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Potential Shortcomings of Catheter Use in Causing UTIs

Written by Rena Zhu and Edited by Kevin Liu

Image by falco from Pixabay 

Urinary tract infections (UTIs) are one of the most common types of healthcare-associated infections, accounting for more than 30% of reported infections in acute care hospitals [1]. A UTI is an infection that occurs in any part of the urinary system, such as in the urethra, bladder, kidneys, or ureter. Fifteen to twenty-five percent of hospitalized patients receive an indwelling urinary catheter, a drainage tube that is inserted through the urethra and connected to the bladder to drain urine [1]. A catheter may be installed due to pain from urination, surgery around any part of the urinary system, inability of the bladder to empty, etc. Although these catheters are installed to help relieve pain or prevent further complications, they, however, can worsen the infection or prolong treatment. It is estimated that catheter-induced urinary tract infections (CAUTI) are directly associated with an annual death count of around 9,000 to 13,000, of which 17% to 69% of the cases are preventable. CAUTIs alone cost the healthcare system $450 million dollars annually [2]. Complications with CAUTIs are the leading cause of sepsis, flooding of microorganisms into the body that complicates treatments, especially prevalent in adult populations over 65. Sepsis is a life-threatening medical emergency and is the 10th leading cause of death in the U.S. [3].

Researchers have suggested that the cause of CAUTIs may be due to breakages in the closed drainage tubing or contamination of the collection urine bag [4]. According to a 2008 survey of U.S. hospitals, more than 50% of hospitals did not monitor which patients were catheterized, and 75% did not monitor times of catheter duration and discontinuation [5]. Since CAUTIs are preventable infections, hospitals need extra precaution in catching such infections before it develops into a larger, potentially irreversible health problem. The resulting ailment can range from mild symptoms, such as fever and urethra and bladder inflammation, to more severe symptoms such as tissue scarring, kidney damage, and sepsis [6]. Some of the most effective strategies for preventing CAUTI include decreasing the frequency of catheter use and decreasing the duration of the urinary catheter’s usage. These two strategies translate into measures such as inserting catheters only when necessary and assessing the appropriateness of alternative methods such as in-and-out catheters, external catheters, or suprapubic catheters. These alternative methods bypass the urethra, thus reducing the risk of infection. Decreasing the usage and duration of urinary catheters by implementing a restrictive catheter policy, paired with consistent reviews of necessity and appropriateness, has shown to decrease catheterization from 18% to 6.6% [7]. Catheters should only be inserted for appropriate situations, such as in severe illness or immobility, at the request of a patient, end-of-life care, urinary obstruction, and loss of bladder control. In addition to those situations, catheters can also be used to measure hourly urine volume and urinary retention, when the bladder is not able to empty completely and leading to increased urination frequency. [8]. Those who are at a higher risk for CAUTI include females, adults ages 65 and older, individuals who have undergone surgical operations, and those with prolonged ICU visits [9].

It is important to recognize when a patient has a CAUTI. Symptoms of a CAUTI include cloudy urine, blood in the urine, pressure or pain in the lower back area or stomach, and fever. Additionally, family members can serve as an essential role in monitoring the patient’s health, as well as engage in conversation with the healthcare providers to better care for their loved ones, such as understanding why a catheter is needed and symptoms to be cautious of to decrease the risk of the patient contracting sepsis.

References

  1. CDC. (2009). Guidelines for Prevention of Catheter-Associated Urinary Tract Infections. Centers for Disease Control and Prevention, 2015, https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html. Accessed 25 Jun. 2020
  2. Klevens, R.M., Edwards, J.R., Richards, C.L., Horan, T., Gaynes, R.P., Pollock, D.A., Cardo, D.M. (2007). Estimating Health Care-Associated Infections and Death in U.S. Hospitals (2002). Public Health Reports. 122: 160-165.
  3. Peach, B.C., Garvan, G.J., Garvan, C.S., Cimiotti, J.P. (2016) Risk Factors for Urosepsis in Older Adults: A Systematic Review. Gerontology & Geriatric Medicine, 2: 1-7.
  4. Maki, D.G., Tambyah, P.A. (2001). Engineering Out the Risk for Infection with Urinary Catheters. Emerging Infectious Diseases. 7: 342-347.
  5. Saint, S., Kowalski, C. P., Kaufman, S. R., Hofer, T. P., Kauffman, C. A., Olmsted, R. N., Forman, J.m Banaszak-Holl, J., Damschroder, L., Krein, S. L. (2008). Preventing Hospital-acquired Urinary Tract Infection in the United States: a National Study. Clin Infect Dis. 46: 243–50.
  6. Jacobsen, S.M. Stickler, D.J., Mobley, H.L.T., Shirtliff, M.E. (2008). Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev. 21(1): 26-59.
  7. Lo, E., Nicolle, L.E., Coffin, S.E., Gould, C. (2016). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infection Control & Hospital Epidemiology. 35: 464-479.
  8. Hanchett, M. (2018). Preventing CAUTI: A patient-centered approach. Strategist.
  9. Gillen, J.R., Isbell, J.M., Michaelis, A.D., Lau, C.L., Sawyer, R.G. (2015) Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients. Surgical Infections. 16: 505-508.
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