Prevention of Catheter Associated Urinary Tract Infections

Patients who are admitted for medical problems or surgical procedures may have a urinary catheter placed because of the difficulty that patients have getting up to urinate or using localized methods to urinate. For this reason catheter associated urinary tract infections (CAUTI) remain a concerning source of infection in hospitalized patients, causing both morbidity and mortality. My father almost died from such an infection after he had a fairly simple medical procedure. He had a catheter placed during his surgery and a few days later started having symptoms of a UTI. He was treated but did not respond. He got sicker and sicker while the team did not recognize the progression. He then suffered a cardiac arrest, likely from the stress that the infection caused to a patient with known cardiac disease. We are not helpless in this fight against hospital acquire infections, there are a variety of strategies that may decrease the risk of these types of hospital associated infection.

Limit Use of Urinary Catheters:

• Use indwelling catheters only when absolutely necessary and remove them as soon as possible.
• Consider creating protocols that automatically remove catheters after 1-2 days.
• Reference: Lo, E., Nicolle, L., Classen, D., et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5):464-479. (DOI:10.1086/675718).

Implement Proper Insertion Techniques:

• Use aseptic techniques and sterile equipment during insertion.
• it is a simple task to ensure that everyone has the appropriate training to determine how to safely insert urinary catheters.
• Reference: Loveday, H. P., Wilson, J. A., Pratt, R. J., et al. Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86 (Suppl 1):S1-S70. (DOI:10.1016/S0195-6701(13)60012-2).

Maintain a Closed Drainage System:

• Ensure the drainage system is kept closed to reduce infection risk. This helps prevent contamination.
• Reference: Saint, S., Trautner, B. W., Fowler, K. E., et al. A Multicenter Study of Bundled Interventions to Reduce Catheter-Associated Urinary Tract infections. American Journal of Infection Control, 44(12), 1382–1387. (DOI:10.1016/j.ajic.2016.08.014).

Proper Catheter Care and Maintenance:

• Routine hygiene around the catheter and meatal area. This seems simple, but it clearly isn’t happening to the degree it should because infections continue to occur.
• Placement of a catheter can seem very routine and perhaps it is the commonality and familiarity in which this procedure occurs that makes people relax and thing it is not a big deal — my father would beg to differ. The care in which we do the routine and mundane matters a great deal to many people.
• Reference: Hooton, T. M., Bradley, S. F., Cardenas, D. D., 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. Clinical Infectious Diseases, 50(5), 625-663. (DOI:10.1086/650482).

Use of Antimicrobial/Antiseptic Coated Catheters:

• Consider using catheters with antimicrobial or antiseptic properties if the patient requires long-term catheterization.
• This is less important for the routine people with short catheterization placement, but matters greatly to those that need longer term placement.
• Reference: Pickard, R., Lam, T., MacLennan, G., et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet, 380(9857), 1927-1935. (DOI:10.1016/S0140-6736(12)61380-4).

Staff Education and Training:

• Regular training and adherence to standardized protocols for catheter management.
• Simulation and discussion about those that have had bad outcomes, may help people recognize the implications of this procedure.
• Reference: Fasugba, O., Cheng, A. C., Gregory, V., et al. Impact of a Trial of an Infection Control Education Intervention Package on Healthcare-Acquired Infections in Australian Adult Acute Care Hospitals: a Multicenter Before and After Intervention Study. Clinical Infectious Diseases, 71(12), e473-e480. (DOI:10.1093/cid/ciaa818).

Regular Monitoring and Feedback:

• Monitor CAUTI rates and provide feedback to healthcare teams.
• Tracking the local rates of CAUTI helps recognize vulnerabilities in existing systems.
• Reference: Fakih, M. G., Krein, S. L., Edson, B., et al. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. American Journal of Infection Control, 42(10 Suppl), S223-S229. (DOI:10.1016/j.ajic.2014.05.023).

Patient and Family Education:

• Educate patients and their families about the risks and care of urinary catheters. This may help people recognize early symptoms of UTI after placement of a urinary cath placement.
• Reference: Winters, B. D., Gurses, A. P., Lehmann, H., et al. Clinical practice: preventing infections in the catheterized urinary tract. Annals of Internal Medicine, 167(4), 664-670. (DOI:10.7326/M22-1395).

Implementing these strategies comprehensively can significantly reduce the incidence of CAUTIs in healthcare settings.