Wisconsin Long-Term Care
Urinary Tract Infection Toolkit

Module 2: How to Prevent Catheter-Associated Urinary Tract Infection (CAUTI)

This module is organized into three sections. Each section includes a slide deck presentation.

Section 1: Background and Risk Factors -+

The prevalence and impact of urinary catheter use is discussed. Risk factors are described and include physiological, resident-related, caregiver, and facility level concerns.


Section 2: Appropriate Indications for Indwelling Catheter Use -+

A summary of CAUTI guidelines is provided, along with tips for evaluating indications related to appropriate and inappropriate catheter use. Examples of alternative approaches to catheter use are included in the presentation.


Section 3: Indwelling Catheter Insertion and Maintenance -+

Information about indwelling catheter insertion and maintenance is presented, including the use of leg bags and urine specimen collection for culture. Finally, potential CAUTI prevention issues are reviewed.

Catheter Insertion Checklist
Catheter Maintenance Checklist
Collection of Urine Specimens for Culture

Additional Resources -+

Along with review of facility policies and procedures, it is also important to note any manufacturer instructions. Catheter Dos and Don’ts Infographic is a one-page document summarizing key points to help prevent a catheter-associated urinary tract infection. Frequently Asked Questions About the Use and Care of Legs in the Long-Term Care Setting was assembled by the AHRQ Safety Program for Long-Term Care to provide answers to frequently asked questions. Additional resources are provided by the AHRQ Safety Program for Long Term Care: CAUTI and include a training video, powerpoint slides, quiz and quiz key.

Catheter Insertion clinical videos are available through the New England Journal of Medicine about Female Urethral Catheterization and Male Urethral Catheterization. Access to the videos may be purchased. Note: some institutional affiliations may provide access free of charge. Additional resources include simulation video demonstrations of Female Urethral Catheterization and Male Urethral Catheterization.

Practicing hand hygiene is key to preventing the transmission of organisms and one of the most effective skills staff can perform to prevent infections and improve resident safety. The Centers for Disease Control and Prevention (CDC) Hand Hygiene in Healthcare Settings offers two education courses for healthcare providers on hand hygiene. The World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care provide a review of scientific data related to hand hygiene, consensus recommendations, process and outcome measurement, national approach to hand hygiene, patient involvement and comparison of hand hygiene guidelines. The Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities module highlights basic hand hygiene principles and best practices.

Reference List -+

  1. Herter, R. and Kazer, M.W. (2010) Best Practices in Urinary Catheter. Home Healthcare Nurse 28(6), 342-349.
  2. Zimlichman. E., Henderson, D., Tamir, O., Franz, C., et al. (2013). Health Care-Associated Infections: A Meta-analysis of Costs and Financial Impact on the U.S. Health Care System. JAMA Internal Medicine, 173(22), 2039-2046. doi: 10.1001/jamainternmed.2013.9763
  3. Wisconsin Healthcare-Associated Infections Long-Term Care Coalition. When To Test Urine–Nursing Tool.
  4. APIC Implementation Guide. (2014). Guide to Preventing Catheter-Associated Urinary Tract Infections.
  5. Gould, C.V., Umscheid, C.A., Kuntz, G., Agarwal, R.K., et al. (2009; last update February 15, 2017). HICPAC Guideline for Prevention of Catheter-Associated Urinary Tract Infections.
  6. Expert opinion, Wisconsin Coalition on Healthcare-Associated Infections in Long Term Care, UTI Toolkit Sub-committee. 2017.
  7. Newman, D.K. Managing and Treating Urinary Incontinence (2002). Health Professions Press.
  8. Urinary Incontinence in the Long Term Care Setting Clinical Practice Guideline (2012). American Medical Directors Association. Columbia, MD.
  9. AHRQ Safety Program for Long-Term Care: HAIs/CAUTI. (March 2017). Frequently Asked Questions About the Use of and Care for Leg Bags in the Long-Term Care Setting.
  10. Stone, N.D., Ashraf, M.S, Calder, J., Crnich, C., et al. (2012). Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infection Control & Hospital Epidemiology, 33(10), 965-977. doi: 10.1086/667743
  11. Hooton, T.M., Bradley, S.F., Cardenas, D.D., Colgan, R., et al. (2010). Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases, 50, 625-663. doi: 10.1086/650482
  12. High, K.P., Bradley, S.F., Gravenstein, S.,  Mehr,D.R., et al. (2009). Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Disease Society of America. Clinical Infectious Diseases, 48 (2), 149–171. doi: 10.1086/595683
  13. Lo, E., Nicolle, L.E., Coffin, S.E., Gould, S.E., et al. (2014). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35, S2, 464-479. doi: 10.1086/675718