Urinary Drainage System Research Articles

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital. Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: sex female, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. In our study the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients removal of the bladder catheter must be performed as soon as possible.

Indwelling catheter-associated urinary tract infections.

Catheter associated urinary tract infection accounts for a large proportion of all hospital-acquired infections, and there has been little change in the incidence of such infections since the introduction of closed sterile urinary drainage systems in the 1960s. The aim of this paper is to review the literature on the subject of catheter associated urinary tract infections, with reference to the use and possible improvement of closed sterile catheter drainage systems.

Electrified urinary drainage bag: an in vitro study.

An experimental study was designed to examine the effect of electrical current on bacteria-contaminating urinary drainage bags. An experimental model analogous to a urinary drainage system has been formed. Bottles containing 1,000 ml urine inoculated with Pseudomonas aeruginosa, Klebsiella pneumoniae or Escherichia coli in different experimental settings were drained with constant speed into urinary drainage bags in which platinum electrodes had been implanted. An experimental procedure involved applying an electrical current with a 12 V DC generator into bags containing urine for 24 h. Cultures were obtained separately from the bags and microorganism-inoculated bottles for 24 h and following a cessation of electrical current for another 24 h. In electrified bags, P. aeruginosa was killed in all experiments. E. coli and K. pneumoniae were eradicated at the end of 24 h. However, K. pneumoniae began to grow in increasing numbers following the cessation of the electrical current. An electrical current might decrease or eradicate the bacteria in urinary-drainage bags. This might be one of the ways to decrease the risk of in vivo cross-contamination and nosocomial infections.

Protocol of a prospective cohort study of the effect of different methods of drainage of neuropathic bladder on occurrence of symptomatic urinary infection, and adverse events related to the urinary drainage system in spinal cord injury patients.

BackgroundTo present a protocol of a prospective, cohort study in which four groups of spinal cord injury (SCI) patients will participate. (Patients with indwelling urethral catheter; patients who perform intermittent catheterisation without wearing a penile sheath; patients who perform intermittent catheterisation and wear penile sheath as well; and patients with penile sheath drainage).Objectives(1) What is the incidence of symptomatic urinary infection in men with spinal cord injury who use different types of bladder drainage? (2) Which are predisposing factors for the occurrence of symptomatic urinary infection in men with spinal cord injury who practise different methods of bladder drainage? (3) What is the incidence of catheter and urinary drainage system-related adverse events in the four groups of SCI patients?PatientsThe criteria for inclusion are as follow: (1) Male patients with neuropathic bladder due to spinal cord injury, who are registered with the Regional Spinal Injuries Centre, Southport, England. (2) Age: 18 years or above. (3) Patients who are willing to give informed consent for participation in the study. (4) Patients willing to be contacted every two weeks by a staff of the spinal unit for 36 months. (5) Patients who are willing to maintain an accurate record of adverse events related to urinary catheter and urinary drainage system and predisposing factors for the occurrence of symptomatic urinary infection. (6) Patients, who are stabilised in a particular method of bladder drainage, and therefore, unlikely to make a permanent change in the method of bladder drainage (e.g. from penile sheath drainage to the use of long-term indwelling catheter) during a foreseeable future.MethodsThe participants will be observed for a period of 36 months. A staff of the spinal injuries unit will contact the participants by telephone every two weeks on a mutually agreed day and time. The information obtained during this standardised telephonic interview conducted once in two weeks will be entered in a database. When a participant develops symptom(s) suggestive of urinary infection, he will undergo urine and blood tests, and imaging studies of the urinary tract.ConclusionThis study will provide information regarding the occurrence of symptomatic urinary infection, predisposing factors for development of urinary infection, and adverse events related to urinary catheter and urinary drainage system in SCI patients using different methods of bladder drainage.

Prune belly syndrome and congenital kidney tumors

High end sonography allows the prenatal localization of the kidneys and the corresponding urine drainage system as early as 10-13 weeks of gestation. In mid second trimester, the voiding and filling of the urinary bladder can be demonstrated by ultrasound. Obstructions are the most common abnormalities of the urogenital tract. Though less frequent in incidence, more complex sequences of anomalies such as Prune Belly Syndrome or Megacystis-Microcolon-Intestinal-Hypoperistalsis-Syndrome (MMIHS) can also be detected in early gestational age. Pathogenesis, prenatal diagnosis, pre- and postnatal treatment options and prognosis are discussed. The same risk-adapted procedures aimed to protect the fetal urinary excretory function known in the therapeutic regimen of obstructive uropathy are available as treatment options. These range from non-invasive ultrasound for diagnosis and surveillance to needle procedures or even endoscopic interventions. Another rare entity of renal abnormalities are congenital neoplasm's--megaloblastic nephroma, nephroblastoma and neuroblastoma. Prognosis and obstetrical management are to be determined individually for each patient.

Prevention of Nosocomial Urinary Tract Infection in ICU Patients: Comparison of Effectiveness of Two Urinary Drainage Systems

To determine whether the rate of acquisition of bacteriuria differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients. Prospective, nonrandomized, controlled trial. Medical/surgical/trauma ICU in a university hospital. Two hundred twenty-four ICU patients requiring an indwelling urinary catheter. We compared the rate of acquisition of bacteriuria in two groups of consecutive patients (n = 113 and n = 111, respectively) who underwent bladder catheterization with a TCOS during the first 6 months and with a CCDS during the next 6 months. Urinary catheters were managed by a team of trained nurses following the same written protocol. No prophylactic antibiotics were administered, either during management of catheter placements or catheter withdrawal, but 75% of patients received one or more antimicrobial medications for treatment of infected sites other than the urinary tract. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. Only patients who required an indwelling catheter for > 48 h were evaluated. There was no statistical difference in the rate of bacteriuria between the two groups. Bacteriuria occurred in 11.5% and 13.5% of patients, and was diagnosed on day 14 +/- 8 and 13 +/- 9 of catheterization (mean +/- SD) for the TCOS and the CCDS, respectively. A CCDS cost $3 (US dollars) more than the TCOS. To our knowledge, this is the first study to compare the effectiveness of a TCOS and a CCDS in ICU patients. No differences were noted between the two systems (alpha = 0.05). The higher cost of a CCDS is not justified for ICU patients.

Incidence and Risk Factors of Bacteriuria after Transurethral Resection of the Prostate

Introduction: Postoperative bacteriuria is a frequent event after transurethral resection of the prostate, despite the use of prophylactic antibiotics. Certain risk factors have been clearly established (preoperative urinary catheter or bacteriuria, operating time), while others remain uncertain. Materials and Methods: We conducted a prospective study in five urology centers, including non–catheterized patients with sterile preoperative urine undergoing transurethral resection of the prostate for benign prostatic hyperplasia. All received antibiotic prophylaxis with cefamandole. The incidence of bacteriuria and its risk factors were investigated. Results: The postoperative bacteriuria rate was 26% (26/101), with 8% on removal of the catheter, 14% between the 7th and 10th postoperative days and 5% 1 month postoperatively. Factors associated with bacteriuria on univariate analysis were: operating time, disconnection of the closed urine drainage system and postoperative catheterization ≧3 days. Two variables were associated on multivariate analysis (logistic regression): operating time >52 min (odds ratio 9.0, 95% confidence interval 2.1–39.0) and disconnection of the closed urine drainage system (odds ratio 26.3, 95% confidence interval 6.1; 6.1–113). Conclusions: The postoperative bacteriuria rate after transurethral resection of the prostate was high in this study, raising the question of the choice and/or duration of prophylactic antibiotics. Prevention of postoperative bacteriuria must be based on careful hemostasis, prevention of postoperative catheter disconnections, and limitation of the duration of postoperative catheterization.

Urinary catheters: selection, maintenance and nursing care.

Catheterization is often undertaken without sufficient assessment, and the high rates of bacteriuria (10-20%) occurring in catheterized patients seem to be accepted (Ward et al, 1997). This article reviews catheter selection, maintenance and nursing care, highlighting problem areas and suggesting measures that may be taken to reduce the risk factors. A problem-solving approach, based on research evidence relating to catheter care, is presented. Often there is a simple solution to a problem, but treatments based on traditions or myths appear to be the first choice in many situations. This article aims to provide nurses with the evidence base required to establish and maintain a urinary drainage system safely.

Maintaining a closed urinary drainage system

WHEN YOUR PATIENT HAS A URINARY CATHETER, KEEPING THE TUBING PATENT AND PROPERLY POSITIONING THE DRAINAGE BAG HELP PREVENT INFECTION. REMEMBER THESE KEY POINTS.

Use of “closed” urinary drainage systems in septic patients in intensive care

The so-called “open” and “closed” urinary drainage systems in patients in intensive care are compared in order to evaluate the cost/benefit ratio in preventing urinary infections. 523 patients were studied; 120 were catheterised with the “open” system, 403 with the “closed” system. The “squared X” test was used for statistical comparisons, with Yates’ continuity correction. In the “open” system group, 70% of patients became infected, a statistically significant result (p<0.05). The higher cost of the “closed” drainage system would seem to be compensated by the fact that the catheter remains in situ for 10-14 days, unless there are complications, while infections are fewer and there is a saving on specific drugs and hospitalisation times.

Bladder Management and Urinary Tract Infections in Danish Hospitals, Nursing Homes, and Home Care: A National Prevalence Study

AbstractObjective:To establish the prevalence of urinary tract infection in patients undergoing various forms of bladder management.Design:A nationwide descriptive point-prevalence survey with logistic regression analysis of the data relating infection to bladder management.Setting:Fifteen hospitals, 21 nursing homes, and 13 home care districts throughout Denmark.Patients:Information was collected on 3,665 patients. On the day of the study, 349 patients had indwelling catheters and 1,150 were using external urine drainage systems (condoms or diapers) for bladder management.Results:The prevalence of urinary tract infections in catheterized patients and those using external drainage systems was 13.2% and 8.1%, respectively. The prevalence of hospital-acquired urinary tract infection (4.2%) had not changed from that reported in 1978. The proportion of these infections related to the indwelling catheter, however, had reduced from 66% to 30%. Logistic regression analysis confirmed that, when corrected for the patient-related confounders (female gender, age >60 years, incontinence, immobility, and stay in hospital for longer than 15 days), condoms (odds ratio [OR], 5.94; 95% confidence interval [CI95], 2.8 to 12.5), indwelling catheters (OR, 3.3; CI95, 2.3 to 4.8), and diapers (OR, 1.5; CI95, 1.1 to 2.1) were significantly (P<.001, P<.001, and P=.008, respectively) related to infection.Conclusions:Prevalence surveys have revealed that over the period 1978 to 1991, during which efforts have been made to restrict the use of indwelling catheters and to encourage the care of catheterized patients according to guidelines recommended by the Danish National Centre for Hospital Hygiene, the percentage of hospital-acquired urinary tract infections associated with indwelling catheters has been halved. External urine drainage systems, however, have emerged as significant risk factors for urinary tract infection.

Catheters: design, selection and management.

Urinary catheterization is a common procedure that is performed on 12% of hospital patients (Crow et al, 1996) and 4% of community patients (Getliffe, 1990). When considering catheterization as a method of care, many decisions need to be made in order to select the optimum equipment and provide effective catheter care. This includes selecting the type of catheterization that needs to be performed, i.e. intermittent or indwelling, and choosing the right catheter material, size and balloon infill volume. The type and design features of the urinary drainage and suspensory system have a direct effect on individual patient comfort, dignity and life. Aspects of catheter care that need to be considered include: meatal hygiene, fluid intake, bladder washouts, constipation, clamping catheters, collecting specimens of urine, fixation of catheters and sexuality.

Examination of biofilm formation and risk of infection associated with the use of urinary catheters with leg bags

Urinary catheters and leg bags were simultaneously colonized by Escherichia coli and Proteus vulgaris using a model urinary drainage system. The system was continuously supplied with filter-sterilized artificial urine using a diurnal flow pattern. The extent of colonization was determined by assessment of both planktonic and biofilm formation over time. Contamination of the catheters resulted in rapid colonization of the whole system within a 24 h period. Contamination of the leg bags resulted in an ascending biofilm formation over a four-day period. Results indicated that infection risks could be minimized by changing the catheter and leg bags at least once a week. The design of the leg bags was not found to influence the rate or extent of biofilm formation.

Control of nosocomial infections in an intensive care unit in Guatemala City.

We tested the effectiveness of specific vs. general infection control interventions in a teaching hospital in Guatemala City. After 3 months of prospective surveillance, we implemented targeted interventions (i.e., modification of respiratory tract care and use of a closed urinary catheter drainage system), an educational program focused on respiratory intervention, and general interventions (i.e., aseptic technique). The rate of nosocomial pneumonia, the most common nosocomial infection, decreased from 33% (41 of 123 patients) before intervention to 16% (21 of 130 patients) after intervention (P = .001). Although the frequency of hand washing increased from 5% to 63% (P < .001), the rates of other types of nosocomial infections did not change significantly. The combination of targeted respiratory intervention and an intense, focused educational campaign reduced the rate of nosocomial pneumonia. General improvements in hygiene and hand washing rates, or even implementation of a closed urinary drainage system without focused education, may not be sufficient to reduce infection rates in intensive care units in developing countries.

The Management of Urinary Catheters: Compliance of Practice in Danish Hospitals, Nursing Homes and Home Care to National Guidelines

The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 25-68% in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.

Experience with Urogenital Reconstruction of Ischiopagus Conjoined Twins

Ischiopagus conjoined twins are joined at the lower chest or abdomen down to the pelvis. We review our experience with such patients at Children's Hospital of Philadelphia. Six sets of ischiopagus twins were separated and their treatment is discussed. In addition, reports on 36 sets of ischiopagus twins are reviewed. If a shared bladder is present, 1 twin retains it while the other receives a temporary urinary drainage system. Later, the twin without a bladder undergoes reconstruction to create a continent catheterizable pouch. When 4 kidneys are present the opposite ureter is reimplanted or crossed with transureteroureterostomy. Twins with 2 sets of genitalia can usually undergo separation and reconstruction appropriately. Occasionally single external genitalia are present and secondary reconstructive genitoplasty is required. Multiple staged genital reconstructions are required but with proper planning satisfactory outcomes will result.

Experience with Urogenital Reconstruction of Ischiopagus Conjoined Twins

Purpose Ischiopagus conjoined twins are joined at the lower chest or abdomen down to the pelvis. We review our experience with such patients at Children's Hospital of Philadelphia. Materials and Methods Six sets of ischiopagus twins were separated and their treatment is discussed. In addition, reports on 36 sets of ischiopagus twins are reviewed. Results If a shared bladder is present, 1 twin retains it while the other receives a temporary urinary drainage system. Later, the twin without a bladder undergoes reconstruction to create a continent catheterizable pouch. When 4 kidneys are present the opposite ureter is reimplanted or crossed with transureteroureterostomy. Twins with 2 sets of genitalia can usually undergo separation and reconstruction appropriately. Occasionally single external genitalia are present and secondary reconstructive genitoplasty is required. Conclusions Multiple staged genital reconstructions are required but with proper planning satisfactory outcomes will result.

Simplified Urinary Drainage Following Orthotopic or Continent Bladder Replacement

A simplified urinary drainage system is described for orthotopic or catheterizable continent urinary diversion. The patient has a single urethral or suprapubic Foley catheter draining the urinary reservoir, decreasing nursing work load and possibly allowing for earlier discharge of the patient from the hospital.

Comparison of three urinary drainage systems and their impact on nosocomial urinary tract infection rates

Comparison of three urinary drainage systems and their impact on nosocomial urinary tract infection rates

Nosocomial catheter-associated bacteriuria: a clinical trial comparing two closed urinary drainage systems

We compared the time of onset and incidence of nosocomial bacteriuria between two different closed urinary drainage systems: a simple closed drainage system containing an antireflux valve (‘Urias A-4’) and a complex closed drainage system (‘Curity Infection Control System’) incorporating: (1) a preconnected, coated catheter, (2) a tamper discouraging seal at the catheter-drainage tubing junction, (3) a drip chamber, (4) an antireflux valve, (5) a hydrophobic drainage bag vent and (6) a povidone—iodine releasing cartridge in line with the outlet tube of the urine collection bag. 181 non-bacteriuric patients, requiring catheter drainage for more than 48 h, were assigned by chance to either of the two systems. Bacteriological monitoring of bladder urines of the enrolled patients was performed every 24 h by establishing viable counts and identification of all microorganisms. No differences in the onset and incidence of nosocomial bacteriuria between the two urine drainage system groups were noted. We conclude that additional complex features aimed at preventing intraluminal spread of bacteria did not reduce the risk of urinary tract infection, compared to a simple closed urinary drainage system.