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Catheter Associated Urinary Tract Infection (CAUTI) Prevention in the ED

JJ Sverha, MD, FACEP
EMA & ASE Clinical Operations Committee

Drew Fuller, MD, MPH, FACEP
EMA & ASE Safety Leadership Group

StethoscopeAccording to the CDC, catheter associated UTIs (CAUTIs) have been a significant source of HAI mortality and injury in the US. It has been estimated that 9,000 deaths and 380,000 UTIs are caused by unnecessary or improperly place urinary catheters. (CDC CAUTI Guideline 2009 ref #22).

Because many urinary catheters (UC) are placed in the ED setting, the American Hospital Association created an ED specific resource as part of their “On the Cusp, Stop HAI” program.  Several valuable tools and resources are located on the site to enroll EDs in the practices for decreasing CAUTI.  The site does have a considerable focus on enrolling participants in a cohort for data collection, which may not be the interest of department leaders looking to achieve simple best practices for their hospital.

To help meet the needs of ED leadership and clinicians, we have developed a web-resource to highlight critical actions and provide focused resources for CAUTI prevention. The site was created by a collaboration of ED clinicians with input from several QIPS members and offers new tools as well as several customized AHA resources.

The main critical leverage points highlighted on the website include:

  1. Establish a department policy that all urinary catheter (UC) placements require a formal provider order with a CDC guideline approved indication
  2. Hardwire urinary catheter orders with indication into the EHR system
  3. Assure that all staff placing and maintaining UCs are properly trained on best practices for:
            a. Aseptic insertion
            b. Securing catheter to the leg (preventing excess movement and urethral traction)
            c. Keeping collecting system closed and below the level of the bladder
  4. Establish a system to reassess the need for all UC placements within 24 hours of admission.

While early in development, we are seeking feedback, resources and recommendations to further engage and empower ED leaders and clinicians to decrease CAUTI and other ED safety threats.  


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