What is the most effective way to prevent infection when providing catheter care?

CAUTI Information

What is CAUTI?

CAUTI is an infection of the urinary tract caused by a tube (urinary catheter) that has been placed to drain urine from the bladder. The urinary tract consists of the kidneys, ureters (tubes joining the kidneys to the bladder), bladder, and urethra (tube leading from the bladder to the outside of the body).

Urinary catheters are used to drain urine in patients who are not able to urinate on their own, to measure the amount of urine produced during intensive care, or during and after surgery or tests of the kidneys and bladder. Germs can travel along the urinary catheter and cause an infection in your bladder or your kidney; this type of infection is called a catheter-associated urinary tract infection (or "CAUTI").

The definition of CAUTI falls into two groups:

• symptomatic urinary tract infection and
• asymptomatic bacteremic urinary tract infection

CAUTI includes those infections in which a patient had an indwelling urinary catheter at the time or within 48 hours before onset of the event. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated.

CAUTI is the most common type of HAI and causes 1of 3 HAIs in patients in hospitals. Among urinary tract infections acquired in the hospital, approximately 75% area associated with a urinary catheter. There are an estimated 13,000 annual death attributed to CAUTI.

CAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible.

Core Prevention Strategies:

• Insert catheters only for appropriate indications
• Leave catheters in place only as long as needed
• Ensure that only properly trained persons insert and maintain catheters
• Insert catheters using aseptic technique and sterile equipment (acute care setting)
• Following aseptic insertion, maintain a closed drainage system
• Maintain unobstructed urine flow
• Hand hygiene and Standard Precautions

Resources:

• An Overview of Catheter-Associated Urinary Tract Infections (UTI)  
• APIC CAUTI Elimination Guide  
• CDC- CAUTI Information
• Facts about CAUTI
• Preguntas frecuentes- Infeccíon urinaria asociada al catéter urinario

Guidelines for CAUTI prevention:

• CAUTI Guideline Appendices 2009 
• CDC-CAUTI Information
• CDC CAUTI Tool kit  
• CDC NHSN CAUTI Event  
• HICPAC Guideline for Prevention of Catheter-Associated Urinary Tract Infections
• Prevention Tools and Resources for Healthcare Professionals

A catheter is a tube in your bladder that removes urine from the body. This tube may stay in place for an extended period of time. If so, it is called an indwelling catheter. The urine drains from your bladder into a bag outside your body.

When you have an indwelling urinary catheter, you are more likely to develop a urinary tract infection (UTI) in your bladder or kidneys.

Many types of bacteria or fungi can cause a catheter-related UTI. This type of UTI is harder to treat with common antibiotics.

Common reasons to have an indwelling catheter are:

• Urine leakage (incontinence)
• Not being able to empty your bladder
• Surgery on your bladder, prostate, or vagina

During a hospital stay, you may have an indwelling catheter:

• Right after any type of surgery
• If you are unable to urinate
• If the amount of urine you produce needs to be monitored
• If you are very ill and cannot control your urine

Urine tests will check for infection:

• Urinalysis may show white blood cells (WBCs) or red blood cells (RBCs).
• Urine culture can help determine the type of bacteria in the urine. This will help your health care provider decide on the best antibiotic to use.

Your provider may recommend:

• Ultrasound of the abdomen or pelvis
• CT exam of the abdomen or pelvis

People with an indwelling catheter will often have an abnormal urinalysis and culture from urine in the bag. But even if these tests are abnormal, you may not have a UTI. This fact makes it harder for your provider to choose whether to treat you.

If you also have symptoms of a UTI, your provider will likely treat you with antibiotics.

If you do not have symptoms, your provider will treat you with antibiotics only if:

• You are pregnant
• You are undergoing a procedure related to urinary tract

Most of the time, you can take antibiotics by mouth. It is very important to take all of them, even if you feel better before you finish them. If your infection is more severe, you may receive medicine into the vein. You may also receive medicine to lessen bladder spasms.

You will need more fluids to help flush bacteria out of your bladder. If you are treating yourself at home, this may mean drinking six to eight glasses of fluid a day. You should ask your provider how much fluid is safe for you. Avoid fluids that irritate your bladder, such as alcohol, citrus juices, and drinks that contain caffeine.

After you have finished your treatment, you may have another urine test. This test will make sure the germs are gone.

Your catheter will need to be changed when you have a UTI. If you have many UTIs, your provider may remove the catheter. The provider may also:

• Ask you to insert a urine catheter intermittently so you don't keep one in all the time
• Suggest other urine collection devices
• Suggest surgery so you do not need a catheter
• Use a special coated catheter that can reduce risk of infection
• Prescribe a low-dose antibiotic or other antibacterial for you to take every day

This can help prevent bacteria from growing in your catheter.

UTIs related to catheters can be harder to treat than other UTIs. Having many infections over time may lead to kidney damage or kidney stones and bladder stones.

Untreated UTI may develop kidney damage or more severe infections.

If you have an indwelling catheter, you must do these things to help prevent infection:

• Clean around the catheter opening every day.
• Clean the catheter with soap and water every day.
• Clean your rectal area thoroughly after every bowel movement.
• Keep your drainage bag lower than your bladder. This prevents the urine in the bag from going back into your bladder.
• Empty the drainage bag at least once every 8 hours, or whenever it is full.
• Have your indwelling catheter changed at least once a month.
• Wash your hands before and after you touch your urine.

UTI - catheter associated; Urinary tract infection - catheter associated; Nosocomial UTI; Health care-associated UTI; Catheter-associated bacteriuria; Hospital-acquired UTI

Centers for Disease Control and Prevention website. Catheter-associated urinary tract infections (CAUTI). www.cdc.gov/hai/ca_uti/uti.html. Updated October 16, 2015. Accessed April 30, 2020.

Jacob JM, Sundaram CP. Lower urinary tract catheterization. Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 11.

Nicolle LE, Drekonja D. Approach to the patient with urinary tract infection. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 268.

Trautner BW, Hooton TM. Health care-associated urinary tract infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 302.

Updated by: Kelly L. Stratton, MD, FACS, Assistant Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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