Catheter-Associated Urinary Tract Infections

Scope and Impact of the Problem

Urinary tract infections (UTIs) are the most common nosocomial infection, accounting for up to 40% of infections reported by acute care hospitals.^1,2 Up to 80% of UTIs are associated with the presence of an indwelling urinary catheter.³

A catheter-associated urinary tract infection (CAUTI) increases hospital cost and is associated with increased morbidity and mortality.^2,5,6 CAUTIs are considered by the Centers for Medicare and Medicaid Services to represent a reasonably preventable complication of hospitalization. As such, no additional payment is provided to hospitals for CAUTI treatment-related costs.⁵

Full Practice Alert

• CAUTI Practice Alert (with AACN Levels of Evidence and complete reference list) [PDF: 11/2011]

Expected Practice

• Prior to placement of any indwelling urinary catheter, assess patient for accepted indications and alternatives. [Level C]
• Adhere to aseptic technique for placement, manipulation, and maintenance of indwelling urinary catheters. [Level E]
• Document all instances of indwelling urinary catheters, including insertion date, indication, and removal date. [Level C]
• Promptly discontinue indwelling urinary catheters as soon as indications expire. [Level C]

Supporting Evidence

• Prolonged catheterization is the major risk factor for CAUTIs.^7,8 
• Twenty-five percent of inpatients and up to 90% of patients in an ICU have a urinary catheter during hospitalization, often without an appropriate indication.⁴
  • Indwelling urinary catheters are placed without sufficient rationale, and/or remain in place after indications expire.⁹
• CAUTIs can be decreased by interventions that facilitate removal of unnecessary catheters.^10,11
• Most hospitals have not implemented effective strategies for preventing CAUTIs.^12,13

Actions for Nursing Practice

• Develop written guidelines for urinary catheterization, include indications for indwelling urinary catheterization, and ensure that catheter placement is limited to patients who meet indications.
• Have available devices, supplies, and techniques that allow alternatives to indwelling catheters (eg, condom catheters, penis pouches, bladder scanners, incontinence products).
• Design and implement standards and training programs for catheter insertion and manipulation.
• Review the necessity of catheter continuation for all patients with urinary catheters on a daily basis.
• Develop systems to ensure prompt removal of catheters when 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.

Need More Information or Help?

• Contact a clinical practice specialist for additional information or access AACN's Clinical Practice page; then select Practice Resource Network and Ask the Clinical Practice Team.
• Lo E, Lindsay N, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41-S50.
• HICPAC/Centers for Disease Control and Prevention. Guideline for Prevention of Catheter-Associated Urinary Tract Infections. 2009. http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed October 5, 2011.

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