The following procedures have been ordered and implemented for a hospitalized patient. Which procedure carries the greatest risk for a healthcare-associated infection?

A. Obtain daily urine specimens by opening the collection drainage system: Opening the drainage system increases the risk of introducing bacteria into the catheter, which can lead to infection.

B. Keep the urine collection bag below the level of the bladder at all times: Keeping the bag below the bladder prevents urine from back flowing into the bladder, which reduces the risk of infection.

C. Retract the foreskin to clean the catheter tubing and meatus outward, leaving the foreskin retracted: While the foreskin should be retracted for cleaning, it must always be returned to its normal position to prevent paraphimosis, a condition where the foreskin becomes trapped and restricts blood flow.

D. Change the indwelling catheter at least every one week: Routine catheter changes are not recommended unless there is an indication such as obstruction or infection. Unnecessary changes increase infection risk.

A. Placing an indwelling urinary catheter: Indwelling urinary catheters are a leading cause of catheter-associated urinary tract infections (CAUTIs), which are common healthcare-associated infections.

B. Administering medications through an NG tube: While NG tubes can introduce bacteria, they are not as high-risk as urinary catheters, which provide a direct route for infection.

C. Changing a sacral wound dressing: While wounds can become infected, proper wound care techniques minimize risk. Urinary catheters pose a greater risk due to prolonged exposure to bacteria.

D. Replacing an ostomy appliance: While maintaining hygiene is important, ostomy appliances are not a major source of healthcare-associated infections compared to urinary catheters.