Preventing Catheter-Associated UTIs: What to Know
Are catheters causing more harm than help in nursing homes? Catheter-associated urinary tract infections (CAUTIs) are one of the most common—and preventable—dangers residents face. These infections can lead to serious health issues if not properly managed. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Kaci Korthuis to talk about how CAUTIs happen, what warning signs to watch for, and the best practices for prevention in long-term care settings.
Korthuis:
So I think it’s best practice to place silicone over latex. This person’s gonna have a long-term catheter. I think that it’s gonna be worth your time and money to be placing silicone catheters. If you’re thinking about placing long-term. You want to place something that’s gonna be effective and decrease the risk of uti.
Schenk:
Hey, out there everybody. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I will be your host for this episode. Today we’re talking about catheter associated UTIs, particularly in those who are going to be using catheters for the long term, not short term but we’re not doing that alone.
We have the wonderful Casey Courthouse with this to talk about the risks and how to mitigate the risks of long-term catheter use.
Casey is the founder of Korthuis Legal Nurse Consulting, LLC brings eight years of diverse nursing experience to her role as a legal nurse consultant with expertise in progressive care, community health and home health case management. She specializes in medical record reviews, case analysis, and expert insights for attorneys passionate about patient advocacy.
Casey’s keen attention to detail, helps uncover deviations from the standard of care, ensuring legal teams have clear evidence-based support and complex medical cases, and we’re so happy to have her here. Casey. Welcome to the show.
Korthuis:
Thank you for having me.
How do catheters increase the risk of UTIs in nursing home residents?
Schenk:
Oftentimes in my experience, I get a call from a family member of a loved one that has been in a nursing home and they’re in the hospital.
And they’re on the hospital because of of sepsis, which with an underlying cause of UTI. And sometimes my question is does that person have a catheter? And I’ve never taken the time to be like why is that my first question? So that’s my first question to you is how do catheters factor into whether or not you’re gonna get a UTI? Does it increase the risk, decrease the risk, that type of thing?
Korthuis:
Yeah, so it, it absolutely increases the risk because you have a medical device that has been inserted into your, internally, into your body and it provides a direct access for bacteria and pathogens to travel into the bladder. And that’s also direct access to your bloodstream because what’s happening is your kidneys are filtering out your.
Blood, creating the urine to be excreted from your body. So when you have bacteria traveling up, it’s going, it’s going backwards causing that sepsis and causing the infection in your body. It’s a really good question to ask when you get those cases of, do they have a catheter?
Because it absolutely increases the risk of UTI by a lot. And in fact, when it comes to, in the healthcare world, placing a catheter, there has to be a super good indication to place that catheter in the first place. We’re not just like. Oh it would just be so much simpler to place a catheter because this person is having incontinence or not able to make it to the bathroom in time.
Learn strategies for preventing UTIs in Georgia nursing homes and why prevention is key.
That’s not why we’re placing catheters to begin with. There’s, in the hospital setting there’s quite often like urinary retention. So somebody’s bladder is just filling up and unable to, relieve themselves and it’s super uncomfortable. So there’s reasons like that. Intensive care purposes.
Sometimes they like extremely accurate intake and output. So whatever the patient or client is consuming through IV or orally they like to get that and then also see what’s coming out. ’cause it can indicate how well the kidneys are working. So that’s that’s in, in the hospital setting.
That’s why. The catheter would be placed.
Review the latest research on the impact of preventive health measures in elderly populations.
Schenk:
That’s interesting. I guess I never thought about it in, in those terms is that it’s the catheter, depending on what your clinical condition isn’t necessarily the first go-to thing and it’s because of that risk of infection, if I understand you correctly.
So there’s gonna be a kind of a cost benefit analysis of whether or not a catheter is gonna be inserted. One of those being okay, if we need to know exactly what your input output is, maybe that’s gonna be a factor in favor of the catheter versus, versus not, et cetera. So what are let’s back up a little bit then.
What are the common signs of a catheter-associated UTI in elderly patients?
Schenk:
What are some of those clinical conditions that would warrant a catheter? Let’s do long term first. ’cause that’s typically, yeah that’s who I’m dealing with.
Korthuis:
Yeah, and it’s typically who I’m dealing with as well. So I am often the nurse who goes in for the orders of placing a catheter every single month.
Sometimes it’s every three weeks. Sometimes it’s more frequent, depending on the client or patient. But for long-term conditions, you would find like spinal cord injuries and then paralysis. It typically in males like prostate issues. So urinary retention is a really big one. And yeah, so those would be like the primary long-term conditions.
Hear about common infections impacting elderly residents in our podcast, Common Infections Found in Nursing Home Residents.
Schenk:
Tell me about the so we have a resident, they have a catheter. What are some of the signs that are observable signs that there is an underlying infection that’s brewing or that’s going on.
Korthuis:
Yeah. Co catheter associated UTIs can be sneaky and they can be pretty angry at beasts.
And with elderly folks, which are the nursing home demographic. Sometimes you don’t get any signs until they start acting very confused. And I’ve had patients like have completely alert and oriented patients and they’re like, last night I thought I saw somebody out my window. And it’s oh, you know what?
That, that kind of gets my nurse brain thinking like, I bet there’s something going on. So then I start asking questions like. How is going to the bathroom? Are you peeing clear? Your sorry, peeing clear, your clear yellow urine. Sorry. That’s, and everybody’s wait, what did you say? What is that?
Are you peeing clear yellow urine? Do you have any pain when you pee? Do you feel like you have any retention? Are you having difficulty peeing? Do you have flank pain or back pain? So that kind of gets me wondering okay, so is some, is something going on. And oftentimes it is, it’s mental the mentation and cognitive status of these clientele especially in the elderly community.
Learn about recent findings on the relationship between infection management and cognitive outcomes in older adults.
Schenk:
That’s interesting that you say that. And you use the term nurse brain. That’s awesome. So if the individual’s baseline is not to hallucinate that they’ve seen, their former wife or former spouse or whatever it is. If there is a catheter, that’s the first thing you’re going to is that this is an initial sign of infection because they have a catheter.
Whereas if they didn’t have a catheter your decision tree might be different.
Korthuis:
Yeah. Catheter would be my first one. I would then go to U UTI I, because you can get UTIs without catheters placed. Catheters are just a, it’s an easy way to get a UTI. I will say too, another thing is weakness.
Just especially like lower extremity weakness. I might have a client who fell last night. I’m like, usually they’re really, strong people or they’re able to ambulate just fine to the bathroom. Why did they fall? Or that, that’s another really good indicator.
If your loved one developed a UTI in care, explore whether you may have a claim.
Schenk:
It’s interesting that you, and you said that, you talked about your nurse brain.
I’m just a lay person, and so what’s interesting to me is, as I hear you say, is that some of the times. The initial symptoms are behavioral or cognitive as opposed to what I would imagine as being the ones that are first, which is different colored urine. Urine smells differently. Perhaps they’re not urinating as much.
Those are be like, for me, that was, that’s what I associate with. But it’s interesting that you talk about behavioral and cognitive differences are the telltale signs.
Korthuis:
Absolutely. Yeah. And quite oftentimes you’re working with clientele who already have cognitive behavioral issues.
And so it’s super important to be listening to the caregivers and the people who are seeing them every single day and do know their base. Line. Because sometimes it’s just something very little. And then advocating for that patient and that client with their provider just being like, I have a se sneaking suspicion.
And not that they can make orders, like I think you should do this, but it’s more of there, there’s some, a couple indications that could mean that they have a UTI and if they have catheters, I’ve never had a provider be like, I don’t know, let’s question this a little bit more. Usually it’s just okay, they’ve got a catheter in place.
Absolutely.
Explore data on how recurrent infections affect long-term health outcomes in nursing home residents.
How can nursing homes reduce UTIs caused by catheters?
Schenk:
Yeah. Straight away you just treat it as a, as an infection. Okay. So let me ask this. We’ve talked about okay, these are the signs of it, right? What about prevention? So let’s talk about, is there anything in particular that’s the that nurses would, should be doing that it’s, that, that would reduce the likelihood that there is a catheter associated UTI.
Korthuis:
Yeah, there’s a lot of little things and I probably won’t be able to get to them or remember all of them. But when I go through my patient education and my caregiver education I talk about cleaning and every time you have a bowel movement cleaning the catheter, and it’s very important when you’re cleaning to clean from the inside out because you don’t wanna be bringing it.
Once again, that bacteria. Into that highway or that pathway into the urethra. So making sure to clean, that’s super, super important. Drinking plenty of fluids that you want to always have drainage coming out of the bag. You want to see that clear yellow urine. Making sure that bag doesn’t go above the bladder.
Learn more about the serious risks and when a urinary tract infection can lead to death.
Making sure it’s always below. So there’s different there’s different bags that you can place. There’s leg bags that are a little bit more discreet just for people and patient dignity. And then there’s like larger nighttime bags or bags that can be put on a wheelchair or something.
Making sure when you’re moving that not bringing it above the bladder. So those are like the main. Tips and tricks that I give to patients and caregivers on how to prevent UTIs.
Understand new clinical approaches on treating and preventing urinary tract infections in institutionalized elderly.
When should a catheter be removed to prevent infections?
Schenk:
We had a guest on many years ago and I’ll link it in the description. And she described that nowadays, and this was news to me at the time, but the catheters can stay in for a month at a time.
And that was that was crazy to me. This, I think this is maybe six or seven years ago we had this episode, but is that still the case? Are we have, we’re still at that point where the standard is typically 30 days with the catheter and then replace.
Korthuis:
Yep. Yep. Say you have a patient or client who just has an order for long-term catheter placement due to urinary retention or maybe some prostate issues.
And they’re expected to have this catheter for a long period of time. Typical first order is changed every 30 days, unless indicated, to change it. And what I typically do with my patient load is if they’re having long-term catheter orders, I would like to opt in for a silicone catheter.
So I think it’s best practice to place silicone over latex and silicone is ver it’s much more expensive than latex. Probably like six times more expensive, depending on the size of catheter. But if you’re thinking about placing long term, you want to place something that’s gonna be effective and decrease the risk of UTI.
Dive into current advancements on biomaterials used in infection prevention and elderly care devices.
So when I’m making my case to the company who’s paying for the equipment I say, this person’s gonna have a long term. Catheter. I think that it’s gonna be worth your time and money to be placing silicone catheters. They’re much they’re easier to place, in my opinion. And they can be more comfortable for the patient.
But typically every 30 days, and if I get that, in my load, then I’ll, start placing silicones.
What are the risks of long-term catheter use in seniors?
Schenk:
That’s interesting that you’re talking about as a nurse preferring silicone catheters over, over late test catheters, at least for long-term people that are gonna be having a catheter for a long time.
What can you say about I understand ease of use and it’s more comfortable and these type of things, but does there, is there any argument about whether or not one or the other reduces the likelihood of UTI.
Korthuis:
Yeah, so silicone catheters may be more expensive initially.
They offer significant benefits. One of ’em reduced risk of en crustacean and blockages. When I go to, provide perineal care to a patient, it’s much easier to clean it. It just, latex can, just build up. Gunk. Yeah. Yeah, we’ll say that. Gunk. We won’t go into health, healthcare terms or anything, but it also lowers the potential for allergic reactions and inflammation.
Greater comfort and durability for prolonged use. So that’s typically like the main reasons that I’ll start using a silicone.
For legal guidance on holding facilities accountable, read about nursing home abuse cases involving urinary tract infections.
How can staff improve catheter care to protect residents?
Schenk:
I see. That makes sense. Obviously if it’s reduces the buildup of things that in a, that in and of itself would lower the likelihood of infection.
That makes sense. So what, like if you had a family in front of you and their loved one is, has a catheter for the long term, what would be some of the things that you would tell them to get them on board with reducing the likelihood of infections?
Korthuis:
Yeah, I’ve had a couple clients recently that it’s been really difficult for them to wrap their head around having a catheter I talked about earlier about the dignity part of this.
And they’re, they, to me, something that I deal with almost daily. It seems straightforward, but I do explain it’s when you go to the bathroom, you just, you’d clean, as you would clean normally. And I once again explain like cleaning inside to out. Regular emptying. So if it makes sense, I usually go to the bathroom this many times without a catheter.
Explore infection prevention standards and violations in our podcast episode, Infection Control in Nursing Homes.
I’m gonna go to the bathroom this many times with the catheter and keep to your routine and not try to like stress too much about it. It. It’s a big life change for these folks. So visiting the bathroom as normal, emptying as normal and yeah, just making sure your peroneal area is clean.
Find out whether multiple urinary tract infections are a sign of nursing home neglect.
Schenk:
Excellent. Casey, we really appreciate you coming on the show and sharing your knowledge with us.
Korthuis:
Yeah. Thank you so much for having me. It was a great opportunity.
Schenk:
Folks, I hope that you found this episode educational. If you have an idea for any topic that you would like for me to cover, please let me know.
If you have an idea for any guests that you would like for me to talk to, please let know that as well. New episodes of the Nursing Home Abuse Podcast come out every single week. Don’t forget to go on to TikTok to try to win. That nursing home abuse podcast mug. And I guess that’s about it. So with that folks.
We’ll see you next time.
Kaci Korthuis’ Contact Information:
- Eden Health on LinkedIn