There is variation within the outcome data being reported
as many clinical teams continue to have difficulty diagnosing
CAUTI and adhering to the national CAUTI definition.
Nursing staff are relying on classical clinical signs and symptoms
for predicting symptomatic CAUTI, i.e. discoloured and
malodorous urine. This is routinely followed up with urine
dipstick testing, prescribing of antibiotics by medical staff and
a catheter specimen of urine being obtained. In many cases,
these patients have CA-ASB and have no clinical signs and
symptoms of CAUTI.The correct processes regarding CAUTI
signs and symptoms, microbiological testing and CAUTI
diagnosis are continually being raised via formal and informal
education sessions and during ward visits. In addition to this,
clinical staff are being referred to the SIGN (2012) and SAPG
(2014) national guidance.All cases of CAUTI that are reported
by senior charge nurses are quality assured to exclude any cases
of CAUTI that are incorrectly reported.
Despite the variation, CAUTI rates are relatively low
(Figure 3), however, additional measures may reduce the rates
further, such as a reduction in UUC placement. Urinary
catheter prevalence is demonstrated in Figure 4.
Observation of practice and reasons stated for urethral
catheterisation suggest that using alternative continence
products/devices such as female slipper pans, uro-sheaths,
male penile pouches, intermittent self-catheterisation;
bladder scanning and appropriate use of continence pad
and pants may not always be considered by clinical areas as
first-line treatment and a UUC may be inserted. Promoting
alternative continence aids has proven successful in some
areas—after all, the easiest and most appropriate way
to prevent CAUTI is to use, where appropriate, other
alternative continence aids (Tenke et al 2008). In the
absence of an acute continence nurse service, nursing staff
feel that their knowledge and continence education is not
up-to-date enough to feel confident to make alternative
product choices.