Catheter-Associated Urinary Tract Infections
Urinary tract infection (UTI) is a collective term used to describe infections affecting any part of the urinary tract, ureters, urethra, kidneys, and the urinary bladder. The kidneys and the ureters comprise the upper urinary tract while the urethra and the urinary bladder comprises the lower tract (Tan & Chlebicki, 2016). Adult women are more likely to develop UTIs than adult men. In fact, urinary tract infections affect women about 30 more times than men (Tan & Chlebicki, 2016). The reason behind this has been attributed to the fact that the main pathogen causing UTIs, Escherichia coli (Tandogdu & Wagenlehner, 2016) is contained as normal flora in the skin surrounding the anus and the distance between the anus and the urinary tract in women is short. This allows easy passage of the bacteria into the urinary tract.Catheter-Associated Urinary Tract Infections
According to the centers for disease control and prevention, UTIs ranks among the highest number of reported healthcare-associated infections. UTIs can be primary or secondary occurring from the underlying disease, and they can also be acquired in the hospital, about 75 percent of hospital-acquired urinary tract infections are associated with a urinary catheter (Centers for disease control and prevention, 2017). It is one of the most common infections acquired by patients in the hospital, a biofilm develops in these catheters leading to bacteriuria which could subsequently lead to bacteremia, and catheter-associated urinary tract infections account for 20 percent of health-care acquired bacteremia in acute care settings and 50 percent in long-term facilities (Nicolle, 2014). These biofilms contain bacterial containing anti-microbial resistant (Soto, 2014). Indwelling catheters are known to be the most common indwelling device used in healthcare facilities accounting for about 17 percent, 23 percent, and 9 percent in medical, surgical, and rehabilitation units respectively (Nicolle, 2014). Indwelling catheters are either short term (less than 30 days) or long term (more than 30 days), acute care settings often use short term catheters, however, the longer it stays in the patient, the higher the chances of developing biofilm that could lead to bacteriuria and bacteremia which are the underlying factors in CAUTI (Nicolle, 2014;Catheter-Associated Urinary Tract Infections
Evidence-based guidelines have also been set in order to prevent the incidence of CAUTI, avoidance of catheter use, policies for insertion and maintenance of catheter, catheter selection, and surveillance of CAUTI (Nicolle, 2014; Barbadoro et al., 2015; Galiczewski, 2016). Researches to implement the use of anti-microbial coated catheters are being carried out as it is believed that this would prevent the high incidence of CAUTI in hospitals and therefore reducing the burden it may cause on the hospital, the patients, and their families (Tenke, Koves, & Johansen, 2014). In some health-care institutions, there have been nurse-driven protocols to prevent CAUTI, the basis of which involved discontinuation of indwelling catheters as well as the use of bladder ultrasound along with intermittent catheterizations (Alexaitis & Broome, 2014). Other researches have shown that the use of urinary catheter reminders and stop orders have significantly reduced the incidence of catheter-associated urinary tract infections (Meddings et al., 2014). Another intervention in reducing cases of CAUTI would be the introduction of external urinary catheters, also called purewick catheter, This should provide baseline data to ensure improvement and normalization of practice.
The outcome of this intervention should include a reduction in the cases of CAUTI and also provide evidence-based knowledge on the interventions to reduce CAUTI in hospitals (Parker et al., 2017). The introduction of external collection devices could also reduce the risk of patient’s exposure to urinary tract infection, and this should be including in nursing protocols and education manuals for undergraduates and healthcare professionals.Catheter-Associated Urinary Tract Infections
The time needed to implement these interventions should take about five months which should include the reduction in the use of indwelling catheters and replacement with the Pickwick catheter.
Prolonged use of indwelling catheters are the primary cause of CAUTI. Therefore it is essential that healthcare providers remove catheters as quickly as possible and as soon as they are no longer needed. Hand hygiene and aseptic techniques have also been known to reduce CAUTI. Evidence-based guidelines to prevent this infection which include avoidance of catheter have also been implemented in healthcare institutions. It is recommended that researchers look for ways external collective devices would be used more frequently in hospitals and incorporated into the nursing protocols.Catheter-Associated Urinary Tract Infections