Preventing CAUTIs: Catheter Removal and Antimicrobial Stewardship

The CAUTI Problem in Healthcare Settings

Basic infection prevention and antimicrobial stewardship must be examined closely given the global need for interventions that address healthcare-acquired infections (HAIs), including urinary tract infections. As the Association for Professionals in Infection Control and Epidemiology notes, "the basics of infection prevention and control are the necessary underpinnings of programs, policies, and protocols that impact HAI" (APIC, 2008, p. 5). One aspect that requires continual attention is the formation of antimicrobial stewardship programs. Such programs have the potential to generate positive outcomes by minimizing adverse consequences associated with catheter-associated urinary tract infections (CAUTIs). This is especially important given the development of colonization, biofilms, asymptomatic bacteriuria, and symptomatic urinary tract infections that are typical with urinary catheter use.

In healthcare settings where CAUTIs are at risk of forming, a common contributing factor is the inappropriate selection and utilization of antimicrobials. Misuse of antimicrobials leads not only to well-documented consequences such as multidrug resistance, but also to ineffective treatments and persistent infections among patients and residents in healthcare facilities. The core problem lies in the mismanagement of drugs combined with a lack of adequate supervision and monitoring. Most CAUTIs occur because of untimely removal of catheters, which results in increased rates of infection.

Why CAUTIs Demand Urgent Attention

"Since the earliest days of national nosocomial infection reporting, UTIs have been shown to occur more frequently than other infections associated with healthcare, accounting for 36% of all HAIs in the United States" (APIC, 2008, p. 5). Because CAUTIs are virtually certain to occur after 30 days of catheterization, resolving this issue is of the utmost concern. Research indicates that regardless of antimicrobial and hygienic protocols, bacteria — especially in women, who are more vulnerable due to their shorter urethras — will likely result in a CAUTI simply from prolonged catheter use.

When an outcome becomes a near-certainty, there must be actions taken to prevent further infections and curb the further misuse of antibiotics. Healthcare in the United States faces constant budget pressures, with funds often failing to meet the increasing demands of infection control. The more affordable option of CAUTI prevention not only spares healthcare facilities unnecessary additional expenses, but also helps prevent the resurgence of more costly consequences such as antibiotic-resistant bacteria and other healthcare-acquired infections.

Project Objective: A Targeted Monitoring Approach

The objective is to implement a monitoring program in conjunction with an antimicrobial stewardship program that addresses effective and timely removal of catheters in order to decrease and prevent CAUTIs. Both programs can be taught to hospital staff and patients, allowing all parties to actively recognize and participate in determining the appropriate time for catheter removal. The typical rate of infection reaches near certainty after 30 days, with infections potentially beginning in as little as 6 days. Therefore, removal of a catheter after 6 days should be considered mandatory.

Proposed Solution: Prompt Catheter Removal

The proposed solution — prompt removal of catheters after defined time limits, generally 6 days — has been proven to be an effective approach to preventing CAUTIs. Not only does it eliminate the near-certain risk of infection, it also prevents antibiotic misuse by avoiding infections altogether. Simply monitoring how long a patient has had a catheter and ensuring its timely removal saves money, conserves time, and significantly reduces infection risk. The implementation of routine hygiene protocols can further assist by reducing the bacterial load within the patient's environment.