Urinary Catheter System Research Articles

Reply to Editorial Comment on "Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device"

Reply to Editorial Comment on "Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device"

Editorial Comment on “Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device”

Editorial Comment on “Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device”

309 Reducing the Catheter Associated Infection Rate Within a Burn Intensive Care Unit

Abstract Introduction Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-onset healthcare-associated infections (HAI) in the United States. HAIs are key quality and safety metrics publicly reported in the acute-care space and linked to hospital reimbursement by the Centers for Medicare and Medicaid Services. CAUTIs, represent approximately 9% of all HAIs, and are associated with increased morbidity, mortality, and cost in intensive care units (ICUs). CAUTIs are thought to impact patient outcomes and healthcare costs significantly. A recent analysis concluded that CAUTIs accounted for only 0.3% of HAI costs in the United States, or approximately $28 million/year. Per patient, CAUTI costs are described in wide ranges from $876 (for inpatient costs to the hospital for additional diagnostic tests and medications) to $10,197 (for inpatient costs to Medicare for ICU patients). The objective of this study was to analyze CAUTI incidences before and after the introduction of a novel urinary catheter with an integrated active drain line clearance system for continuous urine output in a burn intensive care unit. Methods Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015-December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Charts were reviewed to characterize the patients. Results A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (P< 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). Conclusions CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients. Applicability of Research to Practice Implementation of a urinary catheter system with integrated drain line and urine clearance could reduce

Microcontroller-based urine output monitoring system design and implementation

Urinary system disorders that occur at later ages are more common as the average human lifespan increases. Although urinary system disorders are widespread among elderly individuals, these disorders are seen in young people. The catheter system is used in some diseases such as urinary incontinence in the elderly. In addition, patients in different age groups who are hospitalized may need the catheter system during their treatment processes. In this study, a urine output monitoring system was designed and implemented to facilitate the tracking of the patient’s health situation. The designed control system was created based on the PIC18f45K22 microcontroller. The urine output monitoring system was created with a load cell, color sensor, buzzer, liquid crystal display screen, and Bluetooth communication units. A mechanical connection system was developed in which the urinary drainage bag attached to the catheter could be suspended to the control system by means of a hook. Thus, the developed system measured the weight of the urinary bag with a mean relative error value between 0.18% and 1.25%. The load cell–based created control system sensed the weight of the urinary catheter system and gave a warning when the urine in the drainage bag reached a predetermined weight. In addition, the optical density of the urine was measured, sent to the control unit using a wireless Bluetooth communication system, and classified on a 5-point scale to provide a simple visual indicator for caregivers to distinguish normal urine from urine requiring investigation. An audible warning was created using the microcontroller-based system in case of an emergency. The health condition of the patient was visualized through the designed interface program.

55: REDUCING CAUTI EVENTS WITH ACTIVE DRAIN LINE CLEARANCE: A RETROSPECTIVE OBSERVATIONAL STUDY

Introduction: Catheter-associated urinary tract infections (CAUTIs), represent approximately 9% of all hospital-associated infections and are associated with increased morbidity, mortality, and cost in intensive care units (ICUs). We performed a quality improvement study to assess if the use of a bladder catheter with integrated active drain line clearance reduced the rate of catheter-associated urinary tract infections (CAUTIs) in a burn ICU. Methods: We performed an eight-year (2015–2022) retrospective cohort study in a single-center burn ICU with seven beds. CAUTI events were compared from a 48-month period in which gravity bladder catheters had been the standard of care to a 28-month period after the implementation of a novel urinary catheter system. This urinary monitoring system features an active drain line clearance, two one-way valves preventing urinary backflow, and automation of intra-abdominal pressure measurements. Charts were reviewed to characterize the patients. Results: A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. The incidence of CAUTI events pre-implementation was 0.030 (mean 10 CAUTI events per year) compared to 0.002 (mean 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (P < 0.01, risk ratio Accuryn vs. no gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). Median [IQR] urinary catheter dwell time to CAUTI events was 4.5 [2.0, 6.2] pre- and 6.0 [5.5, 6.5] post-novel catheter implementation. Conclusions: A novel urinary catheter system with integrated active drain line clearance reduced the rate of CAUTI after implementation. Active drain line clearance preventing standing urine in the bladder and tubing system and two one-way valves eliminating urine backflow might be favorable features potentially leading to a reduction in CAUTI events compared to gravity urinary catheters.

A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring.

A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). Eight-year retrospective before and after study (2015-2022). A single American Burn Association-verified Burn Center with 14 inpatient beds. Patients meeting criteria for admission to a Burn Center. Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015-December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Patients were transferred from outside hospitals with gravity bladder. A distinction in the chart between catheter types was impossible. Charts were reviewed to characterize patients with CAUTI events. A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (p &lt; 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients.

Safety and efficacy of a novel silver-impregnated urinary catheter system for preventing catheter-associated bacteriuria: A pilot randomized clinical trial

The purpose of this study was to evaluate the safety of a novel silver-impregnated Foley catheter system designed to prevent catheter-associated bacteriuria and funguria, assess recruitment feasibility for a future pivotal trial, and preliminarily assess efficacy. This single-center, randomized controlled trial at a university hospital involved adult neurosurgical patients expected to have a urinary catheter for ≥24 hours. Subjects were randomized to a novel silver-impregnated (test) Foley catheter system or a control system. They were followed for 30 days (or until discharge) while catheterized and for up to 48 hours after catheter removal, with daily bacteriuria testing and assessment for symptoms of infection and catheter intolerance. Ninety-five subjects were randomized (intention-to-treat [ITT] population). Of these, 61 subjects (64%) had a catheter for ≥24 hours without perioperative antibiotics beyond 24 hours (evaluable population). In the ITT population, 11 of 95 (12%) subjects had an asymptomatic bacteriuria (ABU) event. Compared with controls, test system recipients had a trend toward longer time to ABU in the ITT population (P = .08, log-rank test) and a longer time to ABU in the evaluable population (P = .03). All 6 ABU events caused by gram-negative bacilli occurred in the control group. In this pilot randomized trial the test system was well tolerated and seemingly effective in preventing catheter-associated bacteriuria, especially with gram-negative bacilli. A pivotal study is warranted.

A Quality Improvement Program: Structured Exercise for the Outpatient Blood and Marrow Transplant Patient

s / Biol Blood Marrow Transplant 20 (2014) S297eS315 S308 practice. The manufacturers of the indwelling urinary catheter had no recommendations regarding irrigation via the sample collection port. Methods, Intervention, & Analysis: A literature search using key search terms included indwelling catheter, catheterassociated urinary tract infections, bone marrow transplant and oncology resulted in limited findings. Therefore, University Healthcare Consortium (UHC) and nursing staff were surveyed for current bladder irrigation practices. Expert clinicians were consulted regarding the practice of closed catheter irrigation. Retrospective case samples of bone marrow transplant patients (n1⁄4 46) with indwelling urinary catheters were screened for catheter usage and triggers for catheter removal. BMT patients were screened weekly for urinary catheter presence and rationale for removal. Our institution has a nurse-driven indwelling urinary catheter protocol to decrease urinary catheter usage and infection. Registered Nurses on the BMT units were surveyed via an online Survey Monkey survey regarding number on years on the BMT unit; nurses perception of number of patient complaints related to lower abdominal cramping, spasms, or pain while having an indwelling urinary catheter; how nurses and physicians treated this complaint and nurses’ awareness of the nurse-driven catheter removal policy. Findings & Interpretation: The majority of indwelling urinary catheters were removed upon expiration, followed by physician order, followed day of discharge or to extended care facility. Only a small number of urinary catheters were removed per the urinary catheter removal protocol. The literature search was limited but consistently recommended maintenance of a closed drainage system, and not routine catheter irrigation. Five United Healthcare Consortium hospitals responded to the survey; three used closed-system irrigation for urinary catheters. Approximately 25% of BMT nursing staff surveyed used closed catheter irrigation when patients complained of pain, cramping, etc. One unexpected finding from the staff survey was that greater than 70% of those surveyed were unaware of the protocol allowing nurses to remove a urinary catheter without a physician’s order. Discussion & Implications: This study impacts safe patient care. BMT have many factors that can potentially lead to catheter obstruction. Timely removal of catheters when no longer needed could eliminate the problem. Staff education was provided regarding the urinary catheter removal protocol. Weekly urinary catheter surveillance continues to monitor the urinary catheter usage and staff nurses’ adherence to the catheter removal protocol. The nurse driven urinary catheter removal have been posted on the unit. Urinary catheter system remains closed when irrigation is needed thereby reducing the risk of infection. Also, by not having to treat the patient’s painful spams with anti-spasmodic medications and pain medication, this decreases the patient’s fall risk and risk of injury. Future studies could examine the incidence of bladder spasms and the impact of closed drainage system irrigation on a multi-site larger BMT patient sample.

A study to determine whether the use of a preconnect urinary catheter system reduces the incidence of nosocomial urinary tract infections

Nosocomial urinary tract infection (NUTI) is a common problem in the UK and is often related to the use of urinary catheters. In the UK urinary catheters account for approximately 25% of all healthcare associated infections and can have a considerable financial burden on the health service. Bacteria may gain entry into the bladder of a catheterised patient via the intra-luminal route especially if accidental disconnection arises. A prospective study was undertaken to determine the NUTI rates in patients using a preconnected catheter system compared to a traditional bag and catheter system on three medical wards. A total of 205 patients were included in the study. The catheter-associated urinary tract infection rate (CAUTI) in the baseline was 37.8 per 1,000 catheter days and 22.4 per 1,000 catheter days in the intervention group. The rates of CAUTI were 41% lower in the intervention group. The data in this sample group suggests the use of the preconnected catheter offers some protection against infection. The use of the preconnected system is a new concept in the UK and further studies are required to evaluate its effectiveness. The results from this study suggest their use may help to reduce the risk of CAUTI in certain clinical areas.

Traditional Foley Drainage Systems—Do They Drain the Bladder?

Foley catheters are assumed to drain the bladder to completion. Drainage characteristics of Foley catheter systems are poorly understood. To investigate unrecognized retained urine with Foley catheter drainage systems, bladder volumes of hospitalized patients were measured with bladder scan ultrasound volumetrics. Additionally, an in vitro bench top mock bladder and urinary catheter system was developed to understand the etiology of such residual volumes. A novel drainage tube design that optimizes indwelling catheter drainage was also designed. Bedside bladder ultrasound volumetric studies were performed on patients hospitalized in ward and intensive care unit. If residual urine was identified the drainage tubing was manipulated to facilitate drainage. An ex vivo bladder-urinary catheter model was designed to measure flow rates and pressures within the drainage tubing of a traditional and a novel drainage tube system. A total of 75 patients in the intensive care unit underwent bladder ultrasound volumetrics. Mean residual volume was 96 ml (range 4 to 290). In 75 patients on the hospital ward mean residual volume was 136 ml (range 22 to 647). In the experimental model we found that for every 1 cm in curl height, obstruction pressure increased by 1 cm H2O within the artificial bladder. In contrast, the novel spiral-shaped drainage tube demonstrated rapid (0.5 cc per second), continuous and complete (100%) reservoir drainage in all trials. Traditional Foley catheter drainage systems evacuate the bladder suboptimally. Outflow obstruction is caused by air-locks that develop within curled redundant drainage tubing segments. The novel drainage tubing design eliminates gravity dependent curls and associated air-locks, optimizes flow, and minimizes residual bladder urine.

Closed Is the Word: Creating a Closed Urinary Catheter System in a Pediatric Intensive Care Unit

ISSUE: Catheter-associated urinary tract infections (CAUTIs) account for 40% of all healthcare-associated infections. Studies show that a closed catheter system has a direct effect on the prevention of CAUTIs. However, this system is not available for the pediatric population. Evaluation of our 12-bed Pediatric Intensive Care Unit (PICU) in June 2003 revealed a CAUTI rate of 9.7 per 1000 catheter days for the previous 15 months and a catheter utilization ratio of 35%. PROJECT: An initiative was started in July 2003 to reduce our catheter days with the goal of decreasing CAUTIs. Despite a 37% reduction in our catheter utilization ratio, there was no change in the incidence of our CAUTIs (for the 15 months post-intervention there were 10.81 infections per 1000 catheter days). Since our outcome was not one we anticipated, a root cause analysis was done. We investigated nursing practices, procedures and products. These analyses lead us to focus on catheter insertion, maintenance practices and product. A survey that included questions about these specific practices was developed and given to all nursing staff in the PICU. RESULTS: The survey on urinary catheter maintenance did not reveal any reported breaches in infection control practices. However, when nurses were questioned about the steps in catheter insertion, 76% answered that connecting the catheter to the collection bag was the final step in the procedure. Based on this information, we developed a plan to change practice in inserting urinary catheters. Our practice was changed to include the connection of the catheter to the collection bag prior to insertion, thus creating a “closed system” from the start. A multi-faceted educational program was provided to all nursing staff to alert them of this change. LESSONS LEARNED: As Infection Control Professionals, we are challenged to seek out methods/technology to improve patient outcomes. We must remember that not all technological advances aimed for improvement in clinical outcomes target every population at risk. Therefore, there will be times we may need to improvise to obtain our outcome. “Necessity is the mother of all invention.”

Urinary Catheter System Recalled Due to Sterility Risk

Urinary Catheter System Recalled Due to Sterility Risk

A study to determine whether the use of a preconnect urinary catheter system reduces the incidence of nosocomial urinary tract infections

osocomial urinary tract infection (NUTI) is a common problem in the UK and is often related to the use of urinary catheters. In the UK urinary catheters account for approximately 25 per cent of all healthcare-associated infections and can have a considerable financial burden on the health service. Bacteria may gain entry into the bladder of a catheterised patient via the intra-luminal route especially if accidental disconnection arises. A prospective study was undertaken to determine the NUTI rates in patients using a preconnected catheter system compared to a traditional bag and catheter system on three medical wards. A total of 205 patients were included in the study. The catheter-associated urinary tract infection rate (CAUTI) in the baseline was 37.8 per 1,000 catheter days and 22.4 per 1000 catheter days in the intervention group. The rates of CAUTI was 41 per cent lower in the intervention group. The data in this sample group suggests the use of the preconnected catheter offers some protection against infection. The use of the preconnected system is a new concept in the UK and further studies are required to evaluate its effectiveness. The results from this study suggest their use may help to reduce the risk of CAUTI in certain clinical areas.

Silver Urinary Catheter System Is Key to Significant Reduction and Postponement of Urinary Tract Infections

Silver Urinary Catheter System Is Key to Significant Reduction and Postponement of Urinary Tract Infections

Silver Urinary Catheter System Is Key to Significant Reduction and Postponement of Urinary Tract Infections

ISSUE: Catheter-associated urinary tract infection (CA-UTI) is a high-volume nosocomial infection that is of significant consequence to the hospitalized patient in Japan and contributes to the development of antibiotic resistance in the hospital. CA-UTI has been the focus of our infection control program for 9 years with little progress prior to this project. PROJECT: A performance improvement project was designed for the prevention of CA-UTI in our 600-bed acute-care hospital utilizing a preconnected silver/hydrophilic-coated catheter system. An 8-month baseline of symptomatic CA-UTIs was established in 1997 with the standardized use of a hydrophilic-coated preconnected catheter system. Comparison was made with the same 8-month period in 2003 with the standardized use of a silver/hydrophilic-coated preconnected catheter system. All catheterized patients were included in both the baseline and the study periods. Symptomatic CA-UTIs were identified by positive urine culture, and the NISS definition was utilized. The period from catheter insertion to onset of infection was measured. Additionally, the cost of a CA-UTI was computed for cost analysis. RESULTS: A 51.6% reduction in the incidence of CA-UTI was observed with the silver/hydrophilic-coated catheter system. Incidence of onset of CA-UTI within 7 days after insertion was reduced by 84.6% with the silver/hydrophilic-coated catheter. The calculated average cost of CA-UTI for 2003 was 56,872 yen (US $537). LESSONS LEARNED: The silver/hydrophilic catheter system can significantly reduce CA-UTIs. This catheter can also postpone the onset of infection. The impact of these reductions is important to the hospital economy in Japan.