What nursing action must be taken to prevent hospital acquired urinary tract infection among patients who are on indwelling urinary catheter?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

Maintaining a closed urinary drainage system is a key intervention to prevent Catheter-Associated Urinary Tract Infections (CAUTI).
The closed system acts as a physical barrier, preventing microorganisms from entering the catheter tubing and ascending into the bladder.
Any break in this closed system, such as disconnecting the catheter from the tubing, creates a direct portal of entry for pathogens.
Guidelines from the CDC emphasize that tubing connections should not be separated to avoid introducing pathogens.

Option A: While adequate fluid intake helps flush the bladder and can reduce the risk of infection, it is a supportive measure. It does not prevent the primary cause of CAUTI, which is the entry of bacteria into the sterile drainage system.
Option B: Catheterization requires strict aseptic (sterile) technique, not clean technique. Using only clean technique would significantly increase the risk of introducing microorganisms into the bladder during insertion.
Option C: Positioning the drainage bag higher than the bladder is contraindicated and dangerous. Gravity would cause urine to flow back from the bag into the bladder (reflux), significantly increasing the risk of a urinary tract infection.

Clinical Relevance

Nursing practice connection: Knowing Prevention of Catheter-Associated Urinary Tract Infections (CAUTI) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
CAUTIs are one of the most common healthcare-associated infections (HAIs) and lead to increased patient morbidity, mortality, and healthcare costs. Strict adherence to prevention protocols is a core nursing responsibility.
Nurses are at the forefront of CAUTI prevention through proper insertion, daily maintenance, and timely removal of urinary catheters.
What if a urine specimen is needed? The nurse must use the designated sterile access port on the drainage tubing to obtain the sample. The system should never be opened by disconnecting the catheter from the tubing.

How to Approach the Question

First, identify the core of the question: it asks for the key nursing action to prevent a UTI in a patient with an indwelling catheter.
Evaluate each option based on established principles of infection control and catheter care.
Option A (fluids) is helpful but not the primary barrier to infection.
Option B (clean technique) is incorrect; the standard is sterile (aseptic) technique.
Option C (bag higher than bladder) is dangerous and directly causes infection risk through reflux. This is the opposite of correct practice.
Option D (closed system) directly addresses the most common pathway for infection – the introduction of bacteria into a sterile system. This makes it the most critical intervention.

Concept Tested & Keywords

Concept Tested: Prevention of Catheter-Associated Urinary Tract Infections (CAUTI)
Stem keywords: hospital acquired urinary tract infection, indwelling urinary catheter, nursing action, prevent
Lead-in keywords: What
Negative lead-in flag: false

Qc0Wl02bfdmXGc7yTv0kUc

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 254-255

E6 Nursing Fundamentals Taylor p. 604-606

Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.