Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-01-11T11:50:46.241Z Has data issue: false hasContentIssue false
  • English
  • Français

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Evelyn Lo ,
Lindsay Nicolle ,
David Classen ,
Kathleen M. Arias ,
Kelly Podgorny ,
Deverick J. Anderson ,
Helen Burstin ,
David P. Calfee ,
Susan E. Coffin  and
Erik R. Dubberke
...Show all authors
Evelyn Lo
Affiliation:
University of Manitoba, Winnipeg, Canada
Lindsay Nicolle
Affiliation:
University of Manitoba, Winnipeg, Canada
David Classen
Affiliation:
University of Utah, Salt Lake City
Kathleen M. Arias
Affiliation:
Association for Professionals in Infection Control and Epidemiology, Washington, D.C.
Kelly Podgorny
Affiliation:
Joint Commission, Oakbrook Terrace, Chicago
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Durham, North Carolina
Helen Burstin
Affiliation:
National Quality Forum, Washington, D.C.
David P. Calfee
Affiliation:
Mount Sinai School of Medicine, New York, New York
Susan E. Coffin
Affiliation:
Children's Hospital of Philadelphia andUniversity of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Erik R. Dubberke
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Victoria Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Dale N. Gerding
Affiliation:
Loyola University Chicago Stritch School of Medicine, Chicago Hines Veterans Affairs Medical Center, Hines, Illinois
Frances A. Griffin
Affiliation:
Institute for Healthcare Improvement, Cambridge
Peter Gross
Affiliation:
Hackensack University Medical Center, Hackensack, New Jersey University of Medicine and Dentistry–New Jersey Medical School, Newark, New Jersey
Keith S. Kaye
Affiliation:
Duke University Medical Center, Durham, North Carolina
Michael Klompas
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
Jonas Marschall
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Leonard A. Mermel
Affiliation:
Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
David A. Pegues
Affiliation:
David Geffen School of Medicine at the University of California, Los Angeles
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions and University, Baltimore, Maryland
Sanjay Saint
Affiliation:
Ann Arbor Veterans Affairs Medical Center and theUniversity of Michigan Medical School, Ann Arbor, Michigan
Cassandra D. Salgado
Affiliation:
Medical University of South Carolina, Charleston
Robert A. Weinstein
Affiliation:
Stroger (Cook County) Hospital andRush University Medical Center, Chicago
Robert Wise
Affiliation:
Joint Commission, Oakbrook Terrace, Chicago
Deborah S. Yokoe
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
Get access Rights & Permissions [Opens in a new window]

Extract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.

1. Burden of CAUTIs

a. Urinary tract infection is the most common hospital-acquired infection; 80% of these infections are attributable to an indwelling urethral catheter.

b. Twelve to sixteen percent of hospital inpatients will have a urinary catheter at some time during their hospital stay.

c. The daily risk of acquisition of urinary infection varies from 3% to 7% when an indwelling urethral catheter remains in situ.

2. Outcomes associated with CAUTI

a. Urinary tract infection is the most important adverse outcome of urinary catheter use. Bacteremia and sepsis may occur in a small proportion of infected patients.

b. Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means that the cumulative burden of CAUTI is substantial.

c. Catheter use is also associated with negative outcomes other than infection, including nonbacterial urethral inflammation, urethral strictures, and mechanical trauma.

Type
SHEA/IDSA Practice Recommendations
Information
Infection Control & Hospital Epidemiology , Volume 29 , supplement S1: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals , October 2008 , pp. S41 - S50
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Saint, S, Chenowith, CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am 2003;17:411–432.Google Scholar
2.Weinstein, JW, Mazon, D, Pantelick, E, Reagan-Cirincione, P, Dembry, LM, Hierholzer, WJ. A decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epidemiol 1999;20:543–548.Google Scholar
3.Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic. Arch Intern Med 2000;160:678–687.Google Scholar
4.Saint, S, Kaufman, SR, Rogers, MAM, Baker, PD, Boyko, EJ, Lipsky, B. Risk factors for nosocomial urinary tract related bacteremia: a case-control study. Am J Infect Control 2006;34:401–407.CrossRefGoogle ScholarPubMed
5.Saint, S, Lipsky, B, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.Google Scholar
6.Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care: the direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23:27–31.Google Scholar
7.Talja, M, Korpela, A, Jarvi, K. Comparison of urethral reaction to full silicone, hydrogel-coated and siliconized latex catheters. Br J Urol 1990;66:652–657.CrossRefGoogle ScholarPubMed
8.Robertson, GS, Everitt, N, Burton, PR, et al.Effect of catheter material on the incidence of urethral strictures. Br J Urol 1991;68:612–617.CrossRefGoogle ScholarPubMed
9.Johnson, JR, Roberts, PL, Olsen, RJ, Moyer, KA, Stamm, WE. Prevention of catheter-associated urinary tract infection with a silver-oxide-coated urinary catheter: clinical and microbiologic correlation. J Infect Dis 1990;162:1145–1150.Google Scholar
10.Huth, TS, Burke, JP, Larsen, RA, Classen, DC, Stevens, LE. Randomized trial of meatal care with silver sulfa-diazine cream for the prevention of catheter-associated bacteriuria. J Infect Dis 1992;165:14–18.Google Scholar
11.Riley, DK, Classen, DC, Stevens, LE, Burke, JP. A large, randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med 1995;98:349–356.CrossRefGoogle ScholarPubMed
12.Bukhari, SS, Sanderson, PJ, Richardson, DM, Kaufman, ME, Aucken, HM, Cookson, BD. Endemic cross-infection in an acute medical ward. J Hosp Infect 1993;24:261–271.CrossRefGoogle Scholar
13.Schaberg, DR, Weinstein, RA, Stamm, WE. Epidemics of nosocomial urinary tract infection caused by multiply resistant gram-negative bacilli: epidemiology and control. J Infect Dis 1976;133:363–366.Google Scholar
14.Jarvis, WR, Munn, VP, Highsmith, AK, Culver, DH, Hughes, JM. The epidemiology of nosocomial infections caused by Klebsiella pneumoniae. Infect Control 1985;6:68–74.Google Scholar
15.Yoon, HJ, Choi, JY, Park, YS, et al.Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical epidemiologic, and laboratory perspective. Am J Infect Control 2005;33:595–601.CrossRefGoogle Scholar
16.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–32.CrossRefGoogle ScholarPubMed
17.National Healthcare Safety Network (NHSN). NHSN members' page. Available at: http://www.cdc.gov/ncidod/dhqp/nhsn_members.html. Accessed August 12, 2008.Google Scholar
18.Stark, RP, Maki, DG. Bacteriuria in the catheterized patient: what quantitative level of bacteriuria is relevant? N Engl J Med 1984;311:560–564.CrossRefGoogle ScholarPubMed
19.Wong, ES, Hooton, TM. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11:28–36.Google Scholar
20.Pratt, RJ, Pellowe, C, Loveday, HP, et al.The epic project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: guidelines for preventing hospital-acquired infections. J Hosp Infect 2001;47(Suppl):S3–S82.CrossRefGoogle ScholarPubMed
21.Pratt, RJ, Pellowe, CM, Wilson, JA, et al.Epic 2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007;65(Suppl 1):S1–S64.CrossRefGoogle Scholar
22.Niel-Weise, BS, van den Broek, PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev 2005;(3):CD004203.Google ScholarPubMed
23.Phipps, S, Liim, YN, McClinton, S, Barry, C, Rane, A, N'Dow, J. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev 2006;(2):CD004374.Google Scholar
24.Griffiths, R, Fernandes, R. Policies for the removal of short-term indwelling urethral catheters. Cochrane Database Syst Rev 2005;(1):CD004011.Google Scholar
25.Niel-Weise, BS, van den Broek, PJ. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev 2005;(3):CD005428.Google Scholar
26.Brosnahan, J, Jull, A, Tracy, C. Types of urethral catheters for management of short-term voiding problems in hospitalized adults. Cochrane Database Syst Rev 2004;(1):CD004013.Google Scholar
27.Griffiths, R, Fernandez, R. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev 2007;(2):CD004011.Google Scholar
28.Saint, S, Kaufman, SR, Rogers, MAM, Baker, PD, Ossenkop, K, Lipsky, BA. Condom versus indwelling urinary catheters: a randomized trial. J Am Geriatr Soc 2006;54:1055–1061.Google Scholar
29.Lau, H, Lam, B. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization. ANZ J Surg 2004;74:658–661.Google Scholar
30.Baan, AH, Vermeulen, H, van der Meulen, J, Bossuyt, P, Olszyna, D, Gouma, DJ. The effect of suprapubic catheterization after abdominal surgery on urinary tract infection: a randomized, controlled trial. Dig Surg 2003;20:290–295.CrossRefGoogle ScholarPubMed
31.Johnson, JR, Kuskowski, MA, Wilt, TJ. Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 2006;144:116–127.CrossRefGoogle ScholarPubMed
32.Niel-Weise, BS, Arend, SM, van den Brock, PJ. Is there evidence for recommending silver-coated urinary catheters in guidelines. J Hosp Infect 2002;52:81–87.Google Scholar
33.Crnich, CJ, Drenka, PJ. Does the composition of urinary catheter influence clinical outcomes and the results of research studies. Infect Control Hosp Epidemiol 2007;28:102–103.Google Scholar
34.Srinivasan, A, Karchmer, T, Richards, A, Song, X, Perl, T. A prospective trial of a novel, silicone-based, silver-coated Foley catheter for the prevention of nosocomial urinary tract infection. Infect Control Hosp Epidemiol 2006;27:38–43.CrossRefGoogle Scholar
35.Gokula, RRM, Hickner, JA, Smith, MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control 2004;32:196–199.Google Scholar
36.Jain, P, Parada, JP, David, A, Smith, LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155:1425–1429.CrossRefGoogle ScholarPubMed
37.Saint, S, Wiese, J, Amory, JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476–480.CrossRefGoogle ScholarPubMed
38.Stephan, F, Sax, H, Wachsmuth, M, Hoffmeyer, P, Clergue, F, Pittet, D. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study. Clin Infect Dis 2006;42:1544–1551.Google Scholar
39.Doyle, B, Mawji, Z, Horgan, M, et al.Decreasing nosocomial urinary tract infection in a large academic community hospital. Lippincotts Case Manag 2001;6:127–136.Google Scholar
40.Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114:404–407.CrossRefGoogle ScholarPubMed
41.Saint, S, Kaufman, SR, Thompson, M, et al.A reminder reduces urinary catheterization in hospitalized patients, Jt Comm J Qual Patient Saf 2005;31:455–462.Google ScholarPubMed
42.Huang, WC, Wann, SR, Lir, SL, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974–978.Google Scholar
43.Topal, J, Conklin, S, Camp, K, et al.Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20:121–126.CrossRefGoogle Scholar
44.Dumigan, DG, Kohan, CA, Reed, CR, Jekel, JF, Fikrig, MK. Utilizing national nosocomial infection surveillance system date to improve urinary tract infection rates in three intensive-care units. Clin Perform Qual Health Care 1998;6:172–178.Google Scholar
45.Goetz, AM, Kedzuf, S, Wagener, M, Muder, RR. Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections. Am J Infect Control 1999;27:402–404.CrossRefGoogle ScholarPubMed
46.Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979;121:1193–1254.Google Scholar
47.Marklew, A. Urinary catheter care in the intensive care unit. Nurs Crit Care 2004;9:21–27.CrossRefGoogle ScholarPubMed
48.Wong, ES, Rupp, ME, Mermel, L, et al.Public disclosure of healthcare-associated infections: the role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2005;26:210–212.Google Scholar
49.McKibben, L, Horan, TC, Tokars, II, et al.Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2005;26:580–587.Google Scholar
50. Healthcare-Associated Infection Working Group of the Joint Public Policy Committee. Essentials of public reporting of healthcare-associated infections: a tool kit. January 2007. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/06_107498_Essentials_Tool_Kit.pdf. Accessed April 6, 2007.Google Scholar
51.National Quality Forum. National voluntary consensus standards, endorsed November 15, 2007. Available at: http://www.qualityforum.org/pdf/news/lsCSACMeasures.pdf. Accessed December 20, 2007.Google Scholar