AHRQ Safety Program for Long-term Care: HAIs/CAUTI

Catheter Care and

Maintenance

National Content Series

AHRQ Pub. No. 16(17)-0003-12-EF

March 2017
 Objectives
Upon completion of this webinar participants will be able to—

• Explain best practices of indwelling urinary catheter care;

• Review the do’s and don’ts of catheter care and
maintenance; and
• Describe the TeamSTEPPS strategy of mutual support and
how it can be used to improve catheter care and
maintenance and prevent healthcare-associated infections
and catheter-associated urinary tract infections.

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 Entry Pathways for Microbes1,2,3
• Breaks in the catheter tubing
or collection bag
• Contamination of the catheter
tubing or collection bag

• Entry during insertion

• Bacteria movement
up the catheter
Source: www.catheterout.org. Used with permission.

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 Hand Hygiene and Glove Use4,5

Gloves play a key role in preventing hand contamination—but

do NOT replace hand hygiene
Perform hand hygiene and wear gloves immediately before—
• Accessing the drainage system
• Emptying the drainage bag
• Collecting a urine sample

Remove gloves and perform hand hygiene immediately after—

• Handling an indwelling catheter
• Accessing the drainage system
• Emptying the drainage bag
• Collecting a urine sample

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 Drainage Bag Care2,3,6,7
• Only trained staff should empty the urine collection
bag and rinse/store containers
• Follow manufacturer’s instructions on use
• Empty drainage bags regularly (at least once per shift)
• Stabilize the catheter tubing and drainage bag
• Keep drainage bag below level of bladder and off the
floor at all times
• Consider where to place the drainage bag during
resident’s daily activity
• Wheelchair
• Walker (clamp or hook)
• Bed
• Dining/activity area
• Lounge/reading chair (peg on side)
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 Leg Bags and Bath Basins7-10*

Leg Bags Bath Basins

• Residents sometimes prefer leg bags, • Clean and disinfect basins after
which can improve mobility and each bathing procedure
dignity • Keep bath basins clean and dry
• Leg bag care and changing should be when not in use, and stored upside
done per your facility’s policy down to prevent airborne
• The outside of the leg bag and the contamination
leg straps should be— • Replace basins if damaged
• Wiped down during routine, daily • A resident identifier should be
bathing care clearly displayed
• Rinsed and promptly dried
• Do not allow prolonged skin-to-skin
contact with wet/damp materials
*Disclaimer: A multidisciplinary team reviewed the literature, and while there is a general lack of research and evidence surrounding leg bag and bath basin
care, this team was able to make general recommendations. Please remember to follow your facility’s policy and direct any questions to your supervisor.
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 The DO’s of Indwelling Urinary Catheter
Care2,3,6,7

• Do perform peri-care using only soap and water

• Do keep the catheter and tubing from kinking and becoming
obstructed
• Do keep catheter systems closed when using urine collection
bags or leg bags
• Do replace catheters and collection bags that become
disconnected
• Do ensure the resident’s identifier/implementation date is on
their urine collection containers
• Do make sure to disinfect the sampling port before obtaining a
sample
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The DON’Ts of Indwelling Urinary Catheter
Care2,3,6,7
• Don’t change catheters or drainage bags at routine, fixed intervals
• Don’t administer routine antimicrobial prophylaxis
• Don’t use antiseptics to cleanse the periurethral area while a
catheter is in place
• Don’t clean the periurethral area vigorously
• Don’t irrigate the bladder with antimicrobials
• Don’t instill antiseptic or antimicrobial solutions into drainage
bags
• Don’t routinely screen for asymptomatic bacteriuria
• Don’t contaminate the catheter outlet valve during collection bag
emptying
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 Mutual Support in Teamwork11

• Assisting each other

• Providing and receiving feedback

• Exerting assertive and advocacy

behaviors when resident safety is
threatened

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What Behaviors Exemplify Mutual Support?

• Monitoring other team members’ performance to anticipate

assistance requests
• Offering or requesting assistance
• Filling in for a member who cannot perform a task
• Cautioning team members about potentially unsafe situations
• Self-correcting and helping others correct their mistakes
• Distributing and assigning work thoroughly
• Rerouting/delaying work so that an overburdened team member
can recover
• Regularly providing constructive feedback to team members
• Providing encouragement
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 Mutual Support Through Task
Assistance11

Team members foster a

climate in which it is expected
that assistance will be actively
sought and offered as a
method for reducing the
recurrence of error.

Source: TeamSTEPPS© for Long-Term Care Version

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 Case Study

Joe, a certified nursing assistant (CNA), is busy

getting Mr. Rappaport ready for his doctor’s
appointment and Mr. Cortez ready for his therapy
session. Mr. Rappaport is in a wheelchair with urinary
catheter tubing on the floor and a full urine
collection bag attached to the chair.

How could Sarah and Michael, two CNAs with down

time, offer task assistance in this scenario?

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 The Nuts and Bolts of Task Assistance11

Keep communication clear and explicit; share your

specific availability and skills when offering assistance
• Use please and thank you
• Close the communication loop
• Account for your coworker’s experience level
• Foster a supportive climate—pay it forward

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 References
1. catheterout.org. The University of Michigan. http://www.catheterout.org/. Accessed February 1, 2016.
2. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care
hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014 May;35(5):464-79. PMID: 25376068.
3. Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections
2009. Infect Control Hosp Epidemiol. 2010 April;31(4):319-26. PMID: 20156062.
4. Boyce, JM, Pittet D, Healthcare Infection Control Practices Advisory Committee et al. Guideline for hand hygiene in
health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol. 2002 December;23(S12):S3-40.
PMID 12515399.
5. Ellingosn K, Haas JP, Aiello AE, et al. Strategies to prevent healthcare-associated infections through hand hygiene.
Infect Control Hosp Epidemiol. 2014 September; 35(S2):S155-78. PMID 25376074.
6. Lynn P. Taylor’s Clinical Nursing Skills: A Nursing Process Approach. Philadelphia: Wolters Kluwer; 2015.
7. Centers for Medicare & Medicaid Services (CMS). Department of Health & Human Services (DHHS). State Operations
Manual. Appendix PP –Guidance to Surveyors for Long Term Care Facilities. (Rev. 157, 06-10-16).
8. Johnson D, Lineweaver L, Maze LM. Patients’ bath basins as potential sources of infection: a multicenter sampling
study. Am J Crit Care. 2009 January;18(1):31-8. PMID 19116402.
9. Marchaim D, Taylor AR, Hayakawa K, et al. Hospital bath basin are frequently contaminated with multidrug-resistant
human pathogens. Am J Infect Control. 2012 August;40(6):562-4. PMID 22177667.
10. Rupp ME, Huerta Tm Yu S, et al. Hospital basins used to administer chlorhexidine baths are unlikely microbial
reservoirs. Infect Control Hosp Epidemiol. 2013 June;34(6):643-5. PMID 23651900.
11. TeamSTEPPS® Long-Term Care Version. Rockville, MD: Agency for Healthcare Research and Quality; content last
reviewed September 2015. http://
www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/index.html.
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