Resident Physicians as Champions in Preventing Device-Associated Infections Pocket Guide
PREVENT DEVICE-ASSOCIATED INFECTIONS: EVALUATE ALL DEVICES DAILY!
Indwelling devices that HEAL may also HARM! Use them only when necessary.
- What is the Indication for the device?
- Can the device be DISCONTINUED?
- Is there a less risky ALTERNATIVE?
Appropriate Urinary Catheter Indications
- Acute urinary retention or obstruction
- Perioperative use in selected surgeries
- Assist healing of severe perineal and sacral wounds in incontinent patients
- End-of-life care for comfort
- Required strict immobilization for trauma or surgery
- Accurate measurement of hourly urinary output in critically ill patients (ICU only)
Placement and Maintenance
- Use aseptic technique when inserting urinary catheters
- Avoid opening the closed urinary catheter system
- Make sure the urinary catheter has a securement device
- Avoid looping or kinking of catheter
Keep the urinary bag lower than the patient’s bladder.
Central Venous Catheters
- Use complete sterile barrier precautions (CAP, GOWN,MASK, & FULL DRAPE) and chlorhexidine-alcohol antisepsis for central line insertion
- Scrub the hub with an alcohol swab for 15 seconds EVERYTIME you access the line
- Keep dressings intact at all times
- Avoid femoral lines and remove them ASAP
- Remove emergently placed lines within 24 hours
- Evaluate for sedation vacation and weaning trials for patients on mechanical ventilation DAILY
- Keep the head of the bed elevated at least 30 degrees on all intubated patients
- Perform oral care for your patients every 12 hours
- No automatic or reflex culturing
Catheterized patients: cloudy, dark, smelly urine ≠ CAUTI
- Intubated patients: do not obtain sputum culture unless signs suggestive of pneumonia