Reducing Catheter-Associated Urinary Tract Infection in the Critical Care Unit

2010 ◽  
Vol 21 (3) ◽  
pp. 247-257 ◽  
Author(s):  
Mikel Gray
Keyword(s):  
Urinary Tract Infection ◽  
Critical Care ◽  
Urinary Tract ◽  
Tract Infection ◽  
Prevention Program ◽  
Critical Care Unit ◽  
Evidence Based ◽  
Indwelling Catheters ◽  
Tract Infections ◽  
Hospital Acquired

Changes in reimbursement policies have focused attention on the use of indwelling catheters in the critical care unit as well as their role in hospital-acquired urinary tract infections. Implementation of an evidence-based prevention program can significantly reduce both the prevalence of indwelling catheterization and the incidence of hospital-acquired catheter-associated urinary tract infection. This article describes the epidemiology and pathophysiology of catheter-associated urinary tract infection, and outlines essential elements of an evidence-based prevention program for the critical care unit.

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

1996 ◽  
Vol 17 (4) ◽  
pp. 215-221 ◽  
Author(s):  
Jette Zimakoff ◽  
David J. Stickler ◽  
Birgitte Pontoppidan ◽  
Severin O. Larsen
Keyword(s):  
Urinary Tract Infection ◽  
Regression Analysis ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Indwelling Catheters ◽  
Drainage Systems ◽  
Bladder Management ◽  
Tract Infections ◽  
Hospital Acquired

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.

scholarly journals Revisiting CAUTI Prevention: A Multifaceted Approach using Lean Six Sigma

2020 ◽  
pp. 1-64
Author(s):  
Lisa Ann Behrend
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Six Sigma ◽  
Infection Prevention ◽  
Comprehensive Evaluation ◽  
Lean Six Sigma ◽  
Evidence Based ◽  
Infection Rates ◽  
Tract Infections

This project identified gaps in policy and processes to improve patient outcomes related to workflow in the catheter-associated urinary tract infection policy and process at a 400-bed hospital in southern California. Even with an evidence-based infection prevention bundle in place, the current process was not working, as demonstrated by high catheter-associated infection rates for the last two years. This project answers the question: Does the use of a comprehensive evaluation of the current policy and process using the Lean Six Sigma quality improvement model influence a reduction in infection rates in patients who have an internal urinary catheter over 15 weeks? Despite published consensus guidelines for the diagnosis, prevention, and treatment of catheter-associated urinary tract infections; a single, evidence-based approach to the reduction of urinary tract infection does not exist. Avoiding the placement of catheters and encouraging early removal are the most effective interventions to prevent infection. The outcomes of the project resulted in a decrease in infections and significant cost reduction for the organization related to patient days and fines. Implementation of teams, nurse-driven protocols, and the establishment of bi-annual staff education were successful interventions. Lean Six Sigma played a significant role in the recognition of practical strategies required to ensure the effective use of proven infection prevention and to decrease the burden of disease correlated with indwelling urinary catheterization.

scholarly journals Study of incidence and risk factors of urinary tract infection in catheterised patients admitted at tertiary care

2018 ◽  
Vol 6 (5) ◽  
pp. 1730 ◽  
Author(s):  
Bhavana Ashish Kakaria ◽  
Ashish K. ◽  
Raghuwanshi Tushar
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Tertiary Care ◽  
Control Measures ◽  
Colony Count ◽  
Urine Specimen ◽  
Indwelling Catheters ◽  
Tract Infections

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity and mortality in hospitalized patients. The aim of this study was to determine the incidence and risk factors of urinary tract infection in catheterised patients in a tertiary care hospital.Methods: Total of 200 patients above 16 years in whom an indwelling Foley‘s catheter inserted were taken in the study. A urine specimen was obtained aseptically and culture done on nutrient agar, sheep blood agar and MacConkey agar plates. After incubation of 24 hours, colony count done for organisms showing growth and colony count ≥105 was taken significant.Results: The incidence of CAUTI in the present study was 31%. Higher incidence of CAUTI (56.46%) was found in female sex as compared to males (43.54%). Incidence of CAUTI was found higher in first weeks (54.83%). Incidence among diabetes patients is found more (63.33%). Most common isolate found was E. coli (38.71%) among all uropathogens. Uropathogens isolated from CAUTI are more resistant to antimicrobials.Conclusions: It is must to implement following strategy for reducing the risk of infection due to indwelling catheters: 1. reducing the duration of catheterization 2. Use antibacterial substance coated catheter 3. Strict infection control measures.

scholarly journals Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors of Community- and Hospital-Acquired Urinary Tract Infection at Dessie Referral Hospital, Dessie, Northeast Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Berhanu Adugna ◽  
Bekele Sharew ◽  
Mohabaw Jemal
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Susceptibility ◽  
Associated Factors ◽  
Hospitalized Patients ◽  
Diffusion Method ◽  
Bacterial Isolates ◽  
Tract Infections ◽  
Hospital Acquired

Background. Bacterial urinary tract infection is among the most common community and hospital-acquired infections. Therefore, to know the status of the community and hospital-acquired urinary tract infection, antimicrobial susceptibility patterns, and associated factors among urinary tract infection profiles are essential to physicians and health workers to implement appropriate intervention. Methods. An institution-based cross-sectional study was conducted among 422 urinary tract infection suspected patients. All isolates were identified by standard microbiological techniques, and their antibiotic susceptibility was done by the Kirby–Bauer disc diffusion method. Data were entered using EpiData version 3.1 and analyzed by SPSS software version 20. P value < 0.05 at 95% CI was considered statistically significant. Result. Of 422 urine samples processed, 100 (23.7%) yielded bacterial isolates. About 50(30.7%) and 50(19.3%) were bacterial isolates from the community and hospitalized patients, respectively. E. coli 44/103(42.7%) predominated across the two groups, followed by S. aureus 25/103(24.3%), CONs, 14/103(13.5%), Klebsiella spp. 7/103(6.78), Proteus spp. 3/103(2.91), and Enterococcus spp. 3/103 (2.91%). Pseudomonas spp. 3/103 (2.91), Citrobacter spp. 2/103(1.94%), and Acinetobacter spp. 1/103(0.999), which were isolated from only the hospitalized patients. Meropenem susceptibly was 100% in both study groups and Ampicillin resistance was documented as 83.3% to 100% and 76.9% to 100% in hospitalized and community-acquired samples, respectively. Conclusion. This study found a high prevalence of bacterial urinary tract infection in the study area and a high rate of bacterial resistance was observed to most antimicrobial drugs tested. Meropenem and nitrofurantoin were the most active drugs for urinary tract infections. Therefore, expanding routine bacterial culture and identification with antimicrobial susceptibility testing and strengthening regular surveillance systems are essential for appropriate patient care.

scholarly journals Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department

2017 ◽  
Vol 30 (9) ◽  
pp. 608 ◽  
Author(s):  
Maria João Lobão ◽  
Paulo Sousa
Keyword(s):  
Internal Medicine ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Catheter Placement ◽  
Medicine Department ◽  
Bladder Catheter ◽  
Tract Infections ◽  
Hospital Acquired

Introduction: Urinary tract infections are the most frequent healthcare associated infections, being related to both high costs and morbidity. Our intention was to carry out an epidemiological characterization of hospital acquired urinary tract infections that occurred in an internal medicine department of a Portuguese hospital.Material and Methods: Retrospective cohort study (historic cohort). Data were analysed from a systematic random sample of 388 patients, representative of the 3492 admissions occurred in 2014 in that department.Results: One in four patients underwent the placement of a bladder catheter [24.7% (n = 96); 95% CI: 20% - 29%], 36.5% (95% CI: 33% - 48%) of which in the absence of clinical criteria for that procedure. The global cumulative incidence rate for nosocomial urinary tract infections was 4.6% (95% CI: 2.5% - 6.7%). Most hospital acquired urinary tract infections (61.1%) were related to bladder catheter use. We quantified 3.06 infections / 1000 patient-days and 14.5 infections / 1000 catheter-days. Catheter associated urinary tract infection occurred at an early stage of hospitalization. The vast majority of patients (66.7%) that developed a catheter associated urinary tract infection were subjected to bladder catheter placement at emergency department. Seventy one per cent of catheter associated urinary tract infection occurred in patients that were subjected to bladder catheter placement without criteria.Discussion: These results point to an excessive and inadequate use of urinary catheters, highlighting the need for judicious use taking into account the formal clinical indications. The incidence of catheter associated urinary tract infection is similar to what we found in other studies. Nevertheless we found a very high incidence density per catheter-days that may foresee a problem probably related to the absence of early withdrawal of the device, and to both bladder catheter placement and maintenance practices. A significant part of catheter associated urinary tract infection occurred in patients that had the bladder catheter placed in the emergency department, before the admission to the internal medicine ward, which highlights the need to assess the urinary catheterization practices in those departments.Conclusion: The high rate of catheter associated urinary tract infection that occurred in the absence of bladder placement indication reinforces the need to implement prevention strategies that contemplate the reduction of its use. Emergency departments should be part of quality improvement projects in this area. Causes for the early onset of catheter associated urinary tract infection in this cohort should be investigated.

scholarly journals Study of Various Virulence Genes, Biofilm Formation and Extended-Spectrum β-lactamase Resistance in Klebsiella pneumoniae Isolated from Urinary Tract Infections

2019 ◽  
Vol 13 (1) ◽  
pp. 249-255
Author(s):  
Sanaa S. Hamam ◽  
Reem M. El Kholy ◽  
Maysaa E. S. Zaki
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Biofilm Formation ◽  
Virulence Genes ◽  
Esbl Production ◽  
Biofilm Production ◽  
Extended Spectrum ◽  
Tract Infections ◽  
Hospital Acquired

Objective: The aims of the current study were to evaluate the capacity of K. pneumoniae isolated from hospital-acquired urinary tract infection to form biofilm, the relation of this capacity to various virulence genes and the prevalence of Extended Spectrum β-lactamases (ESBL) among these isolates by phenotypic and genotypic methods. Material and Methods: The study included 100 non-duplicate strains of K. pneumoniae isolated from 100 different urine samples from patients with hospital-acquired urinary tract infection. The isolated strains were studied for biofilm formation, ESBL production by phenotypic methods. Molecular studies were applied for the detection of ESβLs genes blaTEM, blaSHV, blaCTX-M and for detection of virulence genes fimH, uge, rmpA, mag A, wzy, kfa and aerobactin genes. Result: The majority of the isolates had the capacity to form a biofilm (81%), with ESBL prevalence rate 41%. The most prevalent gene among ESBL producing K. pneumoniae was blaCTX-M (73.2%) followed by blaSHV (53.6%) and blaTEM (51.2%). Among the virulence genes studied in K. pneumoniae isolates, the most prevalent gene was fimH (76%), uge (70%). There was significant association between ESBL production, and resistance to amikacin, cefepime, ceftazidime, gentamicin, imipenem and meropenem and biofilm production in K. pneumoniae isolates. There was significant association between blaCTX-M, blaSHV, fimH, mag, kfa, wzy, rmpA and aerobactin and biofilm production in K. pneumoniae. Conclusion: The present study highlights the prevalence of virulence genes among biofilm-forming strains of K. pneumoniae isolated from hospital-acquired urinary tract infection. Moreover, there was association between biofilm formation and ESBL production. Further studies are required to elucidate the clinical impact of the association of these different mechanisms.

scholarly journals Reducing Catheter-Associated Urinary Tract Infection Project

2020 ◽  
Author(s):  
◽  
Beatriz Agado
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
The United States ◽  
Evidence Based ◽  
Rehabilitation Center ◽  
Post Intervention ◽  
Practice Problem ◽  
Tract Infections

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) are prevalent and responsible for an estimated 13,000 deaths annually in the United States. Reported cases of CAUTIs remain disproportionately high at a rehabilitation center located in South Texas. PICOT: This evidence-based project answered the following question: In rehabilitation patients, what is the effect of a nurse-driven protocol (NDP) CAUTI bundle on the number of indwelling urinary catheter-related infections, compared to the current practice, over a 12-week time period? Evidence: Twenty high-quality studies that met the inclusion and exclusion criteria recommended using an NDP CAUTI bundle, education, and champions to round the unit to decrease the number of catheter-associated urinary tract infections. Intervention: The evidence-based intervention utilized the implementation of an NDP CAUTI bundle. The intervention bundle included catheter indication, hand hygiene, an insertion technique, maintenance, ongoing assessment to evaluate catheter need, and documentation. Outcome: The evaluation of the outcome measures demonstrated that the CAUTI rate decreased from six incidences in 2019 to two from January to May 2020. There were zero incidences during the project implementation from June to August 2020, and the number of catheter days decreased from 59% at baseline to 41% post-intervention. Conclusion: The implementation of a nurse-driven protocol CAUTI bundle, education, and champions in the unit were successful interventions that decreased the catheter-associated urinary tract infection rates in the rehabilitation center.

Risk Factors in Diabetes and Pregnant Women with Urinary Tract Infections Compared to Younger Aged Female.

2018 ◽  
Vol 1 (3) ◽  
pp. 26-38
Author(s):  
Abdulghani Mohamed Alsamarai ◽  
Shler Ali Khorshed
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pregnant Women ◽  
Female Student ◽  
Mean Value ◽  
Infected Female ◽  
Significant Difference ◽  
Tract Infections

Background: Urinary tract infection is common with health impact in women and characterised by failure to treatment and recurrent episodes. Aim: This study was conducted to determine the risk factors for the development of urinary tract infection in diabetic and pregnant women in comparison to student female. Materials and methods: A prospective cross-sectional study conducted during the period from 1st of June 2015 to the end of January 2016. The population included in the study are 563 women, of them 425 were outpatients, and 138 were inpatients. Their age range between 18 and 80 years, with a mean age of 33.59±15.29 years. Urine samples collected and cultured on blood agar and MacConkey agar by spread plate technique. Bacterial colonies with different morphology were selected, purified and identified according to their biochemical characteristics using conventional standard methods. Results: In diabetic women, there were no significant difference in mean age and BMI values between culture positive and culture negative groups. However, pus cell mean scale was significantly higher [P=0.000] in women with urinary tract infection [1.76±1.25] than in those with negative culture [0.69±1.00]. In pregnant women, BMI mean value was significantly [P=0.013] lower in pregnant women with UTI [26.14] as compared to those without infection [26.99]. Pus cell scale mean value was significantly [P=0.000] higher in pregnant women with UTI [1.55] than women with negative UTI [0.85]. While there was no significant difference in mean age between UTI positive and negative pregnant women. In female student, there was a significant difference between UTI infected and non-infected in mean age [P=0.041] and pus cell scale [P=0.000]. However, BMI was not significantly different between infected and non-infected female student. Other risk factors association are variables in the 3 groups when analysed using X2, while AUC and OR show different trends of association between risk factors and UTI. Conclusion: BMI, pus cell scale, child number, delivery method, operation history and hospital setting were significantly associated with culture positivity in the 3 studied groups as determined by AUC. While OR confirmed association with pus sale scale in the 3 groups.

Sign in / Sign up

Export Citation Format

Share Document