A urinary catheter is a thin tube placed in the bladder to drain urine. Urine drains through the tube into a bag that collects the urine. Catheter-associated urinary tract infections (CAUTIs) are infections caused by bacteria that have entered the urinary tract during the catheter's insertion, through the catheter tube, or through the catheter’s external surface.
Common symptoms of UTIs may include burning during urination, burning and pain in the lower abdomen, fever, and cloudy or bloody urine. In some cases, a person may have a CAUTI and not experience any symptoms.
Some patients may be at higher risk for developing a UTI due to older age, poor hygiene, or poor hydration (not drinking enough fluids). Female sex, older age, method of catheterization, duration of catheterization, and quality of catheter care are risk factors for CAUTI. (citation) It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.
Estimated burden of CAUTIs in healthcare facilities in the United States:
In January 2012, the Centers for Medicare and Medicaid Services (CMS) began requiring acute care hospitals participating in their Hospital Inpatient Quality Reporting Program to report CAUTIs in adult and pediatric intensive (critical) care units. In January 2015, CMS began requiring acute care hospitals to report CAUTIs in adult and pediatric medical, surgical, and medical/surgical inpatient wards. Critical care data are currently available and inpatient ward data will soon be available to the public on Hospital Compare.
In September 2015, the VDH reporting regulations were updated to align state reporting requirements with the CMS Hospital Inpatient Quality Reporting Program. Under the new regulations, hospitals are reporting CAUTI data to VDH through the National Healthcare Safety Network (NHSN) for adult, pediatric, and neonatal critical care units and adult and pediatric medical, surgical, and medical/surgical inpatient wards. For more information on these data and the state regulation mandating their reporting, please see Public Reporting page.
Other CMS quality reporting programs require CAUTI reporting from long-term acute care hospitals (adult and pediatric critical care units and ward locations – October 2012 to present) and inpatient rehabilitation facilities (adult and pediatric wards – October 2012 to present).
Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America
CDC CAUTI toolkit – contains background on epidemiology of CAUTIs as well as core and supplemental prevention strategies
AHA/HRET Hospital Engagement Network 2.0 – change package, improvement strategies, checklist, and other resources
APIC Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008 – Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings
CAUTI FAQ (CDC website)
CAUTI Prevention in Critically Ill Patients (APIC infographic)
Comprehensive Unit-Based Safety Program (CUSP) – safety project designed to improve safety culture and reduce CAUTIs in participating hospitals.
Guide to Patient Safety (GPS) Tool – self-assessment tool to help facilities guide their approach to CAUTI prevention. Designed for use by hospitals that have already initiated some CAUTI prevention activities but are not achieving their desired success.
NHSN Device-Associated Module – protocol and instructions, training, and forms” with “NHSN CAUTI protocol, training, forms, analysis resources, and support materials – click on the appropriate healthcare setting and select the CAUTI link (or urinary tract infections, if a long-term care facility) to access the materials
SHEA Patient Education Guide (CAUTI) – fact sheet that educates patients and their families about 7 types of HAIs (including CAUTIs) and how to work with healthcare professionals to prevent them.
Targeted Assessment for Prevention (TAP) CAUTI Toolkit Implementation Resources (CDC) – Links to resources in multiple domains to aid hospitals in implementing the TAP Strategy
This urinary tract infections (UTI) toolkit contains infection prevention presentations, resources, and tools that have been adapted for long-term care facilities (LTCFs). The toolkit was developed as a result of a collaborative effort between 12 nursing homes in the Eastern region of Virginia, the Virginia Department of Health (VDH) Healthcare-Associated Infections (HAI) Program, and the Virginia Health Care Association (VHCA) to impart best practices in the prevention of UTIs within the long-term care (LTC) population.
These documents have been developed from published literature reviews, evidence-based research, standards of practice, or recommendations obtained from the Centers for Disease Control and Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC), Centers for Medicare and Medicaid Services (CMS), licensing agencies, professional organizations, or other recognized sources. Materials and information from other organizations in this toolkit that use hospital-centered language also apply to LTC settings.
UTIs are very common in residents in long-term care facilities and consequently result in a significant amount of antimicrobial use within the resident population. It is our hope that the toolkit will be used to support best practices for the prevention of urinary tract infections and promote strategies to improve resident care including the judicious use of antimicrobials.
The toolkit is meant to introduce and summarize guidelines and best practices, and does not replace published standards and regulations. Refer to the toolkit component, “UTI Prevention Resources and References”, to help access the official guidelines and regulations and contact the VDH HAI Program with questions.
We would appreciate any feedback on the materials including which resources are most helpful and which have areas for improvement. Please check our website periodically for updates on toolkit materials.
Download the entire toolkit. Individual toolkit components can be downloaded below.