Healthcare-associated infections (HAIs) are infections that patients acquire while receiving health care for other conditions. These infections cost the US healthcare system billions of dollars each year and lead to the loss of tens of thousands of lives.

CDC recommends strategies for surveillance, prevention, and control of HAIs and antimicrobial resistance wherever health care is provided, including hospitals, ambulatory care facilities, and long-term care facilities. CDC works closely with states to implement these recommendations.

The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of a key practice that state health departments can use to reduce HAIs:

State health departments are encouraged to also engage in other practices that will provide actionable HAI data and lead to expanded HAI prevention. These include 1) state health departments validating data sent to CDC’s National Healthcare Safety Network (NHSN), ideally including data on central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTIs); and surgical site infections (SSIs); and 2) working with CDC and other partners using NHSN data to target facilities and units most in need of consultation to prevent HAIs and antimicrobial resistance.

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PURPOSE: The aim of this study was to determine device-associated health care-associated infections (DA-HAI) rates, microbiologic profile, bacterial resistance, and length of stay in one intensive care unit (ICU) of a hospital member of the International Nosocomial Infection Control Consortium (INICC) in Poland.

BACKGROUND: Indwelling urinary catheter duration is an important risk factor for catheter-associated urinary tract infections (CAUTIs).

OBJECTIVE: To evaluate two different methods of measuring catheter-associated urinary tract infection (CAUTI) rates in the setting of a quality improvement initiative aimed at reducing device utilization.

OBJECTIVES: To examine the prevalence, natural history, and clinical significance of high postvoid residual (PVR) volume in ambulatory older women.

Changes in reimbursement policies have focused attention on the use of indwelling catheters in the critical care unit as well as their role in hospital-acquired urinary tract infections.

Implementation of an evidence-based prevention program can significantly reduce both the prevalence of indwelling catheterization and the incidence of hospital-acquired catheter-associated urinary tract infection. This article describes the epidemiology and pathophysiology of catheter-associated urinary tract infection, and outlines essential elements of an evidence-based prevention program for the critical care unit.

Written by:
Gray M. Are you the author?
Department of Urology and School of Nursing, University of Virginia, UVA 2nd Floor, Room 2570, PO Box 800422, Charlottesville, VA 22908, USA. .

Reference: AACN Adv Crit Care. 2010 Jul-Sep;21(3):247-57.

PubMed Abstract
PMID: 20683224

BACKGROUND: Many hospitals are increasing surveillance for catheter-associated urinary tract infections, which requires documentation of urinary catheter device-days. However, device-days are usually obtained by chart review or nursing reports. The aim of this study was to demonstrate that chart review can provide accurate urinary catheter data compared with physical inspection of the urinary catheter at the bedside.

Catheter-associated urinary tract infections account for 40% of all nosocomial infections.

A multidisciplinary team implemented evidence-based guidelines and a urinary catheter bundle, focusing on optimizing the use of urinary catheters through continual assessment and prompt catheter removal. Data were obtained on catheter device days, compliance with urinary catheter orders, and computer documentation of continued catheter indications. Results included an overall reduction of 71% in catheter device days and a 56% reduction in catheter use.

Written by:
Andreessen L, Wilde MH, Herendeen P. Are you the author?
Advanced Imaging Associates, Cheektowaga, New York (Dr. Andreessen); and University of Rochester, Rochester, New York (Drs. Wilde and Herendeen), and Golisano Children's Hospital (Dr. Herendeen), Rochester, New York.

Reference: J Nurs Care Qual. 2012 Feb 9. [Epub ahead of print]

PubMed Abstract
PMID: 22327333

BACKGROUND: The formation of bacterial biofilms on urinary catheters is a leading cause of urinary tract infections in intensive care units. Cytobacteriological examination of urine from patients is often misleading, due to the formation of these biofilms. Therefore, characterizing these biofilms and identifying the bacterial species residing on the surface of catheters are of major importance.

BACKGROUND: Little is known about whether recommended strategies to prevent catheter-associated urinary tract infection (CAUTI) are being implemented in intensive care units (ICU) in the United States.

BACKGROUND: Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described.

Object To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population.

A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate. Methods All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included. The study consisted of two 1-month preintervention observation periods (approximately 1200 catheter days) followed by a 30-month intervention phase (20,394 catheter days). A comprehensive evidence-based UTI bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal was enacted. Results The urinary catheter utilization rate dropped from 100% to 73.3% during the intervention phase (p < 0.0001) without any increase in the rate of sacral decubitus ulcers or other skin breakdown. The rate of catheter-associated UTI was also significantly reduced from 13.3 to 4.0 infections per 1000 catheter days (p < 0.001). There was a linear relationship between the decreased quarterly catheter utilization rate and the decreased catheter-associated UTI rate (r(2) = 0.79, p < 0.0001). Conclusions This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.

Written by:
Titsworth WL, Hester J, Correia T, Reed R, Williams M, Guin P, Layon AJ, Archibald LK, Mocco J. Are you the author?
Department of Neurosurgery.

Reference: J Neurosurg. 2012 Jan 6. [Epub ahead of print]

doi: http://dx.doi.org/10.3171/2011.11.JNS11974

PubMed Abstract
PMID: 22224785

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors.

CONTEXT: Pseudomonas aeruginosa is a gram negative opportunistic bacteria causes several infections commonly colonize these devices and developing biofilms. Bacteria in biofilm can be up to 1,000 times more resistant to antibiotics than the same bacteria circulating in a planktonic state.

What's known on the subject? and What does the study add? A vast literature has been published on the prevalence, morbidity and microbiology of catheter-associated urinary tract infections.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are common, morbid, and costly. Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections. Evidence-based guidelines exist for indwelling urinary catheter management but are not consistently followed.

Biofilm development in urinary tract catheters is an often underestimated problem. However, this form of infection leads to high mortality rates and causes significant costs in health care.