ReviewInterventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review
Introduction
Catheter associated urinary tract infections (CAUTI) account for 36% of all health care associated infections (HAI) in the United States (Rebmann and Greene, 2010). Internationally, CAUTI rates can be 3–5% higher than the United States depending on the resources available and the socioeconomic status of the country (Rosenthal et al., 2012). Urosepsis from an indwelling catheter leads to a significant increase in patient morbidity and mortality and generates an economic and financial burden on health care systems (Leone et al., 2003). The surge in CAUTI incidence due to the increased use of catheters over an extended time period has prompted the development of infection control protocols and initiatives in health care settings (Marra et al., 2011). The intention of these programmes is to decrease the global incidence of CAUTI and improve patient outcomes (Daniels et al., 2014).
Section snippets
Background and significance
The incidence of CAUTI has reached almost two million cases per year and the Centres of Medicare and Medicaid Services (CMMS) in the United States has deemed CAUTI a “never event”, limiting government funded reimbursement (Vacca and Angelos, 2013). A “never event” is considered preventable. In one calendar year, CAUTI can add up to almost 100,000 hospital days and over 400 million dollars (Gray, 2010). As a result, hospitals have urgently implemented various programmes and protocols aiming to
Method
This integrative review analysed the research of interventions and protocols used to control or prevent CAUTI in an ICU setting. Selection of inclusion and exclusion criteria were determined prior to the start of the literature search. The inclusion criteria were: (a) primary research articles addressing prevention and control of CAUTI and (b) sample patient population ≥18 years of age with an indwelling urinary catheter in an ICU setting. Excluded were: (a) non-English written studies, (b)
Results
This literature review sample was made up of 14 studies, of which 10 (71.5%) were classified as quasi-experimental, 1 (7.1%) was a meta-analysis, 1 (7.1%) was a random control trial (RCT), 1 (7.1%) was a secondary data analysis and 1 (7.1%) was a time-sequenced non-randomized study. All of the articles were written in English but the studies originated in many different countries including the United States. The studies were published between the years 1998 and 2014.
Of the 14 articles used in
Implementation of a single intervention to control and prevent CAUTI
Hospitals often seek out best practice protocols and interventions to control and prevent CAUTI events within their institution. One study conducted in a tertiary academic center's five ICUs implemented an algorithm for management of urinary retention (Fuchs et al., 2011). It included interventions established by the Duke Infection Control Outreach Network (DICON) (Network, 2009). It required practitioners to complete a daily checklist identifying the presence of a catheter and if the patient
Implementation of a bundle of interventions to control and prevent CAUTI
ICU patients have a high prevalence of urinary catheterizations and co-morbidities which increase their risk for developing UTIs (Gray, 2010). The implementation of evidence-based protocols and prevention programmes in ICUs may diminish the risk of developing a CAUTI in these catheterized patients (Gray, 2010). A study conducted in a private hospital in Brazil implemented a series of interventions in an ICU and two step down units (SDU) to reduce the incidence of CAUTI (Marra et al., 2011).
Discussion
The incidence of CAUTI in the ICU setting is directly linked to the increased use of catheters in this area (Gray, 2010). Bacteriuria develops at a rate of 3–10% per catheterisation day and it has been shown that CAUTI rates rise in patients with urinary catheters greater than 7 days (Chenoweth and Saint, 2013, Shapiro et al., 1984). This integrative review has shown that studies with a single intervention that included daily review of catheter necessity or early discontinuance of urinary
Conclusion
It is imperative for practitioners to recognise and establish protocols to combat CAUTI in all healthcare settings. A multidirectional approach that includes evidence-based practices recommended by the Centers for Disease Control and Prevention, the implementation of the Institute for Healthcare Improvement's bladder bundle and increasing the knowledge base of patient care providers is essential. Hospitals need to establish committees to oversee the implementation of these protocols and
Acknowledgements
I am the sole author of this manuscript. I confirm that no organization funded this Integrative review study.
Funding: There are no financial disclosures associated with this manuscript.
Conflict of interest: The authors have no conflict of interest to declare.
References (32)
- et al.
Infection prevention in the intensive care unit
Infect Dis Clin North Am
(2009) - et al.
Preventing catheter-associated urinary tract infections in the intensive care unit
Crit Care Clin
(2013) - et al.
Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units
Am J Infect Control
(2012) - et al.
Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001–2010
Am J Infect Control
(2014) - et al.
Four country healthcare associated infection prevalence survey 2006: risk factor analysis
J Hosp Infect
(2008) - et al.
Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in an adult intensive care unit in Lebanon: International Nosocomial Infection Control Consortium (INICC) findings
Int J Infect Dis
(2013) - et al.
Use of silver-hydrogel urinary catheters on the incidence of catheter-associated urinary tract infections in hospitalized patients
Am J Infect Control
(2002) - et al.
Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC)
Am J Infect Control
(2013) - et al.
Preventing catheter-associated urinary tract infection in the zero-tolerance era
Am J Infect Control
(2011) - et al.
Impact of an International Nosocomial Infection Control Consortium multidimensional approach on catheter-associated urinary tract infections in adult intensive care units in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings
Journal of Infection Public Health
(2013)
Preventing catheter-associated urinary tract infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc., Elimination Guide
Am J Infect Control
Implementation of a nurse-driven protocol to prevent catheter-associated urinary tract infections
J Nurs Care Qual
Trends in catheter-associated urinary tract infections in adult intensive care units-United States, 1990–2007
Infect Control Hosp Epidemiol
Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections
Am J Crit Care
Public health focus: surveillance, prevention, and control of nosocomial infections, vol. 41
MMWR Morb Mort Wkly Rep
Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units
Clin Perform Qual Health Care J
Cited by (28)
Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network
2021, Journal of Hospital InfectionCitation Excerpt :CAUTIs are also associated with severe health outcomes including sepsis, a systemic inflammatory condition that occurs when bacteria infecting the urinary tract infect the bloodstream [9]. Surveillance data indicated that sepsis was associated with increased mortality and morbidity in patients of all ages [12,13]. Although preventive strategies, such as educational initiatives, catheter avoidance and limiting catheter days, have been proposed [14], more efforts are needed to control the incidence of CAUTIs and to improve patient outcomes.
Self-Achievement Through Creativity in Critical Care
2020, Critical Care Nursing Clinics of North AmericaCitation Excerpt :Evidence-based nursing protocols are common and guide practice in the ICU. Protocols for managing delirium,27 preventing catheter-associated urinary tract infections28 or pressure ulcers,29 and promoting early mobilization30 exist to standardize care and optimize patient outcomes. The nurse practicing in the ICU should find methods of combining creativity into daily practice along with using protocols and safety checklist to promote the continued development of both empathy and innovation.
Research data in hospitals and health systems
2019, Data for Nurses: Understanding and Using Data to Optimize Care Delivery in Hospitals and Health SystemsComparison of the preventive effect of urethral cleaning versus disinfection for catheter-associated urinary tract infections in adults: A network meta-analysis
2018, International Journal of Infectious DiseasesCitation Excerpt :These include avoiding unnecessary catheterization, considering replacing the catheter with a condom catheter, maintaining an airtight connection and urine patency, ensuring that the drainage bag is below the position of the bladder, inserting the catheter and routinely maintaining it using a strict aseptic technique, adhering to the appropriate type of use of the catheter, and training of nursing staff so that only trained personnel perform catheterization and catheter maintenance (Gould et al., 2010). The incidence of CAUTI increases with a prolonged catheter retention time, hence limiting unnecessary catheterization and the timely removal of the catheter are the most effective measures to prevent CAUTI (Galiczewski, 2016). Urinary tract infections in China are second only to respiratory tract infections, and 75–80% of cases are related to indwelling catheterization (Yuan et al., 2011).
Determinants of urinary catheter removal practices in the pediatric intensive care unit: A survey
2018, American Journal of Infection Control
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Janet M. Galiczewski is a clinical assistant professor at the Stony Brook University School of Nursing for 12 years and a critical care nurse for 27 years in the medical and surgical intensive care units at Long Island Jewish Medical Center. She is currently pursuing her Doctor of Nursing Practice Degree at Stony Brook University.