Relationship between catheter care and catheter-associated urinary tract infection at Japanese acute care hospitals

Abstract

BACKGROUND/OBJECTIVES: Few epidemiologic studies have been conducted to identify risk factors for catheter-associated urinary tract infection (CAUTI) in Japan. We conducted surveillance at acute care hospitals in the Kansai area of Japan, focusing on risk factors associated with catheter use. METHODS: Five hospitals with nine units participated in the CAUTI surveillance. The eligibility criterion for the study was an adult patient being catheterized for >3 days between January and December 2004. The Centers for Disease Control and Prevention (CDC) definition of CAUTI was used for this study. The researcher visited the hospitals twice a week to observe catheter care and collect clinical data. Relative risks for CAUTI with 95% confidence intervals were calculated, and statistical significance was determined with Kaplan-Meier tests. RESULTS: For the 555 subjects (338 women, 217 men), the mean duration of catheterization was 25 days. The catheters were changed every 2 to 4 weeks in most cases. The major reasons for catheterization were output monitoring (32%), bed rest (14%), and urinary incontinence (10%). The CAUTI rate was 3.91 per 1000 device days, with the rate varying considerably from a low of 0.57 to a high of 7.15. The greatest risk factor was fecal incontinence (RR = 2.7). Improper catheter care — use of a common urine collection container (RR = 1.4) or of multidose lubricant (RR = 1.5) — was associated with an increased risk of infection due to cross-infection. Other factors were the use of larger size catheter (>18Fr, RR = 2.4) and incorrect volume of water for the balloon (RR = 1.4). Risk factors directly related to catheter care were lack of daily meatal care (RR = 1.5), disconnecting the closed system (RR = 1.2), and catheters not being taped to the body (RR = 1.3). Although these risk factors did not reach statistical significance due to the relatively small number of infections, they are similar to those reported in Western studies. Of special note is that the hospital with the lowest CAUTI had the best catheter care. CONCLUSIONS: CAUTI rates varied greatly among the five hospitals included in this study. Risk factors for CAUTI were fecal incontinence, incorrect catheter size, incorrect volume of water for the balloon, and insufficient catheter care. Implementation of the correct choice and use of catheters combined with good catheter care would reduce risk of CAUTI in Japanese hospitals.