Catheter associated urinary tract infection

Introduction: A urinary tract infection is an infection, most commonly caused by E. coli, of either the lower or upper urinary tract. Urinary tract infections are the most common hospital acquired infection and the majority of the urinary tract infections acquired are associated with an indwelling urinary catheter. Recently, hospitals and other healthcare facilities have taken a special interest in the prevention of catheter associated urinary tract infections which is likely due to recent healthcare reforms. Facilities will usually have to cover the cost of any hospital acquired catheter associated urinary tract infection, hence why most facilities now have strict guidelines to prevent CAUTI. CAUTI not only is a financial problem for healthcare facilities but it is also a serious problem for the health of their patients. CAUTI increases mortality and morbidity on those who acquire it. The CDC has published a guideline to prevent CAUTI.
CAUTI statistics: * Accounts for 36% of all hospital acquired infections * 10% mortality rate with 13000 associated deaths annually * It increases the length of a patient’s stay at the hospital to about 2-4 days on average * Urinary catheters are used on about 60-90% of the patients on an ICU * About 40-50% of urinary catheters do not have a valid indication for use * The risk of getting a UTI while catheterized increases about 3-10% daily, so by day 30 you will have about a 100% chance of getting a UTI * By following your facilities CAUTI prevention guidelines an estimated 69% of CAUTIs can be prevented annually
Etiology of CAUTI: The source of most organisms related to CAUTI is either from the patient’s own perineal flora, or bacteria on the hands of personnel. The microbes can enter the bladder through two routes, either extra-luminal, which is around the surface of the catheter tubing, or intra-luminal, which is on the inside of the catheter. The infection can be caused during insertion with unclean equipment, or after insertion if the catheter is left in place.
Diagnosis: The primary diagnosis of CAUTI is by finding bacteria in the urine, along with an elevated white blood cell count after a urinalysis. However, there are other symptoms that are associated with a UTI. The patient may experience pain or a burning sensation in their bladder or urethra, they may experience fever, malaise, hematuria, bladder spasms or leakages, catheter obstruction, change in mental status, a change in urine color or a foul odor from their urine.
Risk Factors: Some individuals are more at risk to obtain CAUTI than others. Risk factors increase if the person is female, pregnant, malnourished, diabetic, or if the person has other sites of infections or has an immunodeficiency. Also, how equipment is used can increase risk factors. If the catheter is left in place for extended periods of time, not inserted with sterile technique, or not positioned correctly. You want the tubing and drainage bag below the patient’s bladder so there isn’t any backflow.
Treatment: As stated before, the facility in which the CAUTI was obtained will have to pay for the treatment. Antibiotics are the usual treatment for urinary tract infections. The facility will need to do a culture and sensitivity test of the microbes in the urine to identify the microorganism causing the infection. A choice of treatment with oral or parenteral antimicrobial drugs will be based on the results of the tests.
Prevention: Prevention is the best method when dealing with CAUTI. There are many techniques and methods which will decrease the chances of your patient acquiring CAUTI, but it is always best to seek information from your facilities polices first. Some general principles of prevention include; Only catheterizing a patient if it is necessary, using sterile technique while performing insertion of a urinary catheter, use a catheter with the smallest size lumen possible, minimize the duration of the catheterization, maintain a closed drainage system, keep the tubing and collection bag below the patient’s bladder, routine perineal and catheter care in individuals with long-term catheterization.
Appropriate catheter use is important in the prevention of CAUTI. You should only insert a catheter for appropriate indications and only leave it in as long as needed. Indications for catheter use include; acute urinary retention or bladder obstruction, accurate measurement of output in critically ill patients, pre-operative use for certain surgical procedures, to enhance healing of open perineal or sacral wounds with incontinent patients, if the patient will be immobilized for a prolonged period of time due to a spinal injury or pelvic fracture, or to improve end of life comfort if needed. Some inappropriate uses of indwelling catheters are as follows; a substitute for nursing care with incontinent patients, as a means of obtaining urine for culture or other diagnostic testing, for prolonged post-operative duration without any indications.
Some alternatives to indwelling urinary catheterization include; using intermittent urinary catheterization, using external urinary catheterization, like condom catheters, in male patients who do not have urinary retention, and the use of supra-pubic catheterization instead of long-term urinary tract catheterization.
If you must use an indwelling urinary catheter, make sure the use the proper techniques for inserting and maintaining the catheter. For inserting a urinary catheter; perform hand hygiene before and after inserting the catheter, use sterile technique and equipment, properly secure the indwelling catheter after insertion to prevent movement, and consider using the smallest bore possible. For maintaining the indwelling catheter; you should always wash your hands and don gloves before maintaining equipment, maintain a closed drainage system by replacing any equipment if there are breaks, leaks, or disconnections, make sure the urine flow is unobstructed, change urinary catheters or drainage bags as needed.
Conclusion: In conclusion, catheter associated urinary tract infections are serious issues which nurses should be educated and proactive about. CAUTIs cause financial strain on facilities due to them having to cover the costs for the diagnosis, treatment, and extended stay of the patient. CAUTIs are also very dangerous for patients. They can have a fatal risk for some patients and they can increase further complications of a patient’s illness. The best method when dealing with CAUTIs is to prevent them. Prevention is key and being well informed and proactive about appropriate catheter use indicators, insertion, and maintenance will greatly decrease the patient’s risk for acquiring a catheter associated urinary tract infection. You can find further information about CAUTI by visiting the CDC’s guideline for CAUTI prevention on their website.