Urinary Catheter Care Research Articles

Reducing urinary catheter related infections in care homes: a review of the literature

Although much guidance indicates that indwelling urinary catheters should only be used for the management of urinary retention and incontinence as a last resort, approximately 10% of care home residents have them, leading to increased risks of catheter associated infections and mortality. Catheterisation rates and subsequent infections can be reduced through more proactive management of incontinence and toileting, and removal of urinary catheters from residents discharged from hospital. Staffing in care homes should match residents' nursing and continence needs to allow this proactive approach. Audit of care home should and hospital discharge catheterisation rates, combined with feedback and staff training will raise awareness of the benefits of reducing catheterisation rates. Use of the Department of Health's Essential Steps to Safe, Clean Urinary Catheter Care (2006a) will also help to reduce catheter associated infections.

The Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices

The Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices Introduction. Health care-associated infections (HAIs) are a major threat to patient safety. The spread of HAIs cases in intensive care units (ICUs) and in surgical units is influenced by the severity of the patients' condition, as well as the number of invasive procedures and the environment of the units. The immune systems of critically ill patients are in a severe state which increases the probability of beneficial conditions for a colonisation by pathogenic microorganisms due to invasive procedures. Furthermore, the action of inserting an invasive device (urinary catheter, peripheral vein catheter) disrupts the natural defence mechanisms by itself. Aim of the study. To determine risk factors of HAIs during invasive procedures: peripheral vein catheter and urinary catheter insertion and care at the time. Materials and methods. The research was performed in the ICUs and in the surgical units of Latvia's regional multi-profile hospitals (n=3), using the quantitative research method: questionnaire (n=188), and qualitative research methods: clinically structured empiric research (n=45) and microbiological tests (n=86): a) with a Count-Tact applicator and a special culture medium, b) with a swab, and c) with catheter sedimentation method. Results. The study results showed that surgical nurses take care of 18 to 40 patients per day, while intensive care nurses take care of 2 to 3 patients per day. A common problem identified in ICUs and in surgical units related to the lack of unified nursing protocols on performing invasive procedures in all cases (100%; 45/45). Microbiological investigations showed a high level of bio-contamination during invasive procedures: the amount of microorganisms on the nurses' hands considerably exceeded the acceptable levels in all cases (100%; 4/4), and medium to high levels of bio-contamination were discovered on patient's changed bed sheets (100%; 2/2) as well as in nurses' hair (85.7%; 48/56) and their work wear (78.5%; 44/56). In 25% of the observed cases Staphylococcus aureus was discovered in the sterile zone of the peripheral vein catheter 72 hours and 96 hours after the catheter's insertion. 72 hours after the catheter's insertion, as well as 7 days after the insertion of a urinary catheter, 100% of the cases revealed the presence of at least one and in some cases several of the following pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli , β haemolytic Streptococcus and fungi, such as Candida albicans and Candida tropicalis. Conclusions. The main risk factors of HAIs in patients' care using invasive devices are: the lack of unified nursing protocols, aseptic and antiseptic mistakes and excessive workload, as well as a high level of bio-contamination in the ICUs and in surgical units.

The International Nosocomial Infection Control Consortium (INICC): Goals and objectives, description of surveillance methods, and operational activities

We have shown that intensive care units (ICUs) in countries with limited resources have rates of device-associated health care-associated infection (HAI), including central line-related bloodstream infection (CLAB), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), 3 to 5 times higher than rates reported from North American, Western European, and Australian ICUs. The International Nosocomial Infection Control Consortium (INICC) is an international ongoing collaborative HAI control program with a surveillance system based on that of the US National Healthcare Safety Network. The INICC was founded 10 years ago to promote evidence-based infection control in hospitals in limited-resource countries and in hospitals of developed countries without sufficient experience in HAI surveillance and control, through the analysis and feedback of surveillance data collected voluntarily by the member hospitals. It developed from a handful of South American hospitals in 1998 to a dynamic network of 98 ICUs in 18 countries, and is the only source of aggregate standardized international data on HAI epidemiology. Herein we report the criteria and mechanisms for gaining membership in INICC; the training of personnel in INICC hospitals; the INICC protocol for outcome surveillance of CLABs, VAPs, and CAUTIs in ICUs, microorganism profiles, bacterial resistance, antibiotic use, extra length of stay, extra costs, extra mortality, and risk factor analysis, and for process surveillance, including compliance rates for hand hygiene, vascular catheter care, urinary catheter care, and measures for prevention of VAP; and the use of surveillance data feedback as a powerful weapon for control of HAIs. The INICC will continue to evolve in its quest to find more effective and efficient ways to assess patient risk and improve patient safety in hospitals.

Opinion on Millar et al., ‘Are meticillin-resistant Staphylococcus aureus bloodstream infection targets fair to those with other types of healthcare-associated infection or cost-effective?’

Millar et al. 1 Millar M. Coast J. Ashcroft R. Are meticillin-resistant Staphylococcus aureus bloodstream infection targets fair to those with other types of healthcare-associated infection or cost-effective?. J Hosp Infect. 2008; 69: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar present the hypothesis that the Department of Health (DoH) target for the National Health Service (NHS) in England to reduce meticillin-resistant Staphyloccus aureus (MRSA) bloodstream infections (BSI) has had a detrimental effect on the control of other healthcare-associated infections (HCAIs). However, their argument is based on a premise that activities focused on reducing MRSA BSI are isolated entities, unique to the prevention and control of MRSA BSI and with no beneficial impact on other HCAIs. Furthermore, they present no evidence that this has in fact happened, whereas there is no doubt that the increased attention to HCAIs and the emphasis on infection prevention and control is having a significant beneficial effect on the delivery of safe healthcare in England. The lead author, Dr Millar, like many of us, has spent much of his professional life as a medical microbiologist in an environment where HCAI and the whole issue of infection prevention and control had a very low priority within the medical establishment and NHS management. Now, however, this issue is at the top of the agenda in all NHS bodies and Trust Boards and their Chief Executives are being held to account for delivering safe healthcare with a zero-tolerance approach to avoidable HCAIs. The authors also suggest that the actions aimed at reducing MRSA BSI would not have any beneficial effect on other HCAIs and might lead to a worsening of the situation. This does not fit with the range of activities that has been put in place in the DoH programme. MRSA BSI is the headline infection, the subject of mandatory reporting since 2001, and represents the most severe end of the spectrum of MRSA infections. It is certainly the focus of performance management within the NHS in England, but the package of guidance and action notes within the DoH programme addresses HCAI issues far wider than MRSA BSI. The increased attention to cleanliness and hygiene is perhaps even more relevant to C. difficile, norovirus and Acinetobacter infection than to MRSA BSI itself. Similarly, the antimicrobial prescribing framework guidance is relevant to C. difficile prevention and control and to all HCAIs that are generally caused by antibiotic-resistant organisms (MRSA, extended-spectrum β-lactamase-producing E. coli, Acinetobacter spp., glycopeptide-resistant enterococci). The Saving Lives High Impact Interventions address all HCAI BSI by attention to aseptic practice and proper intravascular device care, all nosocomial urinary tract infections by attention to urinary catheter insertion and care, ventilator pneumonia due to any bacteria in the ventilator care bundle and all wound infections in the surgical site infection bundle. Furthermore, the basic premises of hand hygiene and aseptic clinical procedures are the right approach to the prevention of any HCAIs. Even the most specific MRSA control measure – the requirement to implement screening for MRSA carriage in all patients admitted to NHS Trusts – is appropriate to the control of all MRSA infections, not just BSI.

Long term urinary catheter problems: a flow chart to aid management

In this article the author presents a flow chart designed to assist nurses in providing evidence-based care of long term urinary catheters. The flow chart guides the nurse in making a proper assessment of the reason for urinary bypassing, blockage and non-drainage. The flow chart is intended to help identify a cause and to aid the practitioner in following a long term management plan.

Knowledge and Attitudes of Nursing Home Staff and Surveyors About the Revised Federal Guidance for Incontinence Care

We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home surveyors from a midwestern state attending two statewide workshops on the revised guidance. Of 558 attendees, 500 (85%) responded, including 39% of the state's directors of nursing and 57% of state nursing home surveyors. There were striking deficiencies in knowledge regarding urinary incontinence and catheter care, with significant discrepancies by type of respondent, particularly between state surveyors and nursing home staff. Staff cited documentation and staffing levels as the most frequent concerns about implementation. Open-ended responses reflected the divergence of concerns and antagonism among the stakeholders, and staff nurses' feeling that F315 violated residents' rights. The revised Tag F315 guidance will be unlikely to improve the quality of urinary incontinence care in nursing homes because of significant knowledge and attitudinal discrepancies between nursing home staff and state surveyors, facility staff's focus on documentation and staffing, and reliance on implementation strategies known to be ineffective. Federal, state, and other urinary incontinence guideline efforts should focus on managerial structures and methods to improve quality nursing home care. Research is needed to address how nursing home residents and families define and value "quality" urinary incontinence management and to incorporate these in quality-improvement strategies and measures.

Urinary catheter care

In a previous Nursing & Residential Care (NRC) article (Pomfret and Nazarko, 2006) the costs and benefits of using urinary catheterization in nursing and residential homes were considered.

Back to Basics Education for Urinary Catheter Care in a Home Care Setting

ISSUE: Noting an increase in catheter associated urinary tract infections by internal and external benchmarking, an examination of policies and practices demonstrated inconsistency, brought about by individual physician preferences, long standing cultural habits, and efforts to meet reimbursement criteria. Reference material specific to home care was limited, published guidelines generally commented on catheter care and not the unique care in challenging and complicated chronically ill home bound patients. Networking through a regional home care alliance revealed other home care agencies in the area had similiar issues. PROJECT: Develop a back to basics campaign on urinary catheter management, both for staff and home caregivers. The practice was to change the catheter every 30 days, symptomatic or not. Another practice was to begin with a large gauge catheter, and if leaking, increase diameter until controlled. Education on change intervals, techniques to elimate breaking sterile system and to prevent leakage was provided. Basic care regarding hydration, diet, positioning and hygiene were reinforced. Disparity was found in reveiwing the supplies. Products were upgraded to include anti-microbial features. Reimbursement tied to visit frequency was addressed by education in the appropriate manner to access and document care of chronically catherized patients to comply with regulations and maintain quality care. RESULTS: Several discoveries were made, including a patient with blue urine syndrome, which was quite startling. After a three year initiative, the catheter associated urinary tract infection rate fell from 6.9 to 1.6. The external benchmarks frequently reported home care agencies with zero infections for a 3 month period. This raised concerns with our regional home care networking group. An absence of urinary infections in this population for several months stirred questions of accuracy in reporting and definition adherence. Our regional group voted to develop a database for purposes of external benchmarking to better discover the norms for our community. This is in process. LESSONS LEARNED: Benchmarking with external databases remained problematic. Hospice was included in the first months, until clarified with the external database by definition. Our own data was perplexing. Personnel issues were reveiwed for a four year period and it was suggestive that data collection tools and practices may have been influenced by mutiple personnel changes in the year preceding the initiative. Possibly this demonstrated a more drastic deviation from our internal mean than originally thought. The tool was revised and definition reveiwed at the start of this project to assure consistency. As staff evolves, continuing education is parmount to maintain and further reduce catheter associated urinary tract infections.

Risk factors for hospital-acquired methicillin-resistant Staphylococcus aureus bacteraemia: a case-control study

A case-control study was undertaken in an acute district general hospital to identify risk factors for hospital-acquired bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA). Cases of hospital-acquired MRSA bacteraemia were defined as consecutive patients from whom MRSA was isolated from a blood sample taken on the third or subsequent day after admission. Controls were randomly selected from patients admitted to the hospital over the same time period with a length of stay of more than 2 days who did not have bacteraemia. Data on 42 of the 46 cases of hospital-acquired bacteraemia and 90 of the 92 controls were available for analysis. There were no significant differences in the age or sex of cases and controls. After adjusting for confounding factors, insertion of a central line [adjusted odds ratio (aOR) 35.3, 95% confidence interval (CI) 3.8-325.5] or urinary catheter (aOR 37.1, 95% CI 7.1-193.2) during the admission, and surgical site infection (aOR 4.3, 95% CI 1.2-14.6) all remained independent risk factors for MRSA bacteraemia. The adjusted population attributable fraction, showed that 51% of hospital-acquired MRSA bacteraemia cases were attributable to a urinary catheter, 39% to a central line, and 16% to a surgical site infection. In the United Kingdom, measures to reduce the incidence of hospital-acquired MRSA bacteraemia in acute general hospitals should focus on improving infection control procedures for the insertion and, most importantly, care of central lines and urinary catheters.

Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff

A self-administered questionnaire was used to determine care home staff's reported knowledge of the urinary catheter care standards published by the National Institute for Clinical Excellence (NICE) and the Association of Continence Care, and to see whether this differed in homes with higher catheterization rates. Seven hundred and fifty out of 1438 (52%) nursing and care staff from 37 randomly selected care homes with high, medium and low catheterization rates responded. There was no difference in reported practice in care homes in the three health districts sampled or those with differing catheterization rates. Eighty-three percent of the nursing staff and 40% of the other care staff received formal catheter care training. However, at least 10% of all staff reported not washing their hands before handling a catheter, and delaying emptying a urine bag until it was full, rather than three-quarters full. Only 45% of nursing staff and 40% of other care staff encouraged residents to empty their own catheter bags. Routine use of catheter maintenance solutions or bladder washouts was reported by 50% of all staff. Nursing staff (29%) and other care staff (54%) took urine specimens from the catheter bag tap. Compliance with standards has improved greatly since an audit in 1998. However, some non-compliance remains. There is a need for ongoing local audit and formal training in urinary catheter care, particularly for non-qualified care staff. Education is needed to ensure local implementation of NICE guidance.

Nosocomially acquired urinary tract infections in urology departments: Why an international prevalence study is needed in urology

Nosocomially acquired urinary tract infection (NAUTI) is the most frequent nosocomial infection and a particular problem in urology departments. The incidence of NAUTI has become an important quality parameter and a legal issue. Several characteristics related to the health care provider, the patient and the procedures are known to increase the risk of NAUTI. The single most important risk factor for NAUTI is an indwelling catheter. NAUTI may be prevented by good health care facilities, evidence-based practice, wise patient selection and surgical skill. But the most important factors are tailored antibiotic prophylaxis and continuous monitoring of the incidence and pathogens causing NAUTI in each institution. Raising antimicrobial resistance in some countries calls for a closer monitoring of NAUTI on international level within urology. There is room for improvement in urinary catheter care in many hospitals, and the importance of patient and urological risk factors for development of NAUTI is not fully known. In order to meet these challenges the European Society for Infections in Urology is planning a prevalence study combined with a quality improvement initiative related to NAUTI.

Urinary catheter care in the intensive care unit.

Urinary catheters are associated with a number of complications, and nurses are ideally suited to minimize the associated risks by utilizing the available research in their practice. Urine tract infections caused by urine catheters are associated with increased mortality; however, urine catheter care is a nursing procedure, the importance of which is sometimes overlooked. This study reviews recommended guidelines on urine catheter care and current published literature on the subject. The aim of the study was to identify recommended practice and compare it with the current research and literature to conclude best practice. Conclusions made from this study are that existing guidelines correspond to the recommendations and findings in recent research and literature. However, more detailed guidelines and further research on how to prevent catheter-associated urine tract infections and other complications may be of benefit.

Prevalence of urinary catheterization in UK nursing homes

A postal questionnaire survey was undertaken in registered nursing homes in three different health districts in England: Gloucestershire, North Staffordshire and Leeds. Nursing homes may be registered as general nursing or mental health homes. If homes also have provision for residential beds these are defined as dual registered homes. Overall, 9% (438/4900) of residents, with an equal male:female split, had urinary catheters. There was no significant difference in the overall urinary catheterization rate in the three districts ( P=0.9). There was a wide range of urinary catheterization prevalence between homes, with some homes of all three categories having no catheterized residents and several with a prevalence of over 40%. The wide range of prevalence may be due to differences in residents' underlying medical conditions or to differences in attitudes towards urinary catheterization by nursing home staff. Almost all homes (114/124, 92%) stated they had an infection control policy, but 31% (38/124) did not have a written policy on urinary catheter care. In view of the potential for morbidity, infection control policies should include a section on the care of urinary catheters and this should form part of the continuing training of nursing home staff.

Management of Continence and Urinary Catheter Care: BJN Monograph

Management of Continence and Urinary Catheter Care: BJN Monograph

Management of continence and urinary catheter care Jeremy Pope Cruikshank Management of continence and urinary catheter care and SueWoodward Mark Allen Publishing Ltd1 85642 201 1185642 201120629.99

Management of continence and urinary catheter care Jeremy Pope Cruikshank Management of continence and urinary catheter care and SueWoodward Mark Allen Publishing Ltd1 85642 201 1185642 201120629.99

Management of Continence and Urinary Catheter Care

Management of Continence and Urinary Catheter Care

Management of continence and urinary catheter care Jeremy Pope Cruickshank and Sue Woodward Management of continence and urinary catheter care Quay Books 206pp; £29.99 1 85642 2011 1856422011

This monograph has many contributors from diverse working environments (not all in the continence speciality), which emphasises the fact that bladder or bowel dysfunction and its management covers a wide area of health care.

Management of Continence and Urinary Catheter Care Management of Continence and Urinary Catheter Care

Management of Continence and Urinary Catheter Care Management of Continence and Urinary Catheter Care

Local opinion leaders: effects on professional practice and health care outcomes.

Both the theory of diffusion of innovations and the social influences model of behaviour change suggest that using local opinion leaders to transmit norms and model appropriate behaviour may improve health professional practice. To assess the effects using local opinion leaders on the practice of health professionals or patient outcomes. We searched MEDLINE to May 1998, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles. Randomised trials of the use of local opinion leaders (defined as health professionals nominated by their colleagues as being educationally influential). The participants were health care professionals responsible for patient care. Two reviewers independently extracted data and assessed study quality. Eight studies were included involving more than 296 health professionals. A variety of patient problems were targeted, including acute myocardial infarction, cancer pain, osteoarthritis, rheumatoid arthritis, chronic lung disease, vaginal birth after caesarean section, labour and delivery, and urinary catheter care. Six of seven trials that measured health professional practice demonstrated some improvement for at least one outcome variable, and in two trials, the results were statistically significant and clinically important. In three trials that measured patient outcomes, only one achieved an impact upon practice that was of practical importance: local opinion leaders were effective in improving the rate of vaginal birth after previous caesarean section. Using local opinion leaders results in mixed effects on professional practice. However, it is not always clear what local opinion leaders do and replicable descriptions are needed. Further research is required to determine if opinion leaders can be identified and in which circumstances they are likely to influence the practice of their peers.

Long-term indwelling urinary catheter care: conceptualizing the research base.

The traditional public health concepts of agent, host, and environment can provide a useful interdisciplinary model for analysing the current state of knowledge in long term indwelling urinary catheter care. A broad review of literature about urinary catheter care was carried out to identify major areas of research and gaps in knowledge. Most research in the past decade has focused on understanding how catheter encrustations develop and how such encrustations may contribute to leaking/blocking of the catheter and urinary tract infection. Two tables are presented which summarize research related to the development of sediment/encrustation of the catheter and to irrigation of the catheter. Nevertheless, many areas related to catheter care have not been studied extensively. The patient's perspective is one such area. Other areas that have not been studied in depth include care of the drainage bag and the role of fluid intake. These under-studied concerns relate to environmental factors with which the nurse is directly involved, namely, asepsis and hydrokinetic forces. Further conceptualization of the nursing role in long-term urinary catheter care might aid in the development of nursing theories that could be tested to understand how best to help people manage these catheters.