Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques.

BACKGROUND: The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the prevention of complications including catheter-associated urinary tract infection (CAUTI).
OBJECTIVES: This is the second of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for prevention of CAUTI in patients with short- and long-term indwelling catheters. Part 2 reviews multiple interventions for CAUTI prevention including staff education, monitoring of catheter use and CAUTI incidence, insertion technique, urethral meatal care, securement, use of a closed drainage system, bladder irrigation, frequency of catheter change, and antiseptic solutions in the drainage bag. SEARCH STRATEGY: Nursing actions for prevention of CAUTI were identified based on search of electronic databases and Web-based search engines for national or international clinical practice guidelines focusing on this topic. Evidence related to the above nursing interventions was identified by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, the ancestry of articles identified in these searches and Google scholar.
RESULTS: Limited evidence suggests that the following interventions reduce the incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Mixed evidence suggests that use of a preconnected system reduces inadvertent interruption of a closed urinary drainage system and may prevent CAUTI. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce CAUTI incidence in patients managed by long-term catheterization. Existed evidence suggests that the following interventions are not effective for reducing CAUTI incidence: (1) use of sterile technique for catheter insertion, (2) use of antiseptic solutions or ointments during routine meatal care, (3) use of a 2-chambered urinary drainage bag, (4) use of antiseptic filters incorporated into a urinary drainage bag, (5) bladder or catheter irrigation, (6) frequent changes of the urinary drainage bag, and (7) placement of an antiseptic solution in the urinary drainage bag. IMPLICATIONS FOR PRACTICE: Evidence from parts 1 and 2 of this Evidence-Based Report Card provides a sound basis for designing an evidence-based program to prevent CAUTI. Essential elements of a CAUTI prevention program include staff education, ongoing monitoring of CAUTI incidence, monitoring catheter insertion and ensuring prompt removal, and careful attention to techniques for catheterization and catheter care.