Catheter-Associated Urinary Tract Infections

A catheter-associated urinary tract infection (CAUTI) is an infection of the urinary system. CAUTI is caused by bacteria that enter the urinary tract when an indwelling urinary catheter is used. An indwelling urinary catheter, or Foley is a tube that’s placed into the bladder to drain urine.

The urinary system

This system includes the kidneys, ureters, bladder, and urethra. The kidneys filter blood and make urine. The urine is carried to the bladder through the ureters. From the bladder, urine goes through the urethra to the outside of the body.

What is a urinary catheter?

A urinary catheter is a thin, flexible tube that is placed in the bladder to drain urine. Urine flows from the bladder through the tube into a collecting bag outside of the body. There are different types of urinary catheters. The most common type is an indwelling urinary catheter, also called a Foley catheter. An indwelling urinary catheter may also be called a urethral catheter because it’s placed into the bladder through the urethra.

Why is a urinary catheter needed?

A urinary catheter may be used for any of the following:

• If you are not able to urinate on your own.
• If you have a blockage in your urinary system.
• If your healthcare provider needs to measure the amount of urine you make, for example, during intensive care.
• During some tests of the kidneys and bladder.
• During and after some types of surgery.

In most cases, the urinary catheter is temporary. You'll need it only until the problem that requires it is resolved.

Removing the catheter as soon as possible is important because people with urinary catheters have a much higher chance of an infection than people who don’t have a urinary catheter.  

How does a CAUTI develop?

Bacteria can enter the urinary tract as the catheter is put into the urethra or while the catheter is in place. The most common bacteria that cause a CAUTI are ones that live in the intestine. These bacteria don’t normally cause problems in the intestine. But when they get into the urinary tract, a CAUTI can result. Regular perineal and catheter care can reduce the number of these bacteria and help prevent a CAUTI.  

Why is a CAUTI of concern?

Left untreated, a CAUTI can lead to health problems. These problems may include bladder infection, prostate infection, and kidney infection. A CAUTI can prolong your hospital stay. If the infection is not treated in time, serious health complications may occur.

What are the symptoms of a CAUTI?

• Burning, pressure, or pain in your lower abdomen
• Aching in the back (kidney area)
• Fever
• Bloody urine may be a sign of infection but is also caused by other problems.
• Burning during urination or an increase in the frequency of urination after the catheter is removed.
• Note that sometimes a person won’t have any symptoms but may still have a CAUTI.

Tell a healthcare provider right away if you or your loved one has any of these symptoms.

How is CAUTI diagnosed?

If you have symptoms of CAUTI your healthcare provider will order urine tests and other tests as needed.

How is CAUTI treated? 

Treatment may involve any of the following:

• Antibiotics. Your healthcare provider will use your symptoms and the results of your urine tests to prescribe the most effective antibiotics. If you do not have symptoms or the urine test is negative for bacteria, you may not be prescribed antibiotics. Prescribing antibiotics if they are not needed can lead to an increase in bacteria that resist (can’t be killed by) certain antibiotics which increases the risk for more serious infections that do not respond to medicine.
• Removing the catheter as soon as it’s no longer needed can prevent a CAUTI and also help stop an infection.
• If the catheter needs to remain in place the provider may choose to replace the catheter to help stop the infection.

How do hospital and long-term facility staff prevent CAUTI?

To keep patients from getting a CAUTI, the staff follow certain procedures:

• Use indwelling urinary catheters only when it’s needed and remove as soon as it’s no longer needed.
• Use sterile (“clean”) technique when placing the catheter into the urinary tract. This means before putting the catheter in, the caregiver washes his or her hands with soap and water. He or she then puts on sterile gloves and uses a sterile catheter kit that has cleansers used to clean the genital area before the catheter is inserted.
• Before and after touching the catheter  caregivers wash their hands or use an alcohol-based hand cleanser. If you do not see your provider clean their hands, please ask them to do so.
• Hang the bag lower than your bladder. This prevents urine from flowing back into your bladder.
• Ensure that the bag is emptied regularly. The drainage spout should not touch anything while emptying the bag.
• Secure the catheter to your leg to prevent pulling.
• Check to make sure tubing is not kinked or twisted.
• Avoid disconnection of catheter and drain tube. This helps to prevent germs from getting into the catheter tube.

• Sometimes other methods to drain the urine are used to avoid indwelling urinary catheter placement. These may include external catheters in men (these look like a condom and are placed over the penis instead of inserted into the penis) or using a temporary catheter to drain the urine and removing it right away. This is called intermittent catheterization. What you can do as a patient to prevent CAUTI

What you can do as a patient to prevent CAUTI

You can help prevent yourself from getting a CAUTI by doing the following:

• Every day ask your healthcare provider how long you need to have the catheter. The longer you have a catheter, the higher your chance of getting a CAUTI.
• If a caregiver doesn’t clean his or her hands and put on gloves before touching your catheter, ask them to do so.
• If you’ve been taught how to care for your catheter, always wash your hands before and after each session.
• Make sure your bag is lower than your bladder at all times. If it’s not, tell your caregiver.
• Don’t disconnect the catheter and drain tube. Doing so allows germs to get into the catheter.
• Do not tug or pull on your catheter tubing.
• Do not twist or kink the catheter tubing.
• Regular cleansing of the genital and perineal areas is very important to help decrease bacteria in areas surrounding the catheter. The nursing staff caring for you can provide this care or teach you how to perform.