Preventing CAUTIs

A CPD article improved Lucy Ward’s knowledge of catheter-associated urinary tract infections

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The article discussed the symptoms of catheter-associated urinary tract infections (CAUTIs), the risks associated with catheter use and how to manage catheters safely.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

The CPD article explained that the main risk factor for developing a urinary tract infection is having a urethral catheter in situ, because this interferes with the natural flushing action of urine that eliminates bacteria from a healthy bladder.

The article discussed the patient risks associated with long-term catheterisation, such as encrustation, blockage, leakage, pain and discomfort. By monitoring the pH of patients with long-term catheters, it is possible to identify those with unusually alkaline urine, and therefore monitor for early signs of encrustation.

I was interested to learn that bacteria appear in the urine 24-48 hours after the catheter has been inserted. However, having bacteria in the urine does not necessarily cause problems and half of all patients with an indwelling urethral catheter do not experience any symptoms of an infection. I have also learned about Tiemann tip catheters, which have a curved tip to make catheterisation easier for patients with an enlarged prostate gland.

How did you change or improve your practice?

I work on a ward for men aged 80 years and over, who may be at increased risk of developing a CAUTI. I plan to consider ways to improve the documentation of urinalysis results, and I intend to develop a sticker for use in patients’ medical notes. This will include the reason why the urine sample was taken, a list of the possible results, and what was done with the results – for example, whether the catheter was changed or flushed. This will help to identify patients with unusually alkaline urine, thus identifying early signs of encrustation so that it can be treated.

The article emphasised the importance of patient education in relation to catheterisation. In my practice, patients are given a ‘catheter pack’ to take home on discharge. This contains information about who to contact if they are having problems and how to re-order catheter equipment, as well as spare catheter bags and straps. These packs often help patients and their relatives to feel more comfortable about going home with a catheter in situ.

After reading the article, I plan to use the knowledge I have gained about the different types of catheter tips and monitoring the pH of patients’ urine in my practice, and explore the possibility of using catheters with a Tiemann tip. I also intend to share the information I have learned with my colleagues.

How is this relevant to the Code? 

One of the themes of The Code is preserving safety. The article discussed the procedure for safe uretheral catheterisation and how to manage catheters safely. It also recommended that the use of indwelling catheter is avoided unless there is no alternative, and it should be removed as soon as possible.

Another theme is prioritising people; the article discussed ways of preserving the dignity and privacy of patients with an indwelling catheter.

Lucy Ward is a sister at Southampton University Hospital, Southampton