Advertisement

Catheter-Acquired Urinary Tract Infections

  • Irene Comisso
  • Alberto Lucchini
Chapter

Abstract

Indwelling bladder catheters are widely used in intensive care units to monitor the hourly urine output in critically ill patients. In-hospital patients are frequently catheterized (15–25%), but catheterization is often unappropriated. A 30-day cutoff is used to differentiate between short- and long-term (or chronic) catheterization. Recent data confirmed that CAUTIs represent 23% of HAIs in ICU. In ICU patients, female gender (HR 2.67, 95% CI 1.03–6.91; p 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01–1.13; p 0.019) were identified as risk factors for CAUTI acquisition alone.

Bundles’ implementation relates with a significant reduction in CAUTI incidence. The urinary catheter bundle includes five interventions: perform hand hygiene before insertion and manipulation of UC; keep collection bag lower than the bladder level; maintain unobstructed urine flow; empty collecting bag regularly and avoid allowing the draining spigot to touch the collection catheter; and monitor CAUTIs using standardized criteria to identify patients with CAUTIs and to collect UC days as denominators.

No other routine interventions (such as catheter or collection bag changing, bladder irrigation, systemic and bladder antimicrobial administration) are recommended to prevent CAUTIs.

Although CAUTIs have a strong impact on hospitalized patients’ outcomes, studies concerning the prevention of this problem are generally affected by poor-quality evidences and methodological issues. Therefore several research questions remain unresolved.

References

  1. 1.
    Vacca M, Angelos D. Elimination of catheter-associated urinary tract infections in an adult neurological intensive care unit. Crit Care Nurse. 2013;33:78–80.  https://doi.org/10.4037/ccn2013998.CrossRefPubMedGoogle Scholar
  2. 2.
    Saint S, Kowalski CP, Kaufman SR, Hofer TP, Kauffman CA, Olmsted RN, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis. 2008;46:243–50.  https://doi.org/10.1086/524662.CrossRefPubMedGoogle Scholar
  3. 3.
    Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–63.  https://doi.org/10.1086/650482.CrossRefPubMedGoogle Scholar
  4. 4.
    NHSN Patient Safety Component Manual. http://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Accessed 19 Jun 2016.
  5. 5.
    Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160–6.  https://doi.org/10.1177/003335490712200205.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Press MJ, Metlay JP. Catheter-associated urinary tract infection: does changing the definition change quality? Infect Control Hosp Epidemiol. 2013;34:313–5.  https://doi.org/10.1086/669525.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rebmann T, Greene LR. Preventing catheter-associated urinary tract infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. Am J Infect Control. 2010;38:644–6.  https://doi.org/10.1016/j.ajic.2010.08.003.CrossRefPubMedGoogle Scholar
  8. 8.
    Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol. 2000;21:510–5.  https://doi.org/10.1086/501795.CrossRefPubMedGoogle Scholar
  9. 9.
    Burton DC, Edwards JR, Srinivasan A, Fridkin SK, Gould CV. Trends in catheter-associated urinary tract infections in adult intensive care units-United States, 1990-2007. Infect Control Hosp Epidemiol. 2011;32:748–56.  https://doi.org/10.1086/660872.CrossRefPubMedGoogle Scholar
  10. 10.
    Saint S, Greene MT, Krein SL, Rogers MA, Ratz D, Fowler KE, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374:2111–9.  https://doi.org/10.1056/NEJMoa1504906.CrossRefPubMedGoogle Scholar
  11. 11.
    Fortin E, Rocher I, Frenette C, Temblay C, Quach C. Healthcare-associated bloodstream infections secondary to a urinary focus: the Quebec provincial surveillance results. Infect Control Hosp Epidemiol. 2012;33:456–62.  https://doi.org/10.1086/665323.CrossRefPubMedGoogle Scholar
  12. 12.
    Dudek M, Horan T, Peterson K, Bridsonet KA, Morrell G, Anttila A, et al. National Health Care Safety Network (NHSN) Report, Data Summary for 2011, Device-associated Module. www.cdc.gov/nhsn/PDFs/dataStat/ NHSN-Report-2011-Data-Summary.pdf. Accessed 19 Jun 2016.
  13. 13.
    Greene MT, Chang R, Kuhn L, Rogers MA, Chenoweth CE, Shuman E, et al. Predictors of hospital-acquired urinary tract-related bloodstream infection. Infect Control Hosp Epidemiol. 2012;33:1001–7.  https://doi.org/10.1086/667731.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Temiz E, Piskin N, Aydemir H, Oztoprak N, Akduman D, Celebi G, et al. Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units. Scand J Infect Dis. 2012;44:344–9.  https://doi.org/10.3109/00365548.2011.639031. CrossRefPubMedGoogle Scholar
  15. 15.
    Hagerty T, Kertesz L, Schmidt JM, Agarwal S, Claassen J, Mayer SA, et al. Risk factors for catheter-associated urinary tract infections in critically ill patients with subarachnoid hemorrhage. J Neurosci Nurs. 2015;47:51–4.  https://doi.org/10.1097/JNN.0000000000000111.CrossRefPubMedGoogle Scholar
  16. 16.
    Gillen JR, Isbell JM, Michaels AD, Lau CL, Sawyer RG. Risk factors for urinary tract infections in cardiac surgical patients. Surg Infect. 2015;16:504–8.  https://doi.org/10.1089/sur.2013.115.CrossRefGoogle Scholar
  17. 17.
    Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7:342–7.  https://doi.org/10.3201/eid0702.700342. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tedja R, Wentink J, O'Horo JC, Thompson R, Sampathkumar P. Catheter-associated urinary tract infections in intensive care unit patients. Infect Control Hosp Epidemiol. 2015;36:1330–4.  https://doi.org/10.1017/ice.2015.172.CrossRefPubMedGoogle Scholar
  19. 19.
    Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3:23.  https://doi.org/10.1186/2047-2994-3-23.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jones K, Sibai J, Battjes R, Fakih MG. How and when nurses collect urine cultures on catheterized patients: a survey of 5 hospitals. Am J Infect Control. 2016;44:173–6.  https://doi.org/10.1016/j.ajic.2015.09.003.CrossRefPubMedGoogle Scholar
  21. 21.
    Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines.pdf. Accessed 19 Jun 2016.
  22. 22.
    Wong ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control. 1983;11:28–36.CrossRefPubMedGoogle Scholar
  23. 23.
    Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW, Barrett S, et al. The EPIC project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: guidelines for preventing hospital-acquired infections. Department of Health (England). J Hosp Infect. 2001;47:S3–82.  https://doi.org/10.1053/jhin.2000.0888.CrossRefPubMedGoogle Scholar
  24. 24.
    Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, et al. EPIC 2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007;65:S1–64.  https://doi.org/10.1016/S0195-6701(07)60002-4. CrossRefPubMedGoogle Scholar
  25. 25.
    Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents. 2008;31:S68–78.  https://doi.org/10.1016/j.ijantimicag.2007.07.033. CrossRefPubMedGoogle Scholar
  26. 26.
    Lo E, Nicolle L, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41–50.  https://doi.org/10.1086/675718. CrossRefPubMedGoogle Scholar
  27. 27.
    Conway LJ, Larson EL. Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. Heart Lung. 2012;41(3):271–83.  https://doi.org/10.1016/j.hrtlng.2011.08.001.CrossRefPubMedGoogle Scholar
  28. 28.
    Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86(Suppl 1):S1–70.  https://doi.org/10.1016/S0195-6701(13)60012-2. CrossRefPubMedGoogle Scholar
  29. 29.
    Jahn P, Beutner K, Langer G. Types of indwelling urinary catheters for long-term bladder drainage in adults. Cochrane Database Syst Rev. 2012;10:CD004997.  https://doi.org/10.1002/14651858.CD004997.pub3. CrossRefPubMedGoogle Scholar
  30. 30.
    Feneley RC, Kunin CM, Stickler DJ. An indwelling urinary catheter for the 21st century. BJU Int. 2012;109:1746–9.  https://doi.org/10.1111/j.1464-410X.2011.10753.x.CrossRefPubMedGoogle Scholar
  31. 31.
    Lawrence EL, Turner IG. Kink, flow and retention properties of urinary catheters part 1: conventional foley catheters. J Mater Sci Mater Med. 2006;17:147–52.  https://doi.org/10.1007/s10856-006-6818-0.CrossRefPubMedGoogle Scholar
  32. 32.
    Verma A, Bhani D, Tomar V, Bachhiwal R, Yadav S. Differences in bacterial colonization and biofilm formation property of uropathogens between the two most commonly used indwelling urinary catheters. J Clin Diagn Res. 2016;10:PC01–3.  https://doi.org/10.7860/JCDR/2016/20486.7939.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Noto MJ, Domenico HJ, Byrne DW, Talbot T, Rice TW, Bernard GR, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA. 2015;313:369–78.  https://doi.org/10.1001/jama.2014.18400.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Holroyd S. Innovation in catheter securement devices: minimising risk of infection, trauma and pain. Br J Community Nurs. 2016;21:256–60.CrossRefPubMedGoogle Scholar
  35. 35.
    Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S. Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2014;9:CD004013.  https://doi.org/10.1002/14651858.CD004013.pub4.CrossRefGoogle Scholar
  36. 36.
    Rosenthal VD, Todi SK, Álvarez-Moreno C, Pawar M, Karlekar A, Zeggwagh AA, INICC Members, et al. Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the international nosocomial infection control consortium (INICC). Infection. 2012;40:517–26.  https://doi.org/10.1007/s15010-012-0278-x.CrossRefPubMedGoogle Scholar
  37. 37.
    Kanj SS, Zahreddine N, Rosenthal VD, Alamuddin L, Kanafani Z, Molaeb B. Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in an adult intensive care unit in Lebanon: international nosocomial infection control consortium (INICC) findings. Int J Infect Dis. 2013;17:e686–90.  https://doi.org/10.1016/j.ijid.2013.01.020.CrossRefPubMedGoogle Scholar
  38. 38.
    Leblebicioglu H, Ersoz G, Rosenthal VD, Yalcin AN, Akan OA, Sirmatel F, et al. Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: international nosocomial infection control consortium findings (INICC). Am J Infect Control. 2013;41:885–91.  https://doi.org/10.1016/j.ajic.2013.01.028.CrossRefPubMedGoogle Scholar
  39. 39.
    Galiczewski JM. Interventions for the prevention of catheter associated urinary tract infections in intensive care units: an integrative review. Intensive Crit Care Nurs. 2016;32:1–11.  https://doi.org/10.1016/j.iccn.2015.08.007.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Anesthesia and Intensive Care Unit, University Hospital S. Maria della MisericordiaUdineItaly
  2. 2.General Intensive Care UnitSan Gerardo Hospital, ASST Monza, University of Milano-BicoccaMilanItaly

Personalised recommendations