Infection Prevention, Asepsis, and Catheter Care
This domain tests catheter stewardship: knowing when a catheter is justified, inserting it aseptically, maintaining it correctly, and interpreting urine findings without overtreating.
When a catheter is indicated
Retention or obstruction, accurate output in a critically ill patient, urologic or pelvic surgery, open sacral wounds with incontinence, and comfort in terminal illness. It is not indicated for incontinence alone, convenience, immobility, or staff shortage when external catheters, intermittent catheterization, toileting schedules, or containment products are options.
Aseptic insertion
Hand hygiene, sterile kit and gloves, antiseptic per policy, single-use lubricant. Insert 6-8 inches in males and 2-3 inches in females until urine flows, advance slightly more, then inflate the balloon only after urine return. Secure the tubing, maintain a closed system, and keep the bag below bladder level and off the floor.
Maintenance bundle
- Hand hygiene before and after every manipulation.
- Empty when two-thirds full into a separate container; do not let the spigot touch the receptacle.
- Meatal care with soap and water only - no antiseptics, powders, or routine ointments.
- No routine prophylactic antibiotics; change intervals follow manufacturer guidance and clinical indication, not a reflexive seven-day rule.
- Nurse-driven removal protocols and daily review of necessity.
Specimens and treatment
Sample through the dedicated port after disinfection, never from the drainage bag. Asymptomatic bacteriuria is not treated except in pregnancy and before urologic surgery involving mucosal trauma. Catheter-associated UTI requires an indwelling catheter in place more than two days plus compatible signs and symptoms.
Worked example
A catheter has been in six days. One patient is afebrile with cloudy, odorous urine; another has a temperature of 38.6 C with flank pain. Reasoning: the first meets no CAUTI criteria and should not be cultured or treated - the right action is review of need and possible removal. The second needs urine and blood cultures, evaluation for obstruction, and antibiotics per orders.
Traps that cost marks
- Culturing urine from the drainage bag.
- Daily povidone-iodine meatal cleaning.
- Irrigating a sluggish catheter with antiseptic instead of checking for kinks, constipation, or blockage.
- Omitting the indication and removal criteria from the record.