Clinicians should use pre- and post-catheterization assessments to gauge proper catheter use and monitor early signs of catheter-associated urinary tract infection, according to a new practice alert from the American Association of Critical-Care Nurses.
In the alert, the AACN noted that urinary tract infections account for almost 40% of hospital-acquired infections in acute care hospitals, triggering increased costs and higher morbidity and mortality rates. Additional treatment for such preventable conditions may be ineligible for reimbursement from Medicare, Medicaid and other payers.
According to the alert, AACN expects nursing units to:
• Develop written guidelines for urinary catheterization, including indications for indwelling urinary catheterization and ensuring that catheter placement is limited to patients who meet indications.
• Stock devices and supplies, and be aware of techniques that offer alternatives to indwelling catheters (such as condom catheters, penis pouches, bladder scanner and incontinence products).
• Design and implement standards and training programs for catheter insertion and manipulation.
• Review daily the need for continued catheterization for all patients.
• Develop systems to ensure prompt removal of catheters when their use is no longer indicated.
• Implement infection surveillance programs that include unit-based urinary catheter days and rates of CAUTIs.
• Develop action plans to address needed improvements.
Based on available evidence, the expected practice relating to preventing CAUTIs is to:
• Assess patients for accepted indications and alternatives before placement of any indwelling urinary catheter.
• Adhere to aseptic technique for placement, manipulation and maintenance of indwelling urinary catheters.
• Document all instances of indwelling urinary catheters including insertion date, indication and removal date.
• Discontinue indwelling urinary catheters as soon as indications expire.
The alert is the latest in a collection of evidence-based guidelines issued by AACN to standardize practice and update nurses on new advances and trends. It is available for downloading free of charge at www.aacn.org.