URINARY TRACT INFECTIONS
Catheter Associated Urinary Tract Infection
A urinary tract infection (UTI) is an infection that begins in the urinary system.
UTIs that are limited to the bladder can be painful and annoying. But serious consequences can occur if the infection spreads to the kidneys.
The urinary system is composed of the kidneys, ureters, bladder and urethra. All of these organs play a role in removing waste product from the body.
The kidneys, a pair of bean shaped organs in the upper
posterior abdomen, filter waste from the blood. Tubes called ureters carry urine from kidneys to the bladder where it is stored until it exits the body through the urethra. All of these components can become infected, but most infections involve the lower tract - the urethra and the bladder.
Antibiotics are the typical treatment for urinary tract infections. But there are steps to reduce the chances of a UTI developing in the first place.
The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) sponsored and authored a compendium of practice recommendations to prevent healthcare -associated infections in acute care hospitals in partnership with the Association for Professionals in Infection Control and Epidemiology (APIC), the Joint Commission, and the American Hospital Association (AHA).
Preventing Urinary Catheter Infections Video
Urinary tract infections (UTIs) affect millions of people each year and rank as the second most common type of body infection. Women are more likely to get a urinary tract infection than men, but when they occur in men they can be very serious. Up to 50% of women will develop at least one UTI in their life time and some will experience more than one. UTIs account for over 8 million doctor visits a year.
Catheter associated urinary tract infections (CAUTIs) are the most common nosocomial (acute care and extended care facilities) infection. They are costly, and potentially lethal. CAUTIs account for approximately 40% of all nosocomial infections.
Urinary catheters are inserted in more than 5 million patients per year. One out of four hospitalized patients will have a urinary catheter placed during their hospital stay.
CATHETER ASSOCIATED URINARY TRACT INFECTION STATISTICS & FACTS
CAUTI (bacteriuria or candiduria) develop in up to 25% of patients requiring a urinary catheter for > 7 days.
CAUTI risk increases at 5% per day of indwell time.
CAUTI is the second most common cause of nosocomial bloodstream infection.
CAUTIs are associated with substantially increased institutional death rates.
CAUTIs are asymptomatic (most).
CAUTIs add $500 to $1,000 to the direct costs of acute-care hospitalization.
CAUTIs commonly precipitate unnecessary antimicrobial-drug therapy.
CAUTIs comprise perhaps the largest institutional reservoir of nosocomial antibiotic- resistant pathogens.
CAUTIs pathogens include:
- Enterobacteriaceae (Escherichia coli, Klebsiella, Enterobacter, Proteus, Citrobacter)
- Pseudomonas aeruginosa
- Candida spp.
SYMPTOMS OF A URINARY TRACT INFECTION
The symptoms of a UTI include:
Cloudy urine, blood in the urine, foul or strong urine odor, frequent or urgent need to urinate, need to urinate at night, pain or burning with urination, feeling of pressure in the lower pelvis.
A patient with dysuria (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for urinalysis, specifically the presence of nitrites, leukocytes or leukocyte esterase.
If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. The diagnosis of UTI is confirmed by a urine culture.
If the urine culture is negative:
Symptoms of urethritis may point at Chlamydia trachomatis
or Neisseria gonorrhea infection.
Symptoms of cystitis may point at interstitial cystitis.
In severe infection, characterized by fever, rigors or flank pain,
urea and creatinine measurements may be performed to assess whether renal function has been affected.
According to the Centers for Disease Control and Prevention, the urinary tract is the most common site of healthcare-associated infection, accounting for more than 40% of the total number reported by acute-care hospitals and affecting an estimated 600,000 patients per year.
Most of these infections - 66% to 86% - follow instrumentation of the urinary tract, mainly urinary catheterization. Although not all catheter-associated urinary tract infections can be prevented, it is believed that a large number could be avoided by the proper management of the indwelling catheter.
Nosocomial urinary tract infections (UTIs) account for up to 40% of all hospital-acquired infections. Patients with indwelling urinary catheters, patients undergoing urological manipulations, long-stay elderly male patients and patients with debilitating diseases are at high risk of developing nosocomial UTIs.
The organisms responsible usually originate from patients' endogenous intestinal flora, but occasionally from a moist site in the hospital environment. Nosocomial pathogens causing UTIs tend to have a higher antibiotic resistance than simple UTIs. Infection control policies are important in limiting the number of hospital-acquired UTIs.
Catheters should be inserted by trained healthcare professionals using aseptic technique, including sterile gloves, a fenestrated sterile drape, and an effective cutaneous antiseptic, such as 10% povidone-iodine or 1% to 2% aqueous chlorhexidine. After a catheter is inserted, uncompromising maintenance of closed drainage is of the highest priority and can keep the overall risk of CATHETER-RELATED URINARY TRACT INFECTION (CAUTI) <25% for up to 2 weeks of catheterization.
Avoid unnecessary catheterizations; remove the catheter as soon as no longer needed; maintain uncompromising closed drainage; ensure dependent drainage; minimize manipulations of the system; and separate catheterized patients.
A simple reminder system can prevent those hospitalized patients from having a urinary catheter in place any longer than is necessary, greatly reducing the risk of urinary tract infections. Urinary catheters are a major contributor to hospital acquired urinary tract infections, in part because busy health care providers forget to take the catheters out. Written reminders can successfully flag the issue, thereby shortening the duration of catheter use, and reducing the risk of costly infections.
The collection tubing and bag should always remain below the level of the patient's bladder, but the drainage tubing should always be above the level of the collection bag. In one large prospective study, this was the only catheter-care violation associated with a significantly increased risk of CAUTI. The catheter and the drainage system should be manipulated as little as possible.
Some studies state that use of silver-coated catheters led to a 47% decrease in the incidence of symptomatic UTI. A recent meta-analysis concluded that silver alloy catheters significantly reduced bacteriuria 3-fold compared with standard, non -coated catheters. In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases.
UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).
Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or other disorder. Still, many doctors ask their patients to take antibiotics for a week or two to ensure that the infection has been cured. Single-dose treatment is not recommended for some groups of patients, for example, those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections. Longer treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia, which are usually treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. A follow-up urinalysis helps to confirm that the urinary tract is infection-free. It is important to take the full course of treatment because symptoms may disappear before the infection is fully cleared.
Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally require several weeks of antibiotic treatment. Researchers at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder. In such cases, kidney infections rarely lead to kidney damage or kidney failure unless they go untreated.
Various drugs are available to relieve the pain of a UTI. A heating pad may also help. Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. During treatment, it is best to avoid coffee, alcohol, and spicy foods. And one of the best things a smoker can do for his or her bladder is to quit smoking. Smoking is the major known cause of bladder cancer.
THE CDC's SUMMARY OF MAJOR RECOMMENDATIONS FOR THE PREVENTION OF UTIs
Category I. Strongly Recommended for Adoption
Educate personnel in correct techniques of catheter insertion and care.
Catheterize only when necessary.
Emphasize hand washing.
Insert catheter using aseptic technique and sterile equipment.
Secure catheter properly.
Maintain closed sterile drainage.
Obtain urine samples aseptically.
Maintain unobstructed urine flow.
Category II. Moderately Recommended for Adoption
Periodically re-educate personnel in catheter care.
Use smallest suitable bore catheter.
Avoid irrigation unless needed to prevent or relieve obstruction.
Refrain from daily medical care with either of the regimens discussed in text. Do not change catheters at arbitrary fixed intervals.
Category III. Weakly Recommended for Adoption
Consider alternative techniques of urinary drainage before using an indwelling urethral catheter.
Replace the collecting system when sterile closed drainage has been violated.
Spatially separate infected and uninfected patients with indwelling catheters.
Avoid routine bacteriologic monitoring.
THE REMINDER SYSTEM
A simple reminder system can
prevent hospitalized patients from having a urinary catheter
in place any longer than is
necessary,greatly reducing the
risk of urinary tract infections.
Urinary catheters are a
major contributor to hospital
acquired urinary tract infections, in part because busy health care
providers forget to take the
A University of Michigan Health
System study finds that written
reminders (or computerized
reminders, where feasible) can
successfully flag the issue, thereby shortening the duration of catheter use, and reducing the risk of costly
FOR CDC Guidelines on Preventing CAUTI follow the link below:
WHAT EVERY PATIENT SHOULD KNOW ABOUT HAVING A URINARY CATHETER
1. Make sure the initial catheterization is performed by a trained health care professional with clean hands.
2. If you do not see caregivers washing their hands prior to beginning the procedure, insist that they sanitize their hands immediately, using sterile gloves, sponges, patient drape and single-use petroleum jelly.
3. Make sure the catheter and tubing receive daily soap and water maintenance around the insertion site from the nursing staff.
4.Check the collection bag at regular intervals to be sure it is always below the level of the patient’s bladder, but never resting on the floor and . . .
5. EVERY DAY, ask if the catheter is still necessary.