2009 CAUTI guidelines - Centers for Disease Control and Prevention

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Category I recommendations are defined as strong recommendations with the followingimplications:1. For patients: Most people in the patient’s situation would want the recommended courseof action and only a small proportion would not; request discussion if the intervention isnot offered.2. For clinicians: Most patients should receive the recommended course of action.3. For policymakers: The recommendation may be adopted as a policy.Category II recommendations are defined as weak recommendations with the followingimplications:1. For patients: Most people in the patient’s situation would want the recommended courseof action, but many would not.2. For clinicians: Different choices will be appropriate for different patients, and cliniciansmust help each patient to arrive at a management decision consistent with her or hisvalues and preferences.3. For policymakers: Policy making will require substantial debate and involvement of manystakeholders.It should be noted that Category II recommendations are discretionary for the individualinstitution and are not intended to be enforced.The wording of each recommendation was carefully selected to reflect the recommendation'sstrength. In most cases, we used the active voice when writing Category I recommendations -the strong recommendations. Phrases like "do" or "do not" and verbs without auxiliaries orconditionals were used to convey certainty. We used a more passive voice when writingCategory II recommendations - the weak recommendations. Words like "consider” and phraseslike "is preferable,” “is suggested,” “is not suggested,” or “is not recommended” were chosen toreflect the lesser certainty of the Category II recommendations. Rather than a simple statementof fact, each recommendation is actionable, describing precisely a proposed action to take.The category "No recommendation/unresolved issue" was most commonly applied to situationswhere either 1) the overall quality of the evidence base for a given intervention was low to verylow and there was no consensus on the benefit of the intervention or 2) there was no publishedevidence on outcomes deemed critical to weighing the risks and benefits of a given intervention.If the latter was the case, those critical outcomes will be noted at the end of the relevantevidence summary.Our evidence-based recommendations were cross-checked with those from guidelines identifiedin our original systematic search. Recommendations from previous guidelines for topics notdirectly addressed by our systematic review of the evidence were included in our "Summary ofRecommendations" if they were deemed critical to the target users of this guideline. Unlikerecommendations informed by our literature search, these recommendations are not linked to akey question. These recommendations were agreed upon by expert consensus and aredesignated either IB if they represent a strong recommendation based on accepted practices(e.g., aseptic technique) or II if they are a suggestion based on a probable net benefit despitelimited evidence.All recommendations were approved by HICPAC. Recommendations focused only on efficacy,effectiveness, and safety. The optimal use of these guidelines should include a consideration ofthe costs relevant to the local setting of guideline users.Reviewing and Finalizing the Guideline32
After a draft of the tables, narrative summaries, and recommendations was completed, theworking group shared the draft with the expert panel for in-depth review. While the expert panelwas reviewing this draft, the working group completed the remaining sections of the guideline,including the executive summary, background, scope and purpose, methods, summary ofrecommendations, and recommendations for guideline implementation, audit, and furtherresearch. The working group then made revisions to the draft based on feedback frommembers of the expert panel and presented the entire draft guideline to HICPAC for review.The guideline was then posted on the Federal Register for public comment. After a period ofpublic comment, the guideline was revised accordingly, and the changes were reviewed andvoted on by HICPAC. The final guideline was cleared internally by CDC and published andposted on the HICPAC website.Updating the GuidelineFuture revisions to this guideline will be dictated by new research and technologicaladvancements for preventing CAUTI and will occur at the request of HICPAC.33
Page 4 and 5: AcknowledgementHICPAC thanks the fo
Page 6 and 7: AbbreviationsADLAPACHE IIASAASBBUNC
Page 8 and 9: I. Executive SummaryThis guideline
Page 10 and 11: II. Summary of RecommendationsTable
Page 12 and 13: II. Proper Techniques for Urinary C
Page 14 and 15: 1. If obstruction is anticipated, c
Page 16 and 17: a. Procedure-specific guidelines fo
Page 18 and 19: III. Implementation and AuditPriori
Page 20 and 21: IV. Recommendations for Further Res
Page 22 and 23: V. BackgroundUrinary tract infectio
Page 24 and 25: acteriuria inevitably occurs over t
Page 26 and 27: VII. MethodsThis guideline was base
Page 28 and 29: Figure 2: Results of the Study Sele
Page 30 and 31: After determining the GRADE of the
Page 34 and 35: VIII. Evidence ReviewQ1. Who should
Page 36 and 37: Evidence Review Table 1B. What are
Page 38 and 39: Very low-quality evidence suggested
Page 40 and 41: Q2B.2. Hydrophilic catheters vs. st
Page 42 and 43: For all comparisons, we considered
Page 44 and 45: a. Clamping vs. free drainage prior
Page 46 and 47: studies. 3,25,260-276 The findings
Page 48 and 49: 2D.5. Maintain unobstructed urine f
Page 50 and 51: 15. Jain P, Parada JP, David A, Smi
Page 52 and 53: 44. Chaudhuri P, Vengadasalam D. Ur
Page 54 and 55: 71. Kelleher RE, Meeropol E, Parks
Page 56 and 57: 101. Hirsh DD, Fainstein V, Musher
Page 58 and 59: 132. Van Nagell, JR, Penny RM, Rodd
Page 60 and 61: 163. Lai KK, Fontecchio SA, Lai KK,
Page 62 and 63: 193. Waites KB, Canupp KC, Armstron
Page 64 and 65: 222. Cohen A. A microbiological com
Page 66 and 67: 253. Chavigny KH. The use of polymi

2009 CAUTI guidelines - Centers for Disease Control and Prevention

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