Risk Of Catheter-associated Urinary Tract Infection Research Articles

Liquid-Infused Nitric-Oxide-Releasing Silicone Foley Urinary Catheters for Prevention of Catheter-Associated Urinary Tract Infections.

Urinary catheterization is one of the most common medical procedures that makes a patient susceptible to infection due to biofilm formation on the urinary catheter. Catheter associated urinary tract infections (CAUTIs) are responsible for over 1 million cases in the United States alone and cost the healthcare industry more than $350 million every year. This work presents a liquid-infused nitric-oxide-releasing (LINORel) urinary catheter fabricated by incorporating the nitric oxide (NO) donor S-nitroso-N-acetylpenicillamine (SNAP) and silicone oil into commercial silicone Foley catheters through a two-stage swelling process. This synergistic combination improves NO-releasing materials by providing minimal SNAP leaching and a more controlled release of NO while incorporating the nonfouling characteristics of liquid-infused materials. The LINORel urinary catheter was successful in sustaining a controlled NO release over a 60 day period under physiological conditions with minimal SNAP leaching during the initial 24 h period, 0.49 ± 0.0061%. The LINORel-UC proved successful in reducing bacterial adhesion and biofilm formation for Gram positive Staphylococcus aureus (98.49 ± 2.06%) over a 7 day period in a drip flow bioreactor environment. Overall, this study presents a desirable combination that incorporates the antifouling advantages of liquid-infused materials with the active release of a bactericidal agent, an uncharted territory in aiding to prevent the risk of CAUTIs.

Catheter-associated urinary tract infection: signs, diagnosis, prevention.

Catheter-associated urinary tract infection (CAUTI) is one of the most prevalent healthcare-associated infections (HAIs) in the UK and can have implications for both the patient and the health service. This article highlights those at risk, the signs and symptoms of CAUTI, diagnosis, methods of prevention and treatment. It highlights current guidance available to nurses to help ensure they are following the most recent recommendations for best practice.

Association of Thoracic Epidural Pain Management with Urinary Retention after Complex Abdominal Wall Reconstruction

The association of thoracic epidural analgesia and urinary retention after complex abdominal wall reconstruction (CAWR) is unknown. The purpose of this study was to investigate the association between the presence of a thoracic epidural, timing of Foley catheter removal, and the rates of urinary retention and catheter-associated urinary tract infections (CAUTIs) in patients undergoing CAWR. All patients undergoing CAWR, who had an epidural catheter for postoperative pain management at our institution from September 2015 through April 2016, were prospectively followed. Patients were divided into two groups. Group 1 had their Foley catheters removed on postoperative day one, whereas Group 2 had their Foley catheters removed after epidural removal. The incidence of urinary retention and CAUTI were compared between the two groups. A total of 67 patients met inclusion criteria; 27 (40.3%) patients were in Group 1. Patients in Group 1 were significantly more likely to experience urinary retention requiring Foley catheter replacement (P = 0.02). There was no statistically significant difference in the rate of CAUTI between the two groups (P = 0.51). Patients undergoing CAWR with thoracic epidural pain management are at risk of experiencing postoperative urinary retention. Foley catheter removal after epidural removal does not place the patient at an increased risk for CAUTI and therefore should be strongly considered in this patient population.

EFFECT OF INFECTION CONTROL PROGRAM ON CATHETER ASSOCIATED URINARY TRACT INFECTION IN INTENSIVE CARE UNITS AT ZAGAZIG UNIVERSITY HOSPITAL

ABSTRACT Background: Catheter-associated urinary tract infection produces substantial morbidity in hospitalized patients including discomfort, fever, malaise and unnecessary antibiotic use, which may become an important source of antibiotic resistant organisms. Further, the catheterized urinary tract acts as a reservoir for the dissemination of these drug resistant organisms to other patients. Aim of the study : was to improve the safety of intensive care unit (ICU) patients with urinary catheter via decreasing the incidence of catheter-associated urinary tract infection (CAUTI) at Zagazig University Hospital through assessment of knowledge and practice of ICU staff about catheter associated infection and assessment of the incidence of CAUTI among ICU patients in Zagazig University Hospital and implementation of Infection Control Program in the selected ICUs. Subjects and methods: An interventional study (one-group pre-test post-test design) was conducted during the period from 2016 to 2018 at Zagazig university Hospital in two ICUs; surgical and emergency intensive care units. The study was carried out through two phases; the first included the followings: active electronic surveillance for (CAUTI); assessment of health care providers' knowledge about CAUTI before and after intervention through constructed questionnaire and assessment of health care providers' practice before and after intervention by using performance observation checklist. The second phase, included implementation of infection control program based on the conceptual model of Comprehensive Unit-based Safety Program (CUSP). Results: There was a high statistical significant increase in knowledge of resident physicians and nurses about guidelines for prevention of catheter associated urinary tract infection in the studied intensive care units after intervention (P ˂0.01). There was high statistical significant improvement in urinary catheterization practice in the studied intensive care units after intervention (P ˂0.01). Regarding incidence of CAUTI, before intervention, CAUTI incidence was 10.6 per 1000 urinary catheter days. After intervention, CAUTI incidence significantly dropped to 5.4 per 1000 urinary catheter days. Risk of CAUTI before intervention was approximately twice that after intervention. The intervention reduced risk of CAUTI by 49.1%. Regarding isolated pathogens associated with reported CAUTI, the most frequent isolated pathogens were Klebsiella spp. (31.4%), followed by Candida albicans (21.4%), Pseudomonas spp. (14.3%) and E. coli (12.9%) Conclusion: At Zagazig university hospitals’ ICUs, implementation of infection control program on CAUTI was noticed to be associated with improvement in healthcare providers’ knowledge and practice and decrease in CAUTI incidence. Sustainability is required to maintain such improvement. So. It is recommended to keep continuous training of ICU staff and upgrade ICU protocols according to recent guidelines. Keywords: Infection Control, Catheter Associated Urinary Tract Infection, Intensive Care Unit

Impact of Foley Catheter Placement by Medical Students on Rates of Postoperative Urinary Tract Infection

The aim of this study was to evaluate the impact of medical student placement of Foley catheters on rates of postoperative catheter-associated urinary tract infection (CAUTI). We included adult surgical patients in our institutional National Surgical Quality Improvement Program (NSQIP) database, and defined CAUTI according to NSQIP criteria. A multivariable model risk-adjusting for patient and operative variables associated with CAUTI in univariate analysis (exploratory p < 0.20) evaluated the independent effect of medical student placement of Foley catheters on the odds of CAUTI. There were 891 patients who had a Foley catheter placed by a surgical resident (61%; n= 547), operating room nurse (25%; n= 227), or medical student (13%; n= 117). After risk-adjustment, patients with Foleys placed by medical students were at a more than 4-fold increased risk of CAUTI (odds ratio [OR] 4.09, p= 0.02) compared with patients with catheters placed by nurses. Patients with catheters placed by residents did not have an increased risk-adjusted odds of CAUTI (OR 2.16, p= 0.15). Other significant predictors of postoperative CAUTI included female sex (OR 2.61, p= 0.01), partial/total functional dependence (OR 4.81, p= 0.008), blood transfusion (OR 34.7, p= 0.02), and increased length of Foley stay (OR 1.06, p < 0.001). Surgical patients with Foley catheters placed by medical students are at increased risk-adjusted odds of postoperative CAUTI. More intense supervision of medical students during urinary catheter insertion in the operating room and improved education regarding sterile technique may be important factors in reducing rates of postoperative CAUTI in academic institutions.

Efficacy of bladder irrigation in preventing urinary tract infections associated with short-term catheterization in comatose patients: A randomized controlled clinical trial

Bladder irrigation can be performed to prevent catheter-associated urinary tract infections (CAUTI), but its efficacy has been not reported in short-term indwelling urinary catheterization. This clinical trial aimed to examine the efficacy of bladder irrigation with normal saline solution in preventing CAUTI in comatose patients admitted to intensive care units. Eligible patients were randomized to the experimental group or control group. The experimental group received daily bladder irrigation with 450 cc sterile normal saline, in 3 150-mL doses, for 3 consecutive days. Data on signs of CAUTI, including urine culture, axillary body temperature (primary outcomes), and other urine and blood parameters (secondary outcomes) were obtained at baseline and 5 days later. Results of group comparisons and logistic regression analysis that controlled for fluid intake showed that the risk of CAUTI decreased by 99% in the experimental group compared with the control group (odds ratio, 0.01; P < .001). Additional findings indicated a decrease in axillary body temperature and improvements in urine appearance, urinary red cells and white cells, and erythrocyte sedimentation rates and white-cell counts in the blood following bladder irrigation. Daily bladder irrigation with normal saline during 3 days demonstrated efficacy in preventing CAUTI in comatose patients.

MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER Jason Warncke, Brittan Sutphin, John Hohenmeyer, E. David Crawford, and Brian Flynn Jason WarnckeJason Warncke More articles by this author , Brittan SutphinBrittan Sutphin More articles by this author , John HohenmeyerJohn Hohenmeyer More articles by this author , E. David CrawfordE. David Crawford More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, 75% are catheter-associated urinary tract infections (CAUTI). CAUTI has gained much attention, as in 2008 Medicare regulations ceased reimbursement for costs related to nosocomial CAUTIs. Traditional teaching has been that suprapubic catheters (SPC) are associated with less risk of CAUTI than transurethral catheters (TUC). However, studies directly comparing the CAUTI rate in patients with SPC versus TUC are lacking, particularly in the postoperative Urologic patient. Thus, in this study we aim to compare the CAUTI rate with SPC versus TUC in the postoperative Urologic patient. METHODS We retrospectively reviewed and compared the medical records of 354 patients over a 5-yr period that underwent Urologic surgery. The SPC group consisted of patients that underwent SPC placement at the time of concomitant autologous rectus fascia pubovaginal sling (PVS) by a single surgeon (BJF). SPC placement was accomplished using the T-Spec device from Swan Valley Medical. The TUC group consisted of patients that underwent TUC placement using an 18 Fr Foley at the time of open radical prostatectomy (RP) by a single surgeon (EDC). Patients without a SPC or TUC and patients with both were excluded from the study. The primary outcome of comparison was the CAUTI rate (defined by the 2017 CDC guidelines) between the SPC and TUC cohorts. A Fisher’s exact test was performed to determine if the difference in CAUTI rate between the two cohorts was statistically significant (p<0.05). RESULTS 252 patients were included, including 145 (57.6%) in the SPC group and 107 (42.5%) in the TUC group, mean age 54.5 and 61.5 yrs, respectively. The mean catheter duration at the time of CAUTI for the SPC and TUC groups were 21.3 and 16.0 days, respectively (p=0.79). The mean catheter duration for the TUC group with and without CAUTI was 25.4 and 14.7 days, respectively (p=0.14). The overall CAUTI rate when catheter duration was less than 15 days compared to greater than 15 days was 3.3% and 5.0%, respectively (p=0.39). The CAUTI rate for the SPC group was 2.1% versus the TUC group 7.5% (p=0.039; OR 3.82). CONCLUSIONS In this study of postoperative Urologic patients, SPC was found to have a statistically significant lower rate of CAUTI when compared to TUC. This information may help guide providers when choosing the appropriate bladder drainage modality for their patients, particularly in the postoperative Urologic setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Warncke More articles by this author Brittan Sutphin More articles by this author John Hohenmeyer More articles by this author E. David Crawford More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A study of risk factors for catheter associated urinary tract infection

Background: Catheter associated urinary tract infections (CAUTIs) are the most common causes of UTIs in postoperative cases. Many risk factors are associated with its incidence. The present study was conducted with the aim to determine the related risk factors and to identify the causative agents contributing to the urinary tract infection.Methods: This prospective study was conducted on 210 patients meeting the requirements of inclusion criteria during September 2012 to February 2014. Detailed history of the patients was recorded. Urine culture was done at different time intervals to identify the causative agent suggestive to CAUTI. Univariate analyses of the association of each variable with CAUTI and multivariable logistic regression were done to predict CAUTI outcome.Results: The mean age of study participants was 51.61 years. Among them 141 were males and 69 were female patients. On univariate analysis purpose for urine catheterization, place of catheterization, breach in the closed system of drainage, duration of catheterization, hemoglobin value less than 10, raised renal parameters with serum creatinine more than 1.5 were all significantly associated with development of CAUTI (p value 0.000). Sex of the patient (p value 0.279) and catheter size (p value 0.279) was not found to have a significant correlation with increased risk of CAUTI. On multivariate analysis, age, catheter size, diabetes, duration of catheterization, a breach in the closed system of catheter drainage and sex were found to be the significant risk factors associated with CAUTI (p&lt;0.05).Conclusion: An understanding of the risk factors in development of CAUTI, significantly helps in reducing the additional burden on the health care system. Measures such as shortening the duration of catheterization, strict control of diabetes and sterile precautions in insertion and maintenance of indwelling catheters can help in prevention CAUTI.

Reducing catheter-associated urinary tract infections in hospitals: study protocol for a multi-site randomised controlled study

IntroductionDespite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI...

MP23-17 THE CHARACTERISTICS AND PROGRESSION OF BACTERIAL BIOFILMS ON URINARY CATHETERS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2017MP23-17 THE CHARACTERISTICS AND PROGRESSION OF BACTERIAL BIOFILMS ON URINARY CATHETERS Anh Nguyen, Glenn Werneburg, Jason Kim, Annie Rohan, and David Thanassi Anh NguyenAnh Nguyen More articles by this author , Glenn WerneburgGlenn Werneburg More articles by this author , Jason KimJason Kim More articles by this author , Annie RohanAnnie Rohan More articles by this author , and David ThanassiDavid Thanassi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.745AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The majority of hospital-acquired urinary tract infections (UTIs) are catheter-associated UTIs (CAUTIs), which are associated with increased morbidity and mortality in patients, with 13,000 attributed deaths annually. CAUTIs are also associated with increased length of hospital stays and 0.4-0.5 billion USD in annual healthcare costs, as well as unnecessary antimicrobial use. The formation of biofilms (groups of bacterial cells that adhere to one another and to a fixed surface) on catheters is critical to the development and persistence of CAUTI, as biofilms function as both barriers to antibiotics and reservoirs of microbes. We sought to determine the natural history of biofilm formation on urinary catheters. In particular, we were interested in the starting location(s) of biofilm formation, and whether biofilms predominated proximally or distally on catheters, their timing and manner of progression, and whether catheter biofilm formation was predominantly extraluminal or intraluminal. METHODS Foley catheters (n=19) were collected from outpatient and inpatient clinics at a large university medical center from post-surgical patients at 1 to 28 days indwelling time. Each catheter was sectioned and stained, and biofilms were quantitated using spectrophotometry. RESULTS Short-term catheters (indwelling <1 week) displayed predominant biofilm formation at the proximal (bladder-exposed) end, whereas long-term catheters (indwelling 3-4 weeks) displayed significant biofilm formation throughout all segments. Biofilm growth on short-term catheters was predominantly extra-luminal, whereas long-term catheters demonstrated significant extra- and intra-luminal biofilm staining. CONCLUSIONS The results of this preliminary study inform approaches to developing novel strategies to prevent and eradicate bacterial biofilms from urinary catheters. For example, this study suggests that catheter-coating techniques targeting the extraluminal surface of the proximal end of the urinary catheter may contribute to a delay of biofilm formation, and reduce the overall risk of CAUTI. Efforts are under way to further investigate biofilm progression with larger sample sizes, and to determine how a reduction in biofilm formation and progression may contribute to reduced CAUTI risk. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e300 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Anh Nguyen More articles by this author Glenn Werneburg More articles by this author Jason Kim More articles by this author Annie Rohan More articles by this author David Thanassi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution

Purpose: The purpose of this study is to identify the rate of catheter-associated urinary tract infection (CAUTI) after Cesarean delivery (CD) and to determine if any factors increase risk of infection.Methods: A retrospective cohort study was performed at a multi-center institution for patients who underwent CD in 2013. All patients had urinary catheters inserted before surgery. Diagnosis followed IDSA guidelines with culture growing greater than 103 CFU of bacteria per mL with symptoms or symptomatic urinary tract infections treated at provider discretion. Statistical analysis was assessed with Chi-square and Student’s t-test followed by logistic regression.Results: Of 2419 patients, 36 patients developed CAUTI (1.5%). In the 24 (66.7%) cases diagnosed by IDSA guidelines, Escherichia coli was the most common causative organism (54.1%); followed by Enterococcus faecalis (16.7%), Streptococccus agalactiae (8.3%), and Group A Streptococcus (8.3%). Longer operative time (OR 1.013; 95% 1.002–1.023; p = .02) and pregnancies complicated by STI (OR 4.15; 95% CI 1.11–15.0; p < .05) were associated with higher rates of CAUTI.Conclusions: The overall rate of CAUTI after CD was low at 1.5%. Escherichia coli was the most common causative pathogen. Identification of the patients at high risk for CAUTI allows for risk reduction measures.

ANALYSIS CATHETER ASSOCIATED URINARY TRACT INFECTION IN CHILDREN: THE EDIMO STUDY

Ponte Academic JournalMar 2017, Volume 73, Issue 3 ANALYSIS CATHETER ASSOCIATED URINARY TRACT INFECTION IN CHILDREN: THE EDIMO STUDYAuthor(s): Putri Eyanoer ,Rosmayanti Syafriani Siregar, Putri Chairani Eyanoer, Rafita RamayatiJ. Ponte - Mar 2017 - Volume 73 - Issue 3 doi: 10.21506/j.ponte.2017.3.28 Abstract:Catheter-associated urinary tract infection (CAUTI) is the most common type of healthcare-associated infection. Education-implementation and monitoring (EDIMO) study was one of project to decrease CAUTI rate in our hospital. We evaluate the effect of EDIMO targeted on modifiable risk factors on CAUTI rates. This study was cohort prospective between January 1st, 2015 and September 30th, 2016. Urinary tract infection was defined as if patients with an indwelling urinary catheter (in place for more 2 calender days) have at least 1 of the following sign or symptoms. Compliance was assessed as all or none, meaning that each patient�s event had to comply with all elements of the bundle to be considered compliant. Bacteria were identified by using an ATB kit, and the antibiotic sensitivities were tested by using the Kirby-Bauer method. There were 354 children enrolled in EDIMO study and 165 CAUTI episodes occurred among 153 children. Eschericia coli (27.9%) and Enterobacter (26.1%) predominated for CAUTI infection. Compliance with education (RR,0.68; 95% CI,0.50-0.84), implementation (RR,0.69; 95% CI,0.51-0.83) and monitoring (RR,0.39; 95% CI,0.33-0.82) was independently associated with a lower risk of CAUTI. Compliance with standardized practices for EDIMO study was associated with lower risk of CAUTI infection in pediatric patients.\\\\r\\\\n\\\\r\\\\nKey words: catheter urine, infection , pediatric, education, implementation and monitoring Download full text:Check if you have access through your login credentials or your institution Username Password

The NHSN 2015 Rebaseline—How Updating CAUTI Risk Adjustment Affects the SIRs

BackgroundIn January 2017, the CDC’s National Healthcare Safety Network (NHSN) updated both the aggregate healthcare associated infection (HAI) data that serve as baselines for standardized infection ratios (SIRs) and the risk adjustment (RA) methods used to calculate SIRs. The new baseline data are 2015 HAI incidence data; the new risk adjustment (RA2) models are predictive models developed using new baseline data. The previous RA1 method for catheter-associated urinary tract infections (CAUTI) used location- and facility-stratified rates to predict CAUTI incidence. The 2015 rebaseline used location- and facility-level factors in log-linear models to determine the expected number of infections. The objective of this study was to compare RA2 vs. RA1 SIRs from acute care hospitals (ACH).MethodsWe analyzed 1 year of CAUTI-ACH data reported to NHSN (2015). We compared differences between SIRs under RA2 vs RA1 at the national- and facility- levels. ACHs with <1 predicted infections were excluded. We used paired T and Empirical Distribution Function (EDF) tests to compare differences between means and medians of the SIR distributions respectively. Using quintiles, we compared shifts in facility-level SIRs between RAs (RA1 - referent group).Results4318 ACHs reported CAUTI data to NHSN in 2015. 2917 (67%) vs 2468 (57%) ACHs had ≥1 expected infections and SIRs calculated using RA1 and RA2 respectively; 2466 (57%) ACHs had SIRs calculated using either RA method. The 2015 national pooled mean RA1 SIR was 0.580 (95% CI: 0.573, 0.588), and 0.983 (95% CI: 0.970, 0.996) under RA2. The means and medians of the two SIR distributions were significantly different (P < 0.0001). At the facility level, 1992 (81%) ACHs had SIRs that did not change between RA1 and RA2, 238 (10%) had SIRS that improved (lower in RA2 vs RA1), while 235 (10%) had SIRs increased (higher in RA2 vs RA1).ConclusionThere was a marked increase in the SIR with the introduction of the new baseline towards 1.00 (the national benchmark). This was attributed to the new RA2 models which control for many factors that are known to influence the number of HAI infections, unlike RA1. Comparable proportions of facilities had SIRS improve or worsen between RA1 and RA2 indicating that shifts in facility level SIRs were not large.Disclosures All authors: No reported disclosures.

A Qualitative Study of Factors Facilitating Clinical Nurse Engagement in Emergency Department Catheter-Associated Urinary Tract Infection Prevention.

The aim of this study was to explore the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs. Hospitals face increasing financial pressures to reduce CAUTI. Urinary catheters, often inserted in the ED, expose patients to CAUTI risk. Nurses are the principal champions of ED CAUTI prevention programs. This was a qualitative analysis from a multisite, comparative case study project. A total of 52 interviews and 9 focus groups were analyzed across 6 enrolled EDs. Using a conventional content analysis, members of the research team coded data and developed site summaries to describe themes that had emerged across transcripts. Subsequently, all codes and site summaries were reviewed to identify the actions of nurse leaders that facilitated clinical nurses' engagement in CAUTI prevention efforts. Nurse leaders were the principal champions of CAUTI prevention programs and successfully engaged clinical nurses in CAUTI prevention efforts by (1) reframing urinary catheters as a source of potential patient harm; (2) empowering clinical nurses to identify and address CAUTI improvement opportunities; (3) fostering a culture of teamwork, which facilitated interdisciplinary communication around urinary catheter appropriateness and alternatives; and (4) holding clinical nurses accountable for CAUTI process and outcome measures. The prevention of CAUTI is an important opportunity for nurse leaders to engage clinical nurses in meaningful improvement efforts. Clinical nurses are best positioned to examine urinary catheter insertion workflow and to suggest improvements in avoiding use and improving placement and maintenance. To engage clinical nurses in CAUTI prevention, nurse leaders should focus on how urinary catheters expose patients to potential harm, involve nurses in designing and implementing practice changes, and provide local data to show the impact of nursing practices on patient outcomes.

Assessment of a multi-modal intervention for the prevention of catheter-associated urinary tract infections

Catheter-associated urinary tract infections (CAUTIs) represent an important healthcare burden. To assess the effectiveness of an evidence-based multi-modal, multi-disciplinary intervention intended to improve outcomes by reducing the use of urinary catheters (UCs) and minimizing the incidence of CAUTIs in the internal medicine department of a university hospital. A multi-modal intervention was developed, including training sessions, urinary catheterization reminders, surveillance systems, and mechanisms for staff feedback of results. The frequency of UC use and incidence of CAUTIs were recorded in three-month periods before (P1) and during the intervention (P2). The catheterization rate decreased significantly during P2 [27.8% vs 16.9%; relative risk (RR): 0.61; 95% confidence interval (CI): 0.57-0.65]. We also observed a reduction in CAUTI risk (18.3 vs 9.8%; RR: 0.53; 95% CI: 0.30-0.93), a reduction in the CAUTI rate per 1000 patient-days [5.5 vs 2.8; incidence ratio (IR): 0.52; 95% CI: 0.28-0.94], and a non-significant decrease in the CAUTI rate per 1000 catheter-days (19.3 vs 16.9; IR: 0.85; 95% CI: 0.46-1.55). The multi-modal intervention was effective in reducing the catheterization rate and the frequency of CAUTIs.

Prevalence and Microbiological Profile of Catheter Associated Urinary Tract Infections: A Survey in Secondary Care Hospital in Gaza Strip

Background and Objectives: Healthcare-associated infections is a major health care concern posing potentially serious negative impact on patient safety and outcome. In this paper, we report this microbiological profile and the prevalence of Catheter Associated Urinary Tract Infections (CAUTIs). Methods: This was a prospective observational study for 60 inpatients from eight wards among patients having indwelling catheter for at least 48 hours. Urine cultures were taken in initial phase within 24 hour of admission, at 48 hours and in day 5 of catheterization. Findings: The rate of CAUTIswas 16.7% after 48 hours and 28% (7/25) after 5 days from insertion the indwelling catheter.Candida spp. was the most common cause of CAUTIs (29.4%), followed by E. coli (23.5%), Streptococcus spp. and Klebsiella spp. (17.6%) and last Staphylococcus spp. (11.7%). The coronary care unit (CCU) showed the highest prevalence of CAUTIs (57.1%), followed by Oncology (42.8%), and Internal Medicine (33.3%). Females showed a significantly higher rate of acquired urinary tract infections compared with males (P < 0.05). Conclusions: The risk of CAUTIs was found to be relatively high and increase by duration of catheterization. These results recommend minimally usage of catheter in medical practice in terms of both frequency and time, particularly for female patients and in CCU ward. Identification of the microbiological profile of the CAUTIs would help efficient treatment of the infected patients.

A point prevalence study of healthcare associated urinary tract infections in Australian acute and aged care facilities

Abstract Objectives Surveillance of healthcare associated urinary tract infections (HAUTIs) in Australian acute and aged care facilities is lacking. Therefore, to provide the foundation for a national point prevalence study of HAUTIs and catheter associated urinary tract infection (CAUTIs), a three phase project was developed with recent completion of the second phase. The objectives of Phase II were to (1) develop a website incorporating tools for conducting point prevalence of HAUTIs and CAUTIs, (2) pilot an online process and database for conducting point prevalence of HAUTIs and CAUTIs and (3) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities. This paper reports on the third objective. Methods Point prevalence of HAUTIs and CAUTIs were assessed in 82 acute care and 17 aged care facilities within four Australian jurisdictions using an online survey. Results The study included 1320 patients and 663 residents from acute and aged care facilities respectively. HAUTI prevalence was 1.4% (95% CI 0.8–2.2%) in acute care and 1.5% (95% CI 0.8–2.6%) in aged care. Catheter use in acute care (9.3%) was three times greater than aged care (3.3%). Conclusion Given the relative frequency with which HAUTI occurs, associations with addition length of stay in hospital and risk of systemic sepsis from these infections, efforts should be made to further minimise HAUTI prevalence. There is also a need to develop targeted interventions for catheter use especially in acute care because inappropriate and/or excessive catheter use has implications for the risk of CAUTIs and adds consumable costs.

Catheter-associated urinary tract infection after cardiovascular surgery: Impact of a multifaceted intervention

The aims of this study were to assess the impact of a multifaceted intervention on the incidence of catheter-associated urinary tract infection (CAUTI) and on the urinary catheter utilization (UCU) ratio, evaluating adherence to recommendations for the use of indwelling urinary catheters (IUCs). This prospective, before-and-after interventional study was conducted in three 6-month phases: preintervention (phase 1), intervention (phase 2), and postintervention (phase 3). We observed IUC insertion technique, maintenance care, and removal/nonremoval practices; provided training on CAUTI prevention measures; evaluated professional knowledge; provided adherence feedback; determined the incidence of CAUTI, and calculating the UCU ratio. Between phases 1 and 3, CAUTI incidence fell from 11.42 to 4.40 cases/1000 catheter-days (P=.216), whereas the UCU ratio remained constant. The risk of CAUTI was 2.6-fold higher in phase 1 than in phase 3. Adherence to hand hygiene (before and after IUC insertion) improved significantly, as did adherence to attaching the IUC to the patient and maintenance care guidelines. The reasons for IUC use (including inappropriate reasons) did not differ significantly. Professional knowledge improved significantly after training. A multifaceted intervention effectively reduced CAUTI incidence and improved the quality of care.

How and when nurses collect urine cultures on catheterized patients: A survey of 5 hospitals

Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Evaluating nurses' knowledge regarding appropriate reasons and methods to obtain urine culture specimens are the first steps to improving practice. Nurses at 5 hospitals completed a 40-question survey regarding their knowledge, training, and practices of appropriate reasons for obtaining urine cultures. The survey included different scenarios of patients with urinary catheters and when they would expect to obtain urine cultures. A 12-point scoring system calculated responses regarding urine collection appropriateness. There were 394 nurses who responded to the survey. Of them, 76.1% reported receiving education on CAUTI risk reduction within the last 12months. Although 327 (83%) of all nurses surveyed reported that they never collect urine samples by draining directly from the drainage bag, only 58.4% viewed others to be fully compliant with that standard (P<.001). Nurses who considered their knowledge to be above average to excellent had similar knowledge assessment scores (out of 12 points) for triggers to obtain urine cultures (mean score, 4.9±1.72) compared with those that reported average to poor knowledge (mean score, 4.64±1.78; P=.15). Important opportunities exist for nurses to optimize the decisions to obtain urine cultures and the process for obtaining them. Addressing nurses' knowledge and practice may lead to more appropriate use of urine cultures.

Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients.

Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures. All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs. There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p<0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality. There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to increased diligence and may help to improve peri-operative outcomes. Recognizing patients at high risk for CAUTI may lead to improved measures to decrease CAUTI rates within this population.