this even occur? CAUTI can occur in a couple of different ways.

01:14 So, let's take a look at this list.

01:16 So, if you notice here, improper insertion technique is at the top of the list.

01:21 So, why, when you're in nursing school, we really drill into you about maintaining sterility.

01:27 This is really important here because we're inserting that catheter directly into the bladder.

01:33 So we want to take extra precautions to maintain sterility.

01:38 Next, there's lots of risk factors.

01:40 A couple that comes to mind, if a patient is maybe immunocompromised, for example, what I mean by that, if the patient's undergoing treatment for cancer, for example, this can definitely put them at risk.

01:52 Their immune system is lowered, their ability to fight that defense is lowered, they can definitely be at risk.

01:58 Also our elderly population.

02:01 Guys, this happens a lot.

02:03 There's many times when an elderly patient comes into the ER, maybe they're more confused, for example, more agitated, one of the first things we're gonna do is screen for CAUTI.

02:15 The other thing we want to look at is the duration of how long that catheter stays in our patient? The longer, the worse the risk is.

02:23 So a lot of the times we're gonna assess for "Hey, can we get that thing out? We need to get it out quick." So, duration of the indwelling catheter is important.

02:32 And lastly, hygiene is also really important.

02:35 Not only for the patient to do, but as a nurse, taking care of your patient, good perennial care is really important here.

02:43 So, let's take a look at four important points on how we can prevent this? So, frequent assessment of the need of the catheter is really important.

02:51 So, just know, we may need this for treatment, but early removal is essential.

02:56 And of course, for healthcare providers, we've got to perform our hand hygiene and wear appropriate PPE, for handling and insertion of that catheter.

03:06 And to go along with that last point, maintaining sterility when we insert that catheter.

03:12 This is again, a really important point.

03:14 So when you learn this skill as a nursing student, be conscious to maintain sterility, and to pay close attention on how to do so.

03:23 And lastly, make sure that we perform appropriate perinatal care assessment, and care for the patient.

03:31 So, let's take a look at the slide.

03:34 Let's look at this HOUDINI abbreviation, for example.

03:37 This is just one little way to remember some really important notes of why we may need to take a second guess of does this catheter need to stay in? Or does it not? So, if you see any of these signs, look at it and say, "Contact the doctor have a discussion.

03:55 Is this a good time to remove this or not?" Because again, looking at this HOUDINI acronym, some of these reasons, we may have to pause, hesitate, and keep that catheter in place.

04:06 So, let's take a look at these seven points.

04:08 And let's take a look at the first one.

04:12 So, for age. We're talking about hematuria here and what we call gross hematuria.

04:17 You may say, "Okay, that sounds like a foreign language.

04:20 I'm not sure what that is." Really all this means, if there's a lot of bleeding in the catheter, that's an issue.

04:26 There's some trauma going on.

04:28 We can develop blood clots, that could be a potential issue.

04:31 So, if you notice gross hematuria, or excessive blood in the catheter, we need to stop and talk to our doctor.

04:40 Next, there could be some sort of obstruction.

04:42 This could be an anatomical thing, this could be stones, but this is another reason why, we potentially, may need to question, if the catheter needs to come out or not.

04:52 Now, let's take a look at the UPs, the urologic surgery.

04:56 What we mean by this? Sometimes, a patient needs it catheter, if they've undergone some sort of surgery on the bladder, for example, this may need to stay in to help empty and maybe get rid of excess blood, or empty the bladder.

05:12 Also just know, sometimes catheter placements really difficult.

05:17 It can be really difficult in some patients.

05:20 So, the nurse may, for example, try to place a catheter, this could be a really difficult placement.

05:26 We may need a special urologist to come place that.

05:29 So, if it's a really difficult catheter placement, we may want to question for removal.

05:34 Next, let's look at our fourth point.

05:37 D for Decubitus.

05:38 What we're talking about here, sometimes a patient can have a really bad ulcer on their sacral or peritoneal area.

05:46 Now, if the patient's incontinent, and have a lot of incontinent urine episodes, that urine in contact with the patient's skin can cause serious worsening of that wound.

05:56 So occasionally, we may have an indwelling catheter to keep this contact of the urine from the skin.

06:04 Now, this next point is a biggie. So you see here, I for I and O.

06:08 What we're talking about is intake and output.

06:11 Remember, whatever comes in must come out.

06:14 So, this is really critical for management of specific patient populations.

06:18 And we need to check the volume status of patients, especially in your critical care or ICU patients, strict I, you know, and management and monitoring is crucial.

06:30 Now, let's look like take a look at this N.

06:33 So, N is for neurogenic bladder dysfunction or some sort of chronic indwelling catheter.

06:38 Some patients may have a traumatic event, for example, to where their brain may no longer be able to tell their bladder, it's got an empty.

06:46 So, this can be an issue for urinary retention, or the patient can't empty the bladder on their own, so that catheter may need to stay.

06:56 Also, some patients have had this issue of emptying their bladder for a long time.

07:01 So, they may have a chronic meaning long-term indwelling catheter.

07:05 We may need to question if it has to be removed or not.

07:09 And lastly, immobilization.

07:11 This is not always the reason why we put an indwelling catheter.

07:16 But occasionally while we're healing, if someone has an unstable fracture to where maybe they can't get up and down, or multiple traumatic injuries, they may indeed have an indwelling catheter.

07:27 Now, if any of the above criteria above is selected, you may not want to remove the urinary catheter and you need to question, if it stays or if it goes? But make sure you assess these points.

07:43 Now, let's take a look at this.

07:45 These are some nurse driven protocols for removal.

07:49 So, if you remember the nurses, the one at the forefront of care at the bedside, were attuned of where a patient condition is.

07:56 But we're the ones that are responsible for assessing "Hey, can this catheter get out?" Because longer the catheter is, is in, the more likely you may have a CAUTI or an infection here.

08:08 So, I know this looks really complicated.

08:11 So, what I would like you to do is take this protocol or a protocol like it, bring it to your clinical site, look at your patient case and say, "Okay, is my patient able to have their catheter removed? Let's look at some criteria." So, I don't want this slide to overwhelm you.

08:28 Just know there's some nurse driven protocols out there for removal of the catheter.