Catheter-associated urinary tract infection (CAUTI) is a common infection that a person can contract in a hospital setting. Catheter-associated urinary tract infection is caused by the infection from the tube of an indwelling catheter inserted at the person’s urethra.
An indwelling catheter is used to drain urine from a person’s bladder into a collection bag. A catheter may be needed after surgery or if a person cannot control the bladder function.
It is important to closely monitor the urine that the kidneys are producing. The most common cause of CAUTI is the prolonged use of the urinary catheter.
Signs and Symptoms of CAUTI
A person with CAUTI will show signs and symptoms similar to a typical urinary tract infection. The signs and symptoms of catheter-associated urinary tract infection include:
- cloudy urine
- blood in the urine
- strong and foul urine odor
- leakage of the urine around the patient’s bladder
- pain, pressure, and discomfort in the patient’s lower back or stomach
- chills
- fever
- unexplained fatigue
- vomiting
Diagnosing catheter-associated urinary tract infections may be difficult to diagnose because of the similar symptoms that the patient might experience as part of the patient’s original illness.
Causes of CAUTI
Catheter-associated urinary tract infections happen when germs enter and infect the urinary tract through the urinary catheter. The infection is caused by the bacteria and fungi that entered the urinary tract thru the urinary catheter. The catheter-associated urinary tract infection is a type of UTI that cannot be treated by common antibiotics.
Infection during catheterization occurs when:
- the catheter is already contaminated upon insertion
- the drainage bag is not emptied appropriately
- bacteria from a bowel movement that reached the catheter
- urine in the catheter bag flows backward into the bladder
- the catheter is not regularly cleaned by the caregiver
Insertion and removal of the catheter should be clean to lower the risk of having a catheter-associated UTI. Daily catheter care is required and the catheter should not be left longer than needed.
Risk Factors to CAUTI
Catheter-associated urinary tract infection is more common in women and older people. The duration of use of the patient’s catheter is the main risk factor for the development of catheter-associated urinary tract infections. Other conditions that may increase the risk of getting CAUTI are:
- catheter that is placed for more than two (2) days
- a patient’s history of urinary tract infection
- kidney problems
- diabetes
- immune system problems
Complications of CAUTI
Prompt treatment of catheter-associated urinary tract infections is important. An untreated UTI can cause a more serious kidney infection.
A person with catheters may already have a condition that compromises the person’s immune system. Fighting off a CAUTI may cause further immune system stress to the body that makes the person more vulnerable.
The biggest and the most obvious effect of catheter-associated urinary tract infection is uncomfortable and painful urination.
Any urinary tract infection will irritate the person’s urinary system and will cause discomfort, bad-smelling urine, and potential damage to the person’s internal organs. Untreated CAUTI can cause problems such as:
- narrowed urethra that makes it difficult for a person to urinate in the future
- kidney damage due to chronic and repeated infections of the urinary tract
- kidney infections because of the germs that move from the urethra and the bladder
- sepsis, which is a potentially deadly body-wide infection that affects the urinary system and the bloodstream.
Diagnosis of CAUTI
A catheter-associated urinary tract infection can be diagnosed using:
- Urinalysis. Urinalysis can help detect the presence of blood in the patient’s urine. The presence of blood in the patient’s urine indicates an infection. Urinalysis is used to detect a wide range of disorders that involves the urinary tract.
- Ultrasound scan. The ultrasound scan can be done to detect retained urine. An ultrasound scan is a test that uses high-frequency sound waves that captures live images inside a person’s body. An ultrasound helps the physician to visualize the problems of the organs, vessels, and tissues without incision.
- Urine culture. Urine culture is a test that identifies the present bacteria or fungi in the person’s urine. A urine culture can help to identify the type of microorganism that causes the infection. This test also helps in determining the best treatment and antibiotics that should be given to a patient.
The person’s bladder may not move the urine out of the body quickly which may happen even with a catheter. Bacteria may grow because of the retained urine. The risk for infection will increase if the urine stays longer in the patient’s bladder.
Treatment for CAUTI
CAUTI is more resistant to medications and treatment than other urinary tract infections. CAUTIs are dangerous and may lead to severe infections. Prompt treatment and diagnosis are needed for the patient’s long-term health.
The treatment for CAUTI includes the following:
- Catheter removal. Catheter removal prevents infection and other complications that will be caused by the catheter. When the catheter is removed, it will eliminate the probable source of germs that will decrease the risk of having an infection.
- Medication. The physician may prescribe the patient a medication that will treat the infection. Antibiotics are prescribed by the physician to treat urinary tract infections caused by bacteria. The patient may take antibiotics as prescribed by the physician for at least 1 to 3 weeks.
The nurse must report to the physician if the patient experiences any of the following:
- Fever that is more than 101 degrees Fahrenheit
- Increased urination that the patient usually do
- Lower abdomen feels tender and absence of urine in the catheter bag
- Urine smells particularly bad
- Blood or blood clots in the urine
Prevention of CAUTI
Catheter-acquired urinary tract infection or CAUTI can be prevented by handwashing, not using urine drain tubes and if the drain tubes must be used, insert the tube properly and keep them clean. Catheters must be used only when necessary and removed as soon as possible.
Core prevention strategies include:
- Insert catheters only for proper indications
- Leave the catheter in place only if needed
- Ensure that catheters should be inserted by trained persons only
- Observe proper aseptic and sterile technique when inserting catheters
- Maintain a closed drainage system after aseptic insertion of the catheter
- Always maintain an unobstructed urine flow
- Maintain hand hygiene and standard precautions
- Ask the doctor regularly to make sure if the catheter is still needed for the patient’s health
- Clean the catheter drainage bags carefully by following the instructions from the doctor
- Change the drainage bags at least twice per day
CAUTI Nursing Diagnosis
CAUTI Nursing Care Plan 1
Nursing Diagnosis: Acute Pain related to the inflammation and infection of the urinary tract, secondary to catheter-associated urinary tract infection, as evidenced by, facial grimace, guarding behavior, protective decreased physical activity, and spasm of the lower back and bladder area.
Desired Outcomes:
- The patient will be able to use pharmacological and non-pharmacological pain relief approaches.
- The patient will report acceptable pain control at a level of 3 to 4 on a decreased level of 0 to 10.
- The patient will express and report an absence of pain.
| CAUTI Nursing Interventions | Rationale |
| 1. Ask the patient to define the pain, including the quality, nature, and severity of pain. | Defining the quality, nature, and severity will help the nurse to determine the choice for intervention. |
| 2. Ask the patient if he or she is experiencing any signs and symptoms of a catheter-associated urinary tract infection. | Common symptoms of catheter-associated urinary tract infection should be assessed, such as abnormal urine color, cloudy urine, blood in the urine, foul urine odor, and frequent or strong urge to urinate. |
| 3. Check the laboratory and diagnostic results of the patient such as the WBC count, urinalysis, bacteria in the urine, urine culture and sensitivity, Computed tomography, (CT-Scan), ultrasound, and kidney scans. | Laboratory and diagnostic tests will help the nurse in formulating and determining the proper interventions for the patient. |
| 4. Provide a heating pad and apply it to the suprapubic area of the patient’s lower back. | Heat therapy is one of the effective ways to treat back pain because it helps the body in boosting circulation which allows nutrients and oxygen to travel to the patient’s joints and muscles. |
| 6. Give the patient analgesic and anti-spasmodic agents as indicated. | A patient who is experiencing bladder irritability, spasm, and pain may be given anti-spasmodic and analgesic to relieve pain. |
| 7. Advise the patient to increase his or her fluid intake unless contraindicated. | The patient should be advised to increase fluid intake to at least 2 to 3 liters per day which will help in facilitating urine production, dilutes urine, decrease irritation of the inflamed bladder, promotes renal blood flow, and helps in flushing the bacteria from the urinary tract. |
CAUTI Nursing Care Plan 2
Nursing Diagnosis: Impaired Urinary Elimination related to frequent urination and urgency secondary to, catheter-associated urinary tract infection, as evidenced by, urinary frequency and dysuria.
Desired Outcomes:
- The patient will be able to achieve normal urinary elimination patterns and will not show signs of urinary disorders.
- The patient will show behavioral techniques that will help prevent urinary tract infections.
| CAUTI Nursing Interventions | Rationale |
| 1. Check for the patient’s urinary elimination pattern. Physical assessment of the patient who is experiencing impaired urinary elimination includes: Identify the presence of symptoms such as frequency, urgency, and dysuria.Check for the patient’s urine color, cloudiness, and if there is a presence of a malodorous smell.Check for the patient’s pattern of urination as well as the amount of urination. | Assessing the patient’s pattern of urinary elimination can help the nurse in determining the factors that may cause UTI. Assessing the patient’s pattern of elimination will serve as a basis for determining suitable nursing interventions. |
| 2. Check the patient’s lab works and diagnostics test results. | Laboratories and diagnostic tests should be checked by the nurse to diagnose acute or chronic renal disease. |
| 3. Evaluate the patient’s regular intake and output. | The patient’s intake and output should be evaluated in terms of amount, type, and color, which will also help the nurse in determining the hydration levels of the patient. |
| 4. Check for issues with catheterization. | The nurse should ensure that the catheters that are used for the patient’s bladder dysfunction are correctly placed. |
| 5. Encourage the patient to increase water intake. | Advise the patient to increase intake of water if not contraindicated. If the patient is properly hydrated, the patient will be able to maintain proper urinary elimination and renal function. |
| 6. Routine bladder scanning should be done. | Bladder scanning is a non-invasive ultrasound procedure that will help to diagnose, manage and treat urinary outflow dysfunction. |
CAUTI Nursing Care Plan 3
Nursing Diagnosis: Hyperthermia related to inflammation and infection secondary to catheter-acquired urinary tract infection as evidenced by increased body temperature above the normal range, and flushed skin.
Desired Outcomes:
- The patient will maintain his or her temperature within the normal range.
- The patient will verbalize feeling warm and the flushed skin will be reduced.
| CAUTI Nursing Interventions | Rationale |
| 1. Check for any signs of increased body temperature such as shivering, headache, warm skin, sweating, and body malaise. | A patient with hyperthermia due to a catheter-acquired urinary tract infection may show symptoms such as sweating, shivering, body malaise, and warm skin, which should be monitored by the nurse. |
| 2. Check for the patient’s vital signs, especially the patient’s temperature for any changes at least every 4 hours. | Checking the patient’s vital signs will help the nurse to determine and identify the needs of the patient. The patient’s heart rate and blood pressure may be changed if hyperthermia progresses. |
| 3. Provide a tepid sponge bath if the temperature rises. | A tepid sponge bath is done by application of water to the skin of the patient’s skin surface that will help promote dispersal of body heat if hyperthermia occurs. |
| 4. Advise the patient to take adequate liquids at least 2 liters of fluids throughout the day for at. | An adequate liquid intake will help in preventing dehydration that is caused by an increased temperature due to catheter-associated urinary tract infection. Dehydration may cause fever, fatigue, bad mood, and headache. |
| 5. Advise the patient to use blankets or hypothermia blankets and wrap the patient’s extremities with bath towels. | Providing blankets or hypothermia blankets will help to avoid shivering. |
| 6. Advise the patient to have bed rest. | The nurse should instruct the patient to have complete rest that will help minimize unnecessary energy consumption which may increase body temperature. |
| 7. Give the patient antipyretic medications as needed. | Anti-pyretic medications will help reduce fever. Anti-pyretic medication can be given every four hours if the fever still progresses. |
| 8. Remove and change the patient’s urinary catheter properly and aseptically as needed. | The urinary catheter must be changed because a contaminated urinary catheter may be the cause of the patient’s hyperthermia. |
CAUTI Nursing Care Plan 4
Nursing Diagnosis: Deficient Knowledge related to the unfamiliarity of the condition secondary to catheter-associated urinary tract infection as evidenced by multiple questions, recurrence of CAUTI, and patient’s verbalization of inaccurate information.
Desired Outcomes:
- The patient will express and verbalize learning about the cause and treatment of the condition.
- The patient will express learning about the risk factors and treatment for the condition.
| CAUTI Nursing Interventions | Rationale |
| 1. Ask the patient about his or her readiness to learn, misconceptions about the condition, and the hindrances to learning such as poor memory and poor lifestyle habits. | Asking the patient about his or her knowledge about the condition will help the nurse to evaluate the patient’s cognition and mental status towards the condition. |
| 2. Educate the patient about the condition’s risk factors, cause, prevention, and management. Avoid using a medical terminologist that the patient cannot easily understand. | Provide information in the simplest way possible. Frequent recurrence of the condition may indicate that the patient has difficulty understanding the condition. |
| 3. Instruct the patient about the ways to determine the recurrence of the condition’s signs and symptoms. | This will help the patient to manage his or her health which will allow detecting the recurrence early. The nurse should instruct the patient that CAUTI usually recurs within 1 to 2 weeks after the patient has completed the antibiotic therapy. |
| 4. Teach the patient the importance of drinking at least 2 liters of fluids throughout the day, if it is not contraindicated for the patient. | The nurse should emphasize the need for adequate oral fluid intake that will result in more urine production that will lead to the flushing of bacteria from the person’s bladder after the urine is eliminated. |
| 5. Ask the patient about his or her willingness and eagerness to learn. | The patient will be needing willingness and eagerness to easily learn. The patient must know and understand the need and the purpose of learning. The nurse should also understand that the patient also has the right to refuse educational services. |
| 6. Ask the patient about the patient’s learning style, and ask the patient if he or she has learned and retained new information in the past that will help the patient learn easily. | The nurse should consider the patient’s learning style which may help when planning educational strategies. Some patients may prefer written material over visual materials, while some patients prefer group discussions over individual instruction. |
CAUTI Nursing Care Plan 5
Risk for Urge Urinary Incontinence
Nursing Diagnosis: Risk for Urge Urinary Incontinence related to abnormal bladder contraction and loss of bladder control secondary to catheter-associated urinary tract infection.
Desired Outcomes:
- The patient will be able to identify ways to avoid the occurrence of incontinence episodes.
- The patient will be able to identify the factors that may increase the risk for urinary incontinence.
| CAUTI Nursing Interventions | Rationale |
| 1. Ask the patient about the episodes of incontinence that he or she is experiencing and check for the possible cause of incontinence. | Contraction of the bladder muscles will cause urge incontinence. The patient may report the presence of feeling the need to urinate even with a catheter. |
| 2. Check and record the time, size, and amount of urine. | The nurse should advise the patient to keep a daily diary that indicates the voiding frequency and patterns that will give information for the individualized treatment plan. |
| 3. Check and review the patient’s medication that may cause incontinence. | Medications may have potential adverse effects that include impairment of cognition, and alteration of the bladder tone and may promote diuresis. |
| 4. Examine the patient by performing maneuvers and tests to check for urinary incontinence. | The nurse may instruct the patient to do the cough stress test wherein the patient is instructed to cough to demonstrate involuntary leakage of the urine. |
| 5. Advise the patient to reduce fluid intake at night, but encourage increased fluid intake as tolerated during daytime. | Arranging the patient’s fluid intake will maintain adequate hydration and will promote urinary flow. Caffeine should be avoided because caffeine is a natural diuretic that has an excitatory effect on the bladder’s smooth muscles. |
| 6. Ensure that the catheter is properly placed. | A catheter is important because it has been one of the mainstays of severe anti-incontinence treatment and may be a permanent solution for overflow incontinence. |
| 7. Provide medications as prescribed by the physician. | Stress and urge of urinary incontinence may be treated by medications that are known to be effective. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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