Urinary Tract Infections – Entry 1

Dear Diary:

Hattie has made some progress with her mobility since her hip fracture. She’s transferring better, sitting up in the chair more often and starting to increase her walking distance in therapy. Anna, the charge nurse, removed her indwelling catheter a few days ago. I was hoping they would have removed it sooner, so we’ve really got to talk about some protocols for removing every catheter we can.

In our huddle today, I heard that Hattie seemed listless, was running a temperature, and the nursing assistant reported her urine looked “red-tinged”. Anna is planning to get a urine sample by straight cathing her and will send the sample to the lab as soon as possible. I also learned that the nursing assistant may have noticed the red-tinged urine prior to the catheter being removed but hadn’t reported it. This is another good example of why we have to use the “Stop and Watch” form. Until the urine culture comes back, the nursing staff is going to keep a close eye on Hattie, monitor her temperature, and encourage her to drink fluids. Anna called her doctor and he wants us to watch her closely rather than start her on an antibiotic before the culture comes back. I’m hoping we can start her on an antibiotic soon and not have to send her back to the hospital. I think that would be really hard on Hattie and her daughter Carol.

How can we do a better job in preventing UTIs?

Signed, Donna

3 Comments

  • When completing the Hospital Preadmission assessment, verify if catheter in place and ask that it be removed if indicated before D/C to TCU. Verify that voiding occured after removed and discharged to TCU.

  • We are putting together an inservice for all NARs regarding urinary catheters and infection control. Ihave had several NARs demonstrate the procedure for emptying cath bags as well as changing from bed bag to leg bag. There were serious red flags (i.e. allowing the tubing from bag to touch the inside of dirty urinals, improper cleaning and storage of bag being removed when applying another).

  • I would do cross analysis and see how many pt. on her hall also have a uti? if there is a significant increase in utis on her unit then start your root cause analysis. is there staff turnover? are there hydration stations available? are staff performing correct handwashing techniques? has there been a new soap intoriduced? are there new soap dispensers? Is the soap hard to get out of the dispenser? I would do staff education on handwashing, pericare, hydration, nutrition, toileting frequently.

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