Catheter Associated Urinary

Tract Infection (CAUTI)

Prevention
Morgan Del Principe, Julia Badalov, Lauren Hoyos,
Brandon Harvison, Carolina Ley, Ashlee Osier, Trysha
Hicks, Samantha Merchant, and Rebecca Shiao
How many people have taken care of
someone with a catheter?
Introduction/General Description
➢ CAUTI is the most common device-related health-care acquired
infection (Stenzelius, Laszlo, Madeja, Pessah-Rasmusson, & Grabe, 2016)

➢ 80% of UTIs are related to indwelling urinary catheters (Chung et al., 2017)

➢ Indwelling urinary catheters are placed in 16-25% of hospitalized

patients (Leuck, Johnson, Hunt, Dhody, Kazempour, Ferrieri, & Kline, 2015)

➢ Bacteria develops in 25% of indwelling urinary catheters when placed

≥ 5 days (Leuck et al., 2015)

○ The risk increases by 1-5% each additional day

How much do you think it costs the
hospital per CAUTI?
Introduction/General Description Cont.
➢ The hospital has to pay an average of an additional $3,000-$4,000
per patient that develops a CAUTI (Chung et al., 2017)

➢ Bacteria/pathogens will enter the closed system via a break in the

closed catheter system or they can be introduced at the time of
insertion or migrate along the catheter’s external surface (Leuck et al., 2015)

➢ Causes nurses to deliver more complicated care

➢ Silver is a broad-spectrum anti-septic that acts against bacteria and

fungi without causing resistance (Leuck et al., 2015)
 Let’s Take a Minute to Define a Few Things..

Silver Coated Indwelling Catheter (Silver Catheter):

Catheter manufactured using a silver alloy coating.

Standard Catheter: Silicone catheter.

Clinical Question
Is the use of silver coated indwelling urinary catheters best
practice for preventing CAUTIs in adult medical surgical
patients during hospitalization, compared to indwelling urinary
catheters without silver coated tips?
How many people have taken care of a
patient who had a CAUTI?
Summary of Current Practice
➢ National standards recommend the use of silicone catheters, aseptic
technique for placement, and daily care for indwelling urinary catheters, which
are also used at the state and local level

➢ CAUTI prevention is focused on limiting the use of indwelling urinary

catheters in patients

○ -Patients that require any type of catheterization (intermittent, continuous) are at

risk for developing an infection.

(Gould, Umscheid, Agarwal, Kuntz, Pegues, & Healthcare Infection Control Practices Advisory Committee, 2017)
Summary of Current Practice
➢ Sterile, closed drainage systems are used to prevent introduction of
microorganisms into the genitourinary system, however, it does not eliminate
the risk.

➢ Daily hygiene/care is performed on patients with indwelling catheters.

➢ Nursing care is focused on accurate assessments for the need of urinary

catheters, timely removal, and appropriate care during placement.

➢ Local practice
(Gould et al., 2017)
Synopsis of Current Literature
➢ Silver coated catheters have a lower risk of infection as compared to
standard catheters.

According to the literature, silver-coated catheters…

○ Help to prevent the colonization of gram-negative bacteria, which
typically cause catheter-associated bacteria.
○ It takes longer for microorganisms to colonize on the silver-
impregnated urinary catheter system than on standard catheters.
Synopsis of Current Literature
➢ Overall, the prevention of microorganism biofilms with silver
coated catheters is associated with a 65-90% decrease in
CAUTIs in patients with indwelling catheters over 3 days
compared to patients using standard catheters

➢ In long-term patients with indwelling catheters (800-1000

days), there is a reduction of CAUTIs of 25-31% compared to
patients using standard catheters
Does anyone know what effect silver has
on bacteria?
Silver Coated Catheter’s Effects on Bacteria

Hydrophilic coated silver catheters have an

enhanced release of silver ions, inhibiting
bacterial growth, and inhibit deposition of an
inorganic biofilm(Zare, Juhart, Vass, Franz & Jocham, 2017)
Strengths
➢ Randomized control trial study designs

➢ Used current criteria to identify CAUTI which includes secondary bacteremia and not
asymptomatic bacteriuria (Aljohi et al., 2016)

➢ The same nurses that treated the patients collected the data (Aljohi et al., 2016)

➢ Some studies performed at different hospitals with patients from various ICU units to
provide a variety

➢ Same brand of catheters were placed using sterile procedure

➢ Patients had negative urine cultures before the study

➢ Patients must have positive urine cultures at least two or more days after admission
(Lederer, J.W., Jarvis, W.R., Thomas, L. & Ritter, J., 2014).
Limitations

➢ Some studies were only with patients in the ICU/high acuity setting
who were at high-risk of developing infection (immunocompromised)
(Aljohi et al., 2016).

➢ Small sample size

➢ One study was performed with synthetic urine and not tested inside
an actual person (Zare et al., 2017)
Limitations cont.
➢ Difference in age distribution between the groups

➢ Poor documentation of catheter insertion, care, and CAUTI symptoms

lead to missing data (Lederer et al., 2014)

➢ Catheters were only required in some patients for short periods of

time (Kilonzo, Vale, Pickard, Lam, & N’Dow, 2014)
Evidence Based Nursing Recommendations that
Support Best Practice
➢ From the articles that were researched it is shown that the use of silver coated
catheters is more effective in reducing occurrences of CAUTI then the
currently used standard catheters and support its use as best practice

○ Silver coated catheters should be used in hospitals instead of standard catheters

○ Silver coated catheters should be implemented especially in patients at high risk of CAUTI

■ Patients on critical care/high acuity units

○ Silver coated catheters should be used because they are associated with significant reduction
in CAUTIs

○ Silver coated catheters should be used in both male and female populations, but especially in
females because the reduction of CAUTI was shown to be even more significant in female
Overall Application and Implementation into
Nursing Practice
➢ All staff should be educated on benefits, risks, and outcomes of using silver coated
urinary catheters within 3 months.

➢ Silver coated catheters should replace standard catheters in one specific unit within 6
months.

➢ Outcomes should be evaluated for that specific unit over 1 month.

➢ Replacement of standard catheters should be implemented throughout the facility

within 1 year.

➢ Accurate nursing assessments that evaluate the need for placement, timely removal of
catheter, and proper care upon insertion and during the use of catheters are critical
aspects of catheter care that should be continued as they are part of current practice
and recommendations for the prevention of CAUTIs.
Detailed Cost Analysis
➢ Current CAUTI costs:

○ The U.S. spends an estimated $400-500 million per year (Leuck et al., 2015)

○ An average of $3000 is spent per patient to treat each case of CAUTI (Chung et al., 2017)

➢ Cost from facilities who have implemented this EBP:

○ Silver coated catheters are about $12.81 compared to standard $1.92 (Chung et al., 2017)

○ Silver coated catheters was more expensive than standard catheters

➢ Silver-Catheters Cost-Savings:
○ Prevent excess costs due to increased length of hospital stay
○ Decrease total cost for treating CAUTI’s (Lederer et al.,, 2014)
 Cost-Savings Calculations

● Long term comparison of costs

○ Standard Catheter CAUTI’s: 10 out of 30 (Aljohi et al., 2016)

■ $1.92 x (30 persons) = $57.60

• Silver coated catheters
■ $3000 x (10 persons) = $30,000 would allow hospitals to
save an estimated $26,000
● TOTAL: $30,057.60 per every 30 patients.

○ Silver Coated Catheter CAUTI’s: 1 out of 30 (Aljohi et al., • Hospitals currently spending
2016) $450 million with standard
catheters would only by
■ $12.81 x (30 persons) = $384.30 spending $50 million with
silver-catheters on CAUTI.
■ $3000 x (1 person) = $3000
Cost-Savings for Implementation
➢ Silver coated catheters would be more cost effective in the long-term
compared to overall costs of treating CAUTI caused by standard catheters.

➢ Additional Staff Training

○ Cost of RN educator for one day
○ 10 min info-session per unit

➢ Instituting facility-wide changes

○ Cost of printing informational brochures

Risks
Risk vs. Benefit
➢ Silver coated catheters are more expensive
per unit than standard catheters (Kilonzo et al., 2014)
➢ Researchers are still studying the
effectiveness of silver coated catheters for
long-term use and within certain sub-patient
groups (Bonfill et al., 2017).
➢ Additional costs in nurse educators and
training nurses on the importance of this
switch.
➢ Some patients may develop allergies to the
products used, especially with repeated
exposure.
Benefits
Risk vs. Benefit
➢ Overall savings by preventing excess costs due to
increased length of hospital stay following CAUTI
infections (Aljohi et al., 2016).
➢Decrease cost to the hospital by preventing a
hospital-acquired infection (Chung et al., 2017).
➢ Silver coating is non-toxic and has shown no
adverse effects caused by the coating on the
catheter (Aljohi et al., 2016).
➢ Silver coated catheters were better at preventing
bacterial growth than standard catheters (Cooper, Pollini,
& Palladini, 2016).
Evaluation
➢ Utilizing silver coated indwelling urinary catheters every time a patient
needs a urinary foley catheter placed, will decrease the number of
hospital acquired UTIs by 25% over the next three years.

➢ By utilizing silver coated indwelling urinary catheters to reduce the risk

of UTIs every time a patient is ordered one, the hospital will save at
least $400 million within the first year of implementation.

➢ By utilizing silver coated indwelling urinary catheters every time a

patient needs one placed, the number of UTIs in patients, up to one
month post-hospitalization, will decrease by 33%, over the next two
years.
Summary
➢ Introduction

➢ Description of issue: Extreme costs (approx. $400-500 million), death, longer

hospital stays from complications

➢ Supportive studies

➢ Discussion of best practice: Silver coated catheters are an effective way to

reduce CAUTI

➢ Application to facility

➢ Cost analysis: Although it costs more, it would actually save by reducing the
money spent when there is a nosocomial CAUTI

➢ Risk vs. benefit

QUIZ TIME
Why are CAUTIs more common in
patients in the ICU?
a) There is less monitoring of patients in the ICU for
infection

b) Every patient requires a foley catheter in the ICU

c) They are commonly immunocompromised

d) Nurses on ICU floors have less education about how to

prevent CAUTI
Why are CAUTIs more common in
patients in the ICU?
a) There is less monitoring of patients in the ICU for
infection

b) Every patient requires a foley catheter in the ICU

c) They are commonly immunocompromised

d) Nurses on ICU floors have less education about how to

prevent CAUTI
True or False: Urinary tract infections are the
most common type of healthcare associated
infections.

a) True
b) False
True or False: Urinary tract infections are the
most common type of healthcare associated
infections.

a) True
b) False
Which of the following are risk factors for
developing CAUTI?
a. Long-term use

b. Elderly patients

c. Sterile technique

d. Daily Hygiene

e. Female patients

f. Failing to maintain a closed system

Which of the following are risk factors for
developing CAUTI?
a. Long-term use

b. Elderly patients

c. Sterile technique

d. Daily Hygiene

e. Female patients

f. Failing to maintain a closed system

On average, how much does the U.S.
spend on CAUTIs each year?
a) 100-200 million dollars
b) 400-500 million dollars
c) 50-60 million dollars
d) 10-20 million dollars
On average, how much does the U.S.
spend on CAUTIs each year?
a) 100-200 million dollars
b) 400-500 million dollars
c) 50-60 million dollars
d) 10-20 million dollars
What is the association between time of
having an indwelling urinary catheter and rate
of infection?
a) The longer a patient has a catheter, the lower the rate of infection

b) The shorter time a patient has a catheter, the higher the rate of infection

c) The longer time a patient has a catheter, the higher the rate of infection

d) There is no association between time and rate of infection

What is the association between time of
having an indwelling urinary catheter and rate
of infection?
a) The longer a patient has a catheter, the lower the rate of infection

b) The shorter time a patient has a catheter, the higher the rate of infection

c) The longer time a patient has a catheter, the higher the rate of infection

d) There is no association between time and rate of infection

 How much would silver catheters save
hospitals for every 30 patients?
a) $6,000
b) $16,000
c) $26,000
d) $36,000
How much would silver catheters save
hospitals for every 30 patients?
a) $6,000
b) $16,000
c) $26,000
d) $36,000
True or False: Microorganisms colonize
faster on silver coated catheters.

a) True
b) False
True or False: Microorganisms colonize
faster on silver coated catheters.

a) True
b) False
If you were in charge of making the decision
about whether or not to implement silver
coated catheters instead of standard
catheters in a hospital, would you do it?
Why?
References
Aljohi, A. A., Hassan, H. E., & Gupta, R. K. (2016, October). The efficacy of noble metal alloy urinary catheters in reducing catheter-associated
urinary tract infection. Urology Annals, 8(4), 423-429. doi:10.4103/0974-7796.192099

Bonfill, X., Rigau, D., Esteban-Fuertes, M., Barrera-Chacon, J. M., Jauregui-Abrisqueta, M. L., Salvador, S., Aleman-Sanchez, C. M., Borau, A.,
Bea-Munoz, M., Hidalgo, B., Andrade, M. J., Espinosa, J. R., & Martinez-Zapata, M. J. (2017). Efficacy and safety of urinary catheters
with silver alloy coating in patients with spinal cord injury: A multicentric pragmatic randomized controlled trial. The ESCALE trial. Spine
Journal. doi: 10.1016/j. Spinee.2017.05.025.

Chung, P. H., Lai, C. K., Siu, H. Tsang, D. N., Yeung, K. Ip, D. K., & Tam, P. K. (2017). A prospective interventional study to examine the effect of
a silver alloy and hydrogel-coated catheter on the incidence of catheter-associated urinary tract infection. Hong Kong Medical Journal,
23(3), 239 ̶ 245. doi:10.12809/hkmj164906

Cooper, R., Pollini, & Paladini, F. (2016). The potential of photo-deposited silver coatings on foley catheters to prevent urinary tract infections.
Material Science and Engineering C, 69(1), 414-420. http://dx.doi.org/10.1016/j.msec.2016.07.004

Gould, C. D., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory
Committee. 2017. Guideline for prevention of catheter-associated urinary tract infections. Retrieved from
https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelinespdf)
References
Kilonzo, M., Vale, L., Pickard, R., Lam, T., & N’Dow, J. (2014). Cost effectiveness of antimicrobial catheters for adults requiring short-term
catheteriszation in hospital. European Urology, 66(4). Retrieved from https://doi.org/10.1016/j.eururo.2014.05.035

Lederer, J.W., Jarvis, W.R., Thomas, L., and Ritter, J. (2014). Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated
urinary catheter on symptomatic catheter-associated urinary tract infections. Journal of Wound, Ostomy, & Continence Nursing, 41(5),
473-480. Doi: 10.1097/WON.0000000000000000056.

Leuck, A.M., Johnson, J. R., Hunt, M.A., Dhody, K., Kazempour, K., Ferrieri, P., & Susan, K. (2015). Safety and efficacy of a novel
silver-impregnated urinary catheter system for preventing catheter-associated bacteriuria: A pilot randomized clinical trial.
American Journal of Infection Control, 43(3), 260-265. doi: 10.1016/j.ajic.2014.11.021

Stenzelius, K., Laszlo, L., Madeja, M., Pessah-Rasmusson, H., & Grabe, M. (2016). Catheter-associated urinary tract infections and other infections
in patients hospitalized for acute stroke: A prospective cohort study of two different silicone catheters. Scandinavian Journal of
Urology,50(6), 483-488. doi:10.1080/21681805.2016.1194459

Zare, H. H., Juhart, V., Vass, A., Franz, G., & Jocham D. (2017). Efficacy of silver/hydrophilic poly (p-xylylene) on preventing bacterial growth and
biofilm formation in urinary catheters. Biointerphases, 12(1), 1-10.doi:10.1116/1.4974197