Catheter-associated Urinary Tract Infection Prevention Research Articles

P-1590. Diagnostic Stewardship as a CAUTI Prevention Strategy: Implementation of a Urine Culture Wizard to Drive Institutional Change

Abstract Background Standardized urine culture ordering is an essential practice in the prevention of catheter-associated urinary tract infections (CAUTI). Historically, the University of Colorado Hospital (UCH) offered a stand-alone urine culture order, which required documentation of the culture indication. Frequently, the attestation was incongruent with the clinical scenario, and a preceding urinalysis (UA) was not performed. As a result, cultures often resulted in the detection of asymptomatic bacteriuria, leading to inappropriate antibiotic prescribing. We hypothesized that the creation of a Urine Culture Wizard would decrease unnecessary urine cultures with downstream implications on antibiotic usage and CAUTI reporting. Year-Over-Year % Change by Month and Fiscal YearFigure 1:Year-over-year Reduction in Urine Cultures Performed at UCH by Inpatient Teams Methods In 2021, key stakeholders across the UCHealth system began the development of a Urine Culture Wizard. This replaced all orders for urine cultures in inpatient settings. Multiple synonyms push providers to the wizard, which performs data mining to determine if a urine culture is appropriate. For most, it requires that a preceding UA showing pyuria has been performed. The wizard also allows the ordering of a urine culture without documentation of pyuria if unique patient characteristics are detected in the electronic medical record. These are identified by discrete fields that correspond to criteria as outlined by an institutional governance committee, including specific clinical diagnoses. Educational material was developed to support the launch of the wizard. Year-Over-Year % Change by Month and Fiscal YearFigure 2:Year-over year Reduction in Urine Cultures Performed at UCH by Inpatient Teams Results The Urine Culture Wizard went live in November 2023. Results show a sustained decrease of more than 30% in the number of urine cultures ordered at UCH, and this change meets the criteria for special cause variation. (Figures 1, 2, and 3). Urine Tests Per MonthFigure 3:Statistical Process Control Chart Demonstrating Special Cause Variation Conclusion It has been shown that inappropriate ordering of urine cultures leads to misclassification of colonization as infection and unnecessary prescribing of antibiotics. A standardized approach to ordering urine cultures based on clinical criteria was created for all UCHealth hospitals through the development of a Urine Culture Wizard. Since implementation there has been a continual significant reduction in the number of urine cultures performed, signaling the success of this diagnostic stewardship tool. Disclosures All Authors: No reported disclosures

Assessment Of Knowledge Attitude And Practices Of Operation Theatre Staff Regarding Prevention Of Catheter Associated Urinary Tract Infection

Objective: to evaluate the knowledge, attitudes, and practices of operating theatre staff concerning CAUTI prevention at Health Sciences, Superior University, Lahore, Pakistan. Study Design: A Cross sectional Study Place and Duration of the Study: A cross-sectional study was performed with operating theater personnel, comprising physicians, nurses, and technicians, at Health Sciences, Superior University, Lahore. Methodology: A standardized questionnaire was employed to assess participants' understanding of CAUTI causes, dangers, and preventative measures; attitudes towards CAUTI prevention; and compliance with suggested actions. Data were gathered and examined to pinpoint knowledge deficiencies and intervention opportunities. Results: The study measured the knowledge, attitude, and practices (KAP) of operating room staff with relation to preventing catheter-associated urinary tract infections (CAUTIs). The results showed that, on average, 1.8 out of a possible 5.0 points were deemed sufficient, and that 52.7% shown moderately adequate knowledge. A mean attitude score of 2.05 (SD = 0.75) was produced by the mixed attitudes, with 40.9% exhibiting somewhat positive attitudes and 29.1% indicating favorable attitudes. The staff's level of practice adherence varied; on average, 1.88 (SD=0.6), with 56.4% indicating moderate practice and 43.6% indicating adequate practice. Staff members acknowledged the significance of aseptic technique to a degree of 94.5%, and 79.1% were in favor of prompt catheter removal to avoid CAUTI, according to key responses. Higher levels of practice adherence were linked to more professional experience (χ² = 19.172, p < 0.01), and there were notable positive associations between attitude and practice (rho = 0.264, p < 0.01). Despite a moderate degree of knowledge and practice, patient safety can only be improved by targeted education that fills attitude gaps and enhances CAUTI prevention strategies. Conclusion: CAUTI is a common healthcare-associated disease. Healthcare personnel had sufficient CAUTI prevention knowledge, attitudes, and practices in this study. Every hospital's infection prevention program must create, implement, and monitor urinary catheter infection prevention policies. Health care organizations must establish medical education programs, interdisciplinary training, and catheter care checklist audits to improve staff knowledge and practices. Keyword: knowledge attitude and practices, operation theatre staff, urinary tract infection, catheter

Going commando as part of a multifaceted intervention to reduce CAUTIs in critically ill children.

This project was initiated in a large pediatric intensive care unit to reduce catheter-associated urinary tract infections (CAUTIs). Implementing removal of diapers and a urine collection device that prevented urine backflow in March 2021 decreased the rate from 3.3 to 0.9 CAUTIs/1000 catheter-days. These interventions could augment CAUTI prevention strategies.

Test Smart, Treat Smart-using clinician feedback to adapt a catheter-associated urinary tract infection intervention for spinal cord injury.

Catheter-associated urinary tract infection (CAUTI) prevention is a major target for hospital quality metrics because it is linked to increased morbidity, mortality, and health care costs. Health care systems use strict protocols surrounding catheterization and maintenance, which often disregard the clinical needs of special populations (eg, spinal cord injury [SCI]). However, for populations that rely on chronic instrumentation of the bladder, asymptomatic (ie, nonpathogenic) bacterial colonization in the bladder is common but not linked to adverse outcomes. Additionally, alterations in neurologic and sensory function after SCI make it difficult for clinicians to discern asymptomatic bacteriuria from acute urinary tract infection requiring antibiotics. Institutional policies for screening urine during SCI annual exams often lead to detection of bacteriuria but create a clinical decision-making challenge when determining whether antibiotic treatment is appropriate. To conduct preimplementation SCI-focused adaptations to the evidence-based practice (EBP) "Kicking CAUTI"-to develop a guide for SCI providers surrounding testing and treatment of CAUTI. Four 1-hour focus groups were conducted with SCI clinicians (prescribers and nursing staff) to assess insights on needed modifications to adapt Kicking CAUTI for SCI. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to plan and report adaptations in this work and the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide adaptation of the EBP for the SCI population. Content and thematic analysis guided our process. The clinical algorithm was simplified, a urinary symptom assessment added, and provider- and patient-facing educational materials were developed to support implementation efforts to create the Test Smart Treat Smart Intervention. Traditional CAUTI protocols do not adequately address the needs of those with SCI and modifications are needed. Provider feedback provides valuable insights when adapting population appropriate interventions.

Prevention and Control of Catheter-Associated Urinary Tract Infection (CAUTI): A Patient Safety and Quality Improvement Project.

This patient safety and quality improvement report outlines the successful reduction of catheter-associated urinary tract infections (CAUTI) through a comprehensive interdisciplinary team approach. It emphasizes the implementation of best practices and the involvement of both patients and their families in catheter care. The project was conducted at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East, with 511 beds and over 20 inpatient units. The primary objective of this project was to assess gaps in current CAUTI prevention practices and implement effective strategies to reduce infection rates. By adopting quality improvement methodologies from the Institute of Healthcare Improvement (IHI) and the Deming Four-Stage Cycle, the aim was to prevent CAUTIs and improve patient safety and clinical outcomes. Urinary catheters, commonly used for patients with neurogenic bladder dysfunction and sacral deep pressure injuries, posed a high risk of infection, with a daily infection risk of 3-7%. Despite available preventive measures, the facility experienced a high average CAUTI rate of 1.28/1000 catheter daysfrom 2021 to mid-2023. This project involved the systematic identification of gaps, the adoption of evidence-based practices, and the engagement of healthcare staff, patients, and families in rigorous CAUTI prevention efforts. The project resulted in a significant reduction in the CAUTI rate, decreasing from 1.28 infections per 1000 catheter days pre-intervention to 0.42 infections per 1000 catheter days post-intervention. This improvement highlights the effectiveness of collaborative efforts and evidence-based interventions in controlling and preventing CAUTIs. The findings of this project demonstrate that CAUTI prevention is achievable through a coordinated approach involving healthcare providers, strong evidence-based interventions, and the active participation of patients and families. This collaborative model led to better patient safety outcomes and significantly reduced CAUTI rates, showing the importance of comprehensive care strategies in mitigating preventable patient harm.

Novel Nano Drug-Loaded Hydrogel Coatings for the Prevention and Treatment of CAUTI.

Catheter-associated urinary tract infection (CAUTI) is a prevalent type of hospital-acquired infection, affecting approximately 15% to 25% of patients with urinary catheters. Long-term use of the catheter can lead to colonization of microorganisms and biofilm formation, and may develop into bacterial CAUTI. However, the frequent replacement of catheters in clinical settings can result in tissue damage, inflammation, ulceration, and additional complications, causing discomfort and pain for patients. In light of these challenges, a novel nanodrug-supported hydrogel coating called NP-AM/FK@OMV-P/H has been developed in this study. Through in vitro experiments, it is confirmed that OMV nano-loaded liquid gel coating has an effective reaction against E.coli HAase and releases antibacterial drugs. This coating has also demonstrated strong inhibition of E.coli and has shown the ability to inhibit the formation of bacterial biofilm. These findings highlight the potential of the OMV nanoparticle gel coating in preventing and treating bacterial infections. Notably, NP-AM/FK@OMV-P/H has exhibited greater efficacy against multidrug-resistant E.coli associated with UTIs compared to coatings containing single antimicrobial peptides or antibiotics. Additionally, it has demonstrated good biosecurity. In conclusion, the NP-AM/FK@OMV-P/H coating holds great potential in providing benefits to patients with CAUTI.

The bacterial displacement test: an in vitro microbiological test for the evaluation of intermittent catheters and urinary tract infection.

Intermittent catheters (ICs) are commonly used in bladder management, but catheter-associated urinary tract infections (CAUTIs) remain challenging. Insertion tips may reduce the risk of CAUTIs by minimizing bacterial transfer along the urinary tract. However, there are few laboratory tests to evaluate such technologies. We describe the use of an adapted in vitro urethra agar model to assess bacterial displacement by ICs. Simulated urethra agar channels (UACs) were prepared with catheter-specific sized channels in selective media specific to the challenge organisms. UACs were inoculated with Escherichia coli and Enterococcus faecalis before insertion of ICs, and enumeration of UAC sections was performed following insertion. Four ICs were evaluated: Cure Catheter® Closed System (CCS), VaPro Plus Pocket™, Bard® Touchless® Plus, and SpeediCath® Flex Set. CCS demonstrated significantly reduced bacterial displacement along the UACs compared to the other ICs and was also the only IC with undetectable levels of bacteria toward the end of the UAC (representing the proximal urethra). The bacterial displacement test demonstrated significant differences in bacterial transfer between the test ICs with insertion tips, which may reflect their different designs. This method is useful for evaluating CAUTI prevention technology and may help guide future technology innovations.

Going Commando as Part of a Multifaceted Intervention to Reduce CAUTIs in Critically Ill Children

Background and Objectives: Catheter associated urinary tract infections (CAUTIs) are a source of preventable harm in children. Insertion and maintenance bundles have significantly reduced CAUTIs, but infections still occur. Starting in mid-2019, we experienced an increase in CAUTIs in our pediatric intensive care unit (PICU). The objective was to identify preventable causes of CAUTI and develop and test interventions to reduce them. Methods: This quality improvement project was initiated in the PICU of a large tertiary children’s hospital. Interdisciplinary rounds led by the hospital epidemiologist and unit nursing leader with the bedside nurse occurred weekly (starting October 2019) for patients with urinary catheters in place for greater than three days. Discussions included strategies to optimize maintenance of the urinary catheter and identify catheters that could be removed. Additional interventions included no diapers for patients with a urinary catheter (starting March 2021) and use of a urine collection device that prevented both urine stasis in the drainage tube and retrograde flow of urine into the bladder (starting August 2021). Hand hygiene and CAUTI prevention bundle compliance was measured by direct observation of staff. CAUTIs were identified by prospective surveillance by infection prevention using standard definitions. The rate of CAUTIs over time was analyzed using statistical process control charts. Results: The baseline CAUTI rate (January 2017 - June 2019) was 0.5 infections/1000 catheter days with an average of 349 days between CAUTIs. Between July 2019 and February 2021, the CAUTI rate increased to 3.3 with an average of 88 days between CAUTIs. Annual compliance with hand hygiene and the CAUTI prevention bundle elements remained above 90% throughout all time periods. No improvement was seen after the institution of weekly interdisciplinary rounds. Starting in March 2021 after removal of diapers and implementation of the urine collection device that prevented retrograde flow, the CAUTI rate decreased to 0.9 and an average of 200 days between CAUTIs. Currently, it has been 512 days since the last CAUTI. Conclusion: CAUTIs decreased after removing diapers in children with urinary catheters and use of the urine collection device. Removal of diapers likely reduced stool contamination around the catheter and urethral opening. The urine collection device prevented inadvertent retrograde flow of urine into the bladder. These interventions could augment current CAUTI prevention strategies.

Catheter-associated urinary tract infection prevention: Implementation of a multimodal and evidence-based education program.

Catheter-associated urinary tract infection prevention: Implementation of a multimodal and evidence-based education program.

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P>0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P>0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Multidrug resistance among biofilm-forming uropathogens isolated from catheter-associated urinary tract infection from a rural tertiary care center in Eastern India.

Background: Urinary tract infections (UTIs) are prevalent nosocomial infections, accounting for 30-40% of hospital-acquired infections. Indwelling urinary catheters create conducive environments for biofilm formation, limiting antimicrobial diffusion and facilitating the transfer of antimicrobial resistance genes. Multidrug resistance (MDR) among biofilm-forming uropathogens poses significant therapeutic challenges. This study aimed to assess the prevalence of MDR among biofilm-forming uropathogens in catheter-associated UTIs (CAUTIs) and characterize their antimicrobial resistance patterns. Methodology: The study included 95 catheterized patients over six months. Uropathogens were isolated and identified using standard methods. Biofilm production was assessed using tissue culture plates, tube tests, congo red agar, and modified congo red agar methods. The antibiotic resistance profiles of biofilm producers and non-producers were determined. Results: The prevalence of CAUTIs was 68.42%, with Escherichia coli being the most common uropathogenic (43.07%). Among the 65 isolates, 58.46% were identified as biofilm producers using four different methods. Biofilm producers exhibited higher resistance compared to non-producers, particularly against ampicillin (100% vs. 82.35%), Amoxiclav (90.62% vs. 58.82%), and cotrimoxazole (90.62% vs. 70.58%). Multidrug resistance was significantly higher among biofilm producers (80.64%) than non-producers (38.88%). Conclusion: The study highlights a high prevalence of biofilm formation among CAUTIs patients, contributing to antibiotic resistance. Multidrug resistance among biofilm producers exacerbates therapeutic challenges for clinicians. Strict aseptic techniques during catheterization are crucial to prevent infections by multidrug-resistant biofilm-forming uropathogens. Regular updates to institutional empirical therapy protocols are necessary to mitigate recurrence and treatment failure in UTI cases.

Nanozyme-reinforced hydrogel coatings for prevention of catheter-associated urinary tract infection

Catheter-associated urinary tract infection (CAUTI) presents a significant clinical challenge globally, given its elevated infection risk, substantial treatment costs, and the emergence of drug-resistant strains. Despite extensive clinical endeavors, such as the development of antimicrobial catheters and prophylactic approaches, addressing CAUTI remains intricate due to the microenvironment complexity, sustained antimicrobial requirements, the necessity for antibiofilm strategies, and concurrent inflammatory responses. Herein, an innovative solution involving an ultra-low loading gold/iron co-doped silver peroxide nanozyme-reinforced hydrogel coating is introduced for the prevention of CAUTI. The silicone urinary catheter is modified through a straightforward and cost-effective chemical process to impart multienzyme-like activities, including peroxidase- and catalase-like functions, which exhibit antimicrobial, antibiofilm, and anti-inflammatory properties tailored to the unique urinary tract microenvironment. Additionally, the hydrogel coating enhances the hydrophilicity of catheter, thereby improving patient comfort. In vitro and in vivo experiments substantiate the efficacy of the modified catheter in inhibiting bacterial colonization, curtailing biofilm formation, enhancing oxygen supply, and modulating immune responses. This study not only proposes an alternative strategy for prevention and treatment of CAUTI but also provides a promising therapy that addresses multifaceted therapeutic needs through the utilization of multienzyme-like nanozymes.

Study of biofilm formation among uropathogens isolated from catheter-associated UTI patient from a tertiary care hospital

Background: Catheter-associated urinary tract infection (CAUTI) is a serious health threat and challenging infection. CAUTI accounts for up to 40% of all nosocomial infections. Biofilm provides a survival strategy to microorganisms and ultimately leads to re-infections and recurrence of urinary tract infections (UTI) despite a full course of antibiotics. Aims and Objectives: The present study was conducted to determine the prevalence of CAUTI in suspected UTI patients and prevalence of biofilm-forming uropathogens among CAUTI patients. Materials and Methods: The cross-sectional study was done over a period of 6 months among 95 catheterized CAUTI patients. Biofilm production among isolated uropathogens was tested by tissue culture plate, tube test, and congo red agar method. Isolates were identified as biofilm producer if they were tested positive by any one of the all four methods, and isolates were considered biofilm non-producer in consensus with all four methods. Results: In this study, the prevalence of CAUTI was 68.42%. Among 65 isolates most common uropathogen was 28 (43.07%) Escherichia coli. In this present study, the prevalence of biofilm-forming uropathogens was 58.46% (38). Tissue culture plate was the most sensitive (97.36%) method in detecting biofilm formation followed by modified congo red agar (82.21%), congo red agar (71.05%), and tube test (65.78%). Biofilm productions were significantly associated with female gender, diabetes, and prolonged catheterization. Conclusion: Indwelling urinary catheter acts as a nidus for biofilm formation among microorganisms. Duration of catheterization is inversely associated with UTI. Hence, the need for catheter removal should be assessed daily to prevent infection. Periodic surveillance should be done to detect biofilm formation where prolonged catheterization is inevitable.

Catheter-associated urinary tract infections in critically Ill patients with COVID-19: a retrospective cohort study.

Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19. The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19. Single-center, retrospective cohort study. The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (n = 56) and non-CA-UTI (n = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI. CA-UTIs developed in 28% of patients (n = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, p < 0.001) and more elevated mortality rates (75.0% vs 54.5%, p = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, p = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, p < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly Klebsiella pneumoniae (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%. The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.

Knowledge, Attitude, Practice, and Associated Factors Toward the Prevention of Catheter-Associated Urinary Tract Infection Among Nurses in Ethiopia: Cross-Sectional Study.

Catheter-associated urinary tract infection (CAUTI) is one of the major device-associated hospital-acquired infections of the urinary tract. The nurse's knowledge, attitude, and practice (KAP) are the primary inputs for preventing the patient from developing CAUTI. Nevertheless, poor knowledge, a negative attitude, and poor practice toward the prevention of CAUTI among nurses remain an extensive problem. This study aimed to assess KAP and associated factors toward the prevention of CAUTI among nurses in public hospitals in Addis Ababa, Ethiopia, in 2021. An institution-based cross-sectional study was conducted among nurses from March 1 to April 30, 2021, in five public hospitals in Addis Ababa, Ethiopia. A total of 344 nurses were chosen for the study using a systematic random sampling technique. Data were collected using knowledge, attitude, and practice toward the prevention of CAUTI questionnaires. Data were entered into Epi Data 4.2 and exported into SPSS 25 for analysis. Binary and multivariate logistic regression were performed, and the statistical significance of associations between the variables was determined using odds ratios with a 95% confidence interval and p < .05. The study included 344 nurses, with a 97.7% response rate. Of the total nurses, 42.7% had good knowledge, 48.0% had a positive attitude, and 54.9% had good practice toward the prevention of CAUTI. Being married, having guidelines, and having a positive attitude were associated with good knowledge, whereas being married, having good knowledge, and having good practice were associated with a positive attitude toward the prevention of CAUTI. Having a high monthly income, having guidelines, having good knowledge, and having a positive attitude were associated with good practices toward the prevention of CAUTI. The findings of this study show that nurses have a low level of knowledge, a negative attitude, and poor practice toward the prevention of CAUTI. Factors such as marital status, monthly income, and having guidelines in the working unit were associated with KAP toward the prevention of CAUTI. Therefore, the Ministry of Health and Hospital Interventions focused on these findings are required to improve KAP toward the prevention of CAUTI among nurses.

Healthcare workers’ compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen

BackgroundCatheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter.MethodsAn observational study using a descriptive cross-sectional design was conducted at Sana’a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study.ResultsThe majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education.ConclusionYemeni healthcare workers’ overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Anti-infective Efficacy of Duloxetine against Catheter-Associated Urinary Tract Infections Caused by Gram-Positive Bacteria.

Catheter-associated urinary tract infections (CAUTIs) frequently occur following the insertion of catheters in hospitalized patients, often leading to severe clinical complications. These complications are exacerbated by biofilm-forming organisms such as Staphylococcus aureus, contributing to the emergence of multidrug-resistant (MDR) strains, which complicates treatment strategies. This study aims to investigate the antibacterial, antibiofilm, and antiadhesive properties of duloxetine against S. aureus in the context of CAUTI. Our findings demonstrate that duloxetine exhibits significant antibacterial activity, as evidenced by the agar diffusion method. A minimal inhibitory concentration (MIC) of 37.5 μg/mL was established using the microdilution method. Notably, duloxetine displayed inhibitory effects against biofilm formation on polystyrene surfaces up to its MIC level, as demonstrated by the crystal violet method. Intriguingly, the study also revealed that duloxetine could prevent biofilm formation at lower concentrations and reduce mature biofilms, as confirmed by scanning electron microscopy (SEM) and quantitative biofilm assays. Furthermore, duloxetine-coated silicone catheter tubes exhibited antibacterial properties against S. aureus in a bladder model, visualized by confocal laser scanning microscopy (CLSM) and corroborated through FDA and PI staining, highlighting noticeable morphological changes in S. aureus post-treatment. In conclusion, this study presents duloxetine as a promising alternative agent with antibacterial and antiadhesive properties against S. aureus in the prevention and management of CAUTI, warranting further exploration in the clinical setting.

CAUTI Elimination: A Systematic Elimination of CAUTI in Long-Term Care Facility

Catheter-associated urinary tract infection (CAUTI) in nursing-home residents is commonly associated with multiple problems. Lack of proper intervention to prevent CAUTI in the elderly and frail nursing-home residents leads to sepsis, hospitalization, and antimicrobial use, ultimately causing the colonization with multidrug- resistant organisms (MDROs). Furthermore, it inflates the costs. The project aims to systematically determine an approach to eliminate CAUTI in long-term care facilities. There, the establishment of antibiotic stewardship is at its infancy stage. The CAUTI project contributes significantly to the wide-reaching efforts to reduce the threats posed by antimicrobial-resistant organisms. The crucial element of an impactful strategy is the prevention by utilizing evidence-based bundle of care education and evidence-based urinary catheter protocols (UCP), both funded by the Agency for Healthcare Research and Quality (AHRQ). The CAUTI project’s outcome is measured using National Healthcare Safety Network (NHSN) and the symptomatic definition of CAUTI provided by the Centers for Disease Control and Prevention (CDC) to identify and count the cases in the unit; the team uses the NHSN’s data for benchmarking. The qualitative and quantitative methodology approaches utilized to implement a CAUTI prevention strategy at Burbank Healthcare Center and Rehabilitation. Thirty participants were selected out of 172 populations during the study for the CAUTI project. The findings indicate that 11 out of 30 participants developed CAUTI, of which three acquired it at the facility and eight at the community. Further, although female participants were fewer than males, females seem to develop a CAUTI with higher frequency than male participants.

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update.

The intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals published in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission.

What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: Results from a national survey in the United States.

The ways that device-associated infection prevention practices changed during the coronavirus disease 2019 (COVID-19) pandemic remain unknown. We collected data mid-pandemic to assess the use of several infection prevention practices and for comparison with historical data. Repeated cross-sectional survey. US acute-care hospitals. Infection preventionists. We surveyed infection preventionists from a national random sample of 881 US acute-care hospitals in 2021 to estimate the current use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated events (VAE). We compared the 2021 results with those from surveys occurring every 4 years since 2005. The 2021 survey response rate was 47%; previous survey response rates ranged from 59% to 72%. Regular use of most practices to prevent CLABSI (chlorhexidine gluconate for site antisepsis, 99.0%, and maximum sterile barrier precautions, 98.7%) and VAE (semirecumbent positioning, 93.4%, and sedation vacation, 85.8%) continued to increase or plateaued in 2021. Conversely, use of several CAUTI prevention practices (portable bladder ultrasound scanner, 65.6%; catheter reminders or nurse-initiated discontinuation, 66.3%; and intermittent catheterization, 37.3%) was lower in 2021, with a significant decrease for some practices compared to 2017 (P ≤ .02 for all comparisons). In 2021, 42.1% of hospitals reported regular use of the newer external urinary collection devices for women. Although regular use of CLABSI and VAE preventive practices continued to increase (or plateaued), use of several CAUTI preventive practices decreased during the COVID-19 pandemic. Structural issues relating to care during the pandemic may have contributed to a decrease in device-associated infection prevention practices.