ASPIRE HOSPITAL PVT. LTD.

BHUBANESWAR
CAUTI MAINTENANCE BUNDLE CARE CHECK LIST
Patient Name: IP NO: Ward / Bed NO:
Admission Date: Date of Catheter insertion: Date Of Reporting:
Sl No. CRITERIA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Hand hygiene
Before & After
procedure
2 Ensure closed
drainage system
3 Ensure daily
meatal care
4 Regular empty
of urinary
drainage bag
into a separate
clean container
5 Maintain
unobstructed
urine flow
6 Remove the
catheter if not in
use or remain in
SITU
Signature of Morning
Nursing Staff Evening
Night
Date Sample Organism Antibiotic Profile
Remarks Sign of Nursing I/C :