AIMS: Long-term indwelling catheterisation may affect health related quality of life, but clinical assessment and monitoring of people with indwelling catheters is poorly recorded because there are no validated measures to capture these criteria.
This article is a case study examining the diagnosis and management of bladder dysfunction and catheter-associated pain in an older woman with diabetes and a hypotonic bladder.
In a survey of acute care hospitals across the United States, we found that many hospitals use indwelling urinary catheters for reasons that are not medically necessary (eg, urinary incontinence without outlet obstruction and patient/family requests).
BACKGROUND: Caesarean section (CS) is the most common obstetric surgical procedure, with more than one-third of pregnant women having lower-segment CS.
BERKELEY, CA (UroToday.com) - We observed that the removal of urinary catheters within 24 hours of kidney transplantation did not increase the incidence of urine leaks as might be expected from such expeditious catheter removal.
BACKGROUND: Urinary tract infection (UTI) is the most common hospital-acquired infection.
Background: Although indwelling urethra catheterization is a medical intervention with well-defined risks, studies show that approximately 14-38% of the indwelling urethra catheters (IUCs) are placed without a specific medical indication. In this paper we describe the prevalence of IUCs, including their inappropriate use in the Netherlands. We also determine factors associated with inappropriate use of IUCs in hospitalized patients.
SinR is the master regulator that determines whether Bacillus subtilis switches from a free-living, planktonic lifestyle to form a biofilm, a community of cells attached to a surface by an extracellular matrix. Biofilms are an increasing environmental and healthcare issue, causing problems ranging from the bio-fouling of ocean-going vessels, to dental plaque, infections of the urinary tract and contamination of medical instruments such as catheters. SinR inhibits biofilm formation by repressing a number of extracellular matrix-associated operons. The activity of SinR is controlled by the SinR antagonists, SinI, SlrA and SlrR, which interact with SinR to regulate its function. We have combined isothermal titration calorimetry (ITC) and surface plasmon resonance (SPR) to determine the thermodynamic and kinetic parameters governing the protein:protein and protein:DNA interactions at the heart of this epigenetic switch. Finally, we present the crystal structure of the SinR tetramer in complex with DNA, revealing the molecular basis of base-specific DNA recognition by SinR and the mode by which SinR activity is controlled by interaction with its antagonists.
Newman JA, Rodrigues C, Lewis RJ Are you the author?
University of Newcastle, United Kingdom.
Reference: J Biol Chem. 2013 Feb 21. (Epub ahead of print)
Clinical urine specimens are usually considered to be sterile when they do not yield uropathogens using standard clinical cultivation procedures. Our aim was to test if the adult female bladder might contain bacteria that are not identified by these routine procedures. An additional aim was to identify and recommend the appropriate urine collection method for the study of bacterial communities in the female bladder. Consenting participants who were free of known urinary tract infection provided urine samples by voided, transurethral, and/or suprapubic collection methods. The presence of bacteria in these samples was assessed by bacterial culture, light microscopy, and 16S rRNA gene sequencing. Bacteria that are not or cannot be routinely cultivated (hereinafter called uncultivated bacteria) were common in voided urine, urine collected by transurethral catheter (TUC), and urine collected by suprapubic aspirate (SPA), regardless of whether the subjects had urinary symptoms. Voided urine samples contained mixtures of urinary and genital tract bacteria. Communities identified in parallel urine samples collected by TUC and SPA were similar. Uncultivated bacteria are clearly present in the bladders of some women. It remains unclear if these bacteria are viable and/or if their presence is relevant to idiopathic urinary tract conditions.
BACKGROUND: The urinary system is the most common site for all hospital-acquired infections, accounting for approximately 40% of all nosocomial infections. The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the prevention of complications including catheter-associated urinary tract infection (CAUTI).
OBJECTIVES: This is the first of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for prevention of CAUTIs in patients with short- and long-term indwelling catheters. Part 1 reviews evidence for materials for catheter construction, including incorporation of antimicrobial substances into the catheter, and selection of catheter size.
SEARCH STRATEGY: Nursing actions for prevention of CAUTIs were identified based on search of electronic databases and Web-based search engines for national or international clinical practice guidelines focusing on this topic. Evidence related to 2 common nursing interventions, selection of the material of construction and selection of catheter size, was identified by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, and the ancestry of articles identified in these searches.
RESULTS: We found robust evidence supporting insertion of a silver alloy-coated catheter to reduce the risk of CAUTIs for up to 2 weeks in adult patients managed by short-term indwelling catheterization. We also found evidence supporting the insertion of an antibiotic-impregnated catheter for reduction of CAUTI risk for up to 7 days. There was insufficient evidence to determine whether regular use of an antimicrobial catheter reduces the risk of CAUTIs in adults managed with long-term indwelling catheterization. There was insufficient evidence to determine whether selection of a latex catheter, hydrogel-coated latex catheter, silicone-coated latex catheter, or all- silicone catheter influences CAUTI risk. Expert opinion suggests that selection of a smaller French-sized catheter reduces CAUTI risk, but evidence is lacking.
IMPLICATIONS FOR PRACTICE: Insertion of an antimicrobial catheter, either silver alloy or antimicrobial coated, is recommended for patients with short-term indwelling catheterization. There is insufficient evidence to recommend their use in patients managed by long-term indwelling catheterization. Selection of smaller French sizes for short- or long-term catheterization is thought to improve comfort and reduce CAUTI risk, but further research is needed to substantiate these best practice recommendations.
Parker D, Callan L, Harwood J, Thompson DL, Wilde M, Gray M. Are you the author?
St Joseph Hospital, Bellingham, Washington, USA.
Reference: J Wound Ostomy Continence Nurs. 2009 Jan-Feb;36(1):23-34.
OBJECTIVE: Urinary tract infections (UTIs) are the most common type of hospital-acquired infection, and most are associated with indwelling urinary catheters, that is, catheter-associated UTIs (CAUTIs). Our goal was to reduce the CAUTI rate.
DESIGN/SETTING/INTERVENTIONS: We retrospectively examined the feasibility and cost-effectiveness of a bundle of four evidence-based interventions upon the incidence rate (IR) of CAUTIs in a community hospital. The first intervention was the exclusive use of silver alloy catheters in the hospital's acute care areas. The second intervention was a securing device to limit the movement of the catheter after insertion. The third intervention was repositioning of the catheter tubing if it was found to be touching the floor. The fourth intervention was removal of the indwelling urinary catheter on postoperative Day 1 or 2, for most surgical patients.
MAIN OUTCOME MEASURE: Rates of CAUTI per 1000 catheter days were estimated and compared using the generalized estimating equations Poisson regression analysis.
RESULTS: During the study period, 33 of the 2228 patients were diagnosed with a CAUTI. The CAUTI IR for the pre-intervention period was 5.2/1000. For the 7 months following the implementation of the fourth intervention, the IR was 1.5/1000 catheter days, a significant reduction relative to the pre-intervention period (P = 0.03). The annualized projection for the cost of implementing this bundle of four interventions is $23,924.
CONCLUSION: A bundle of four evidence-based interventions reduced the incidence of CAUTIs in a community hospital. It is relatively simple, appears to be cost-effective and might be sustainable and adaptable by other hospitals.
Clarke K, Tong D, Pan Y, Easley KA, Norrick B, Ko C, Wang A, Razavi B, Stein J. Are you the author?
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, 1365 Clifton Road, Suite A4326, Atlanta, GA 30322,, USA.
Reference: Int J Qual Health Care. 2012 Dec 6.
Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate. There is no doubt that this overuse of antibiotics is contributing to the growing challenges posed by Clostridium difficile and other antibiotic-resistant bacteria in many hospitals. However, studies also demonstrate that improving the use of antibiotics in hospitals can not only help reduce rates of Clostridium difficile infection and antibiotic resistance, but can also improve individual patient outcomes, all while saving hundreds of thousands of dollars in healthcare costs. "Get Smart for Healthcare" is a CDC campaign focused on improving antibiotic use in inpatient health care facilities, starting with hospitals and then expanding to long-term care facilities.
As part of the 2012 Get Smart About Antibiotics Week activities, CDC and the nation’s leading health care organizations have united to issue an important policy statement focused on preserving antibiotic effectiveness and combating resistance.
(2012) Centers for Disease Control and Prevention
This report is a summary of device-associated module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2009 and reported to the Centers for Disease Control and Prevention (CDC) by October 18, 2010. This report updates previously published device-associated module data from NHSN and provides contemporary comparative rates. Procedure-associated module data will be reported separately: surgical site infection (SSI) data will be reported as standardized infection ratios utilizing new logistic regression models; post-procedure pneumonia rates for 2009 are available on the NHSN public website. This report complements other NHSN reports, including national and state-specific standardized infection ratios (SIRs) for select health-care associated infections (HAIs).
(2011) American Journal of Infection Control
This report is a summary of device-associated (DA) and procedure-associated (PA) module data collected and reported by hospitals and ambulatory surgical centers participating in the National Healthcare Safety Network (NHSN) from January 2006 through December 2008 as reported to the Centers for Disease Control and Prevention (CDC) by July 6, 2009. This report updates previously published DA and PA module data from the NHSN.
(2009) American Journal of Infection Control
This report uses results from the published medical and economic literature to provide a range of estimates for the annual direct hospital cost of treating health-care associated infections (HAIs) in the United States. Applying two different Consumer Price Index (CPI) adjustments to account for the rate of inflation in hospital resource prices, the overall annual direct medical costs of HAI to U.S. hospitals ranges from $28.4 to $33.8 billion (after adjusting to 2007 dollars using the CPI for all urban consumers) and $35.7 billion to $45 billion (after adjusting to 2007 dollars using the CPI for inpatient hospital services). After adjusting for the range of effectiveness of possible infection control interventions, the benefits of prevention range from a low of $5.7 to $6.8 billion (20% of infections preventable, CPI for all urban consumers) to a high of $25.0 to $31.5 billion (70% of infections preventable, CPI for inpatient hospital services).
Scott, D. R. II. (2009). "Economist." Centers for Disease Control and Prevention.
This guideline updates and expands the original Centers for Disease Control and Prevention (CDC) Guideline for Prevention of Catheter-associated Urinary Tract Infections (CAUTI) published in 1981. Several developments necessitated revision of the 1981 guideline, including new research and technological advancements for preventing CAUTI, increasing need to address patients in non-acute care settings and patients requiring long-term urinary catheterization, and greater emphasis on prevention initiatives as well as better defined goals and metrics for outcomes and process measures. In addition to updating the previous guideline, this revised guideline reviews the available evidence on CAUTI prevention for patients requiring chronic indwelling catheters and individuals who can be managed with alternative methods of urinary drainage (e.g., intermittent catheterization). The revised guideline also includes specific recommendations for implementation, performance measurement, and surveillance. Although the general principles of CAUTI prevention have not changed from the previous version, the revised guideline provides clarification and more specific guidance based on a defined, systematic review of the literature through July 2007. For areas where knowledge gaps exist, recommendations for further research are listed. Finally, the revised guideline outlines high-priority recommendations for CAUTI prevention in order to offer guidance for implementation.
Healthcare Infection Control Practices Advisory Committee (HICPAC)
PURPOSE: The purpose of this document is to provide evidence-based practice guidance for the prevention of catheter-associated urinary tract Infections (CAUTI) in acute and long-term care settings.
BACKGROUND: Health-care associated infections (HAIs) are infections acquired during the course of receiving treatment for other conditions within a health care setting. HAIs are one of the top 10 leading causes of death in the United States, according to the Centers for Disease Control and Prevention (CDC), which estimates that 1.7 million infections were reported annually among patients. It has long been acknowledged that CAUTI is the most frequent type of infection in acute care settings. In a study that provided a national estimate of health-care associated infections, urinary tract infections comprised 36% of the total HAI estimate.
Association for Professionals in Infection Control and Epidemiology (APIC)
What follows are the NHSN criteria for all healthcare-associated infections (HAIs). These criteria include those for the “Big Four” (surgical site infection (SSI), pneumonia (PNEU), bloodstream infection (BSI) and urinary tract infection (UTI)), outlined in earlier chapters of this NHSN manual, as well as criteria for other types of HAIs. Of particular importance, this chapter provides further required criteria for the specific event types that constitute organ/space SSIs (e.g. mediastinitis (MED) following coronary artery bypass graft, intra-abdominal abscess (IAB) following colon surgery, etc.).
National Healthcare Safety Network, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
The 2011 report on the occurrence and patterns of health care-associated infections (HAIs) is the fourth to be released by the Pennsylvania Department of Health (PADOH) since the passage of Act 52 in 2007. The overall findings for 2011 show a continued pattern of steady decline in the incidence of HAIs in Pennsylvania. Declines were also seen in the incidence of each of the three categories of HAIs used by PADOH for hospital benchmarking. These categories are: catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and selected types of surgical site infections (SSIs). The declining numbers are likely the result of ongoing efforts undertaken by infection preventionists, health care providers and systems, professional societies and governmental agencies to control and prevent HAIs. The impact of these efforts should be improved health status and outcomes of patients cared for in Pennsylvania hospitals, which are the primary motivation for HAI prevention and control, along with reduced health care expenditures.
Pennsylvania Department of Health