Nursing interventions for Foley catheter care

AHRQ Safety Program for Long-Term Care: CAUTI

Slide 1: Urinary Catheter Types andCare for Residents With Catheters

Slide 2: Learning Objectives

Upon completion of this module, clinicians and staff who care for residents with catheters will be able to—

• Explain the similarities and differences between the four different types of catheters.
• Explain ways to prevent catheter-associated urinary tract infections; and
• Identify some common errors when caring for catheters.

Slide 3: Indwelling Urinary Catheter Entry Pathways for Microbes1

Bladder

• Entry during insertion.
• Bacteria movement up the catheter.

Urethra
(Urinary tract entrance)

• Breaks in the catheter tubing or collection bag.
• Contamination of the catheter tubing or collection bag.

Image source: Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7.
CMS, State Operations Manual, 2014.

1. Maki DG, Tambyah PA. Engineering out the Risk for Infection with Urinary Catheters. Emerg Infect Dis. 2001;7(2):342-7.

Slide 4: Alternatives to Indwelling Urinary Catheter Types

• Suprapubic catheters.
• Straight catheters.
• External "condom" catheters.

Slide 5: Hygiene and Standard Precautions Assisting the Nurse With Catheter Insertion2

• Wash your hands!
• Don gloves and gown.
• Help the resident to get comfortable in a supine position and assist the nurse as needed.
• Catheter insertion is done as a sterile technique. Do not touch the sterile field.
• Assist to place and secure the catheter drainage bag below the level of the bladder and off the floor.
• Remove gown and gloves and wash hands!

2. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54.

Slide 6: Drainage Bag2

• Only trained staff should empty the urine collection bag and rinse/store containers.
• Follow manufacturer instructions on use.
• Empty drainage bags regularly (at least once per shift).
• Stabilize the catheter and drainage bag.
• Keep drainage bag below level of bladder at all times OFF floor.
• Consider where to place the drainage bag during resident's daily activity
  • Wheelchair
  • Walker (clamp or hook)
  • Bed
  • Dining/activity area
  • Lounge/reading chair (peg on side)

2. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54.

Slide 7: Maintenance Avoiding Common Mistakes3

• Wash hands BEFORE and AFTER any contact with urinary catheter, tubing, or bag.
• Keep bag below bladder at all times without kinking.
• When emptying bag, do not let outlet port touch ANYTHING
  • Drain into a container used only for ONE resident.
• Sampling port must be DISINFECTED before any use
  • Only STERILE needle/syringe can be used to aspirate urine.

Slide 8: Maintenance Care of Indwelling Urinary Catheter3

• Use standard precautions before contact with catheter, tubing, or bag.
• When performing peri-care use only soap and water
  • Periurethral area should NOT be cleaned vigorously or with antiseptic solutions.
• Keep the catheter and all tubing from kinking/obstruction.
• Indwelling urinary catheter and suprapubic catheter systems must be kept CLOSED
  • If any disconnection of tubing or bag leakage, replace it.
• Make sure you don't contaminate catheter outlet valve when emptying the collection bag.
• Certified nursing assistants are daily hands on the "front line" between residents and families, and potential infection-causing microbes.

3. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(S2):S32-S47.

Slide 9: Teaching Family and Residents About Catheters4,5

Image: FAQ CAUTI - A snapshot from Catheterout.org's FAQ page about CAUTIs and catheter care.

Resources for educating residents and families can be found on the following Web sites:
Centers for Disease Control and Prevention
National Consumer Voice

4. Catheter-Associated Urinary Tract Infections. October 2015. Centers for Disease Control and Prevention.
5. Infection Prevention: Catheter-Associated Urinary Tract Infection. 2016. The National Consumer Voice for Quality Long-Term Care.

Slide 10: References

1. Maki DG, Tambyah PA. Engineering out the Risk for Infection with Urinary Catheters. Emerg Infect Dis. 2001;7(2):342-7.
2. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54.
3. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(S2):S32-S47.
4. Catheter-Associated Urinary Tract Infections. October 2015. Centers for Disease Control and Prevention.
5. Infection Prevention: Catheter-Associated Urinary Tract Infection. 2016. The National Consumer Voice for Quality Long-Term Care.