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CAUTIs Continue To Be A Challenge!

BBD Report Admin | May 04, 2022

Catheter-associated urinary tract infections continue to be an issue for clinicians and institutions, particularly hospitals.  The Agency for Healthcare Research and Quality (AHRQ) released many documents that clinicians and infectious disease experts will find useful in fighting this problem.  One is a Toolkit for Preventing CLABSI and CAUTI in ICUs that offers customizable tools and training resources to prevent central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) in intensive care units (ICUs).

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diane k newman

Diane K. Newman, DNP FAAN BCB-PMD is a Urologic Nurse Practitioner, Adjunct Professor of Urology in Surgery, Research Investigator Senior, Perelman School of Medicine, University of Pennsylvania, and Former Co-Director of the Penn Center for Continence and Pelvic Health. She is the author of several books. The most recent is as lead editor of the 1st edition of the SUNA Core Curriculum for Urologic Nursing and of Clinical Application of Urologic Catheters, Devices and Products.

Videos
Clinical Conversations by Experts

Intermittent Catheters

Indwelling Catheters

Bladder Health

Study Finds Dose-Response Relationship Between Pack-Year Smoking and Urinary Urgency - Avanti Rangneka
Air Force 1: Innovative Cost-Effective Ureteroscopic Force Sensor "Presentation" - Bruce Gao
COURAGE Trial: Vibegron for BPH Patients with Persistent OAB Symptoms - David Staskin
Oxybutynin-Associated Cognitive Impairment: Evidence and Implications for Overactive Bladder Treatment - Beyond the Abstract
Risk Classification for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) Using Machine Learning Based Predictions - Beyond the Abstract
A Comprehensive Guide to Interstitial Cystitis - Jill Peters-Gee
AUA/SUFU Overactive Bladder Guidelines Emphasize Shared Decision-Making - Ariana Smith
Rise for Health Study: Investigating Bladder Health and LUTS in Women Across Ages - Siobhan Sutcliffe
Managing Urinary Incontinence in Dementia Patients: External Collection Devices and Absorbent Products - Diane Newman
Overcoming Environmental Barriers to Incontinence Management in Dementia Patients - Diane Newman
Understanding Urinary Incontinence in Older Adults: Anatomy, Types, and Risk Factors - Diane Newman
Topical Estrogen Therapy in Preventing Recurrent UTIs in Women - Rachael Sussman, Charlotte Houston with Ruchika Talwar
Male Pelvic Pain Treatment: Beyond the Misconception of Prostatitis - Jeannette Potts
Strategies to Assess Pelvic Pain Without Resorting to Cystoscopy - Jeannette Potts
Women in Urology and the Path Forward - Siobhan Hartigan
Breaking Free from Incontinence: A Journey to Reclaiming Confidence and Comfort - Carolyn Sampselle
Food Insecurity Is Associated With Urge Urinary Incontinence: An Analysis of the 2005-2010 National Health and Nutrition Examination Survey - Nitya Abraham
In-Depth Discussion: BlueWind Implant for Overactive Bladder Treatment - A Promising Breakthrough in Urology - John Heesakkers
Autonomic Dysreflexia: Discussion on Urologic Concerns Part 2 - Todd Linsenmeyer
Autonomic Dysreflexia: Managing a Complex Patient Part 1 - Todd Linsenmeyer
Insights into Effective Bladder Health Interventions - Diane Newman
Changing Habits for Better Bladder Health - Diane Newman
Preventing Urinary Incontinence in Women - Diane Newman
Your Comprehensive Guide to Bladder and Pelvic Health - Diane Newman
Bladder Health, Anatomy, and Physiology - Diane Newman
Unveiling the Burdens of Urinary Incontinence - Diane Newman
The Science of Incontinence: Strategies for Accurate Assessment - Diane Newman
Breaking the Stigma: The Effort to Empower Women with Bladder Control Issues - Diane Newman
The Path to Bladder Confidence: Understanding the Benefits of Bladder Training and Urge Suppression - Diane Newman
Outcomes of the Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms (GLADIOLUS) Study - Diane Newman
Personalized Strategies for Bladder Control: Expert Tips on Lifestyle Modifications - Diane Newman
Creating Impact on Advanced Practice Providers in Urologic Care - Diane Newman
Transforming Lives through Pelvic Floor Muscle Training: A Proven Approach to Bladder Control - Diane Newman
Unlocking the Power of Pelvic Floor Muscles - Diane Newman
Biofeedback Assisted Pelvic Floor Muscle Training - Diane Newman
Revolutionizing Urodynamics: Uromonitor's Comfortable, Real-Life Bladder Pressure Tracking - Diane Newman & Howard Goldman
Exploring Burnout in Healthcare "Fist Pumps: The Prescription for Provider Burnout" - Scott MacDiarmid
Understanding Nocturia: Part 1 - Jeannette Potts
Understanding Nocturia: Part 2 - Jeannette Potts
Understanding Nocturia: Part 3 - Jeannette Potts
We Must Stop Misusing the Term Prostatitis - Jeannette Potts
Urogynecology Controversies: Female Pelvic Medicine and Reconstructive Surgery - Briana Walton
Single-Use Disposable Cystoscopy - Roger Dmochowski, David Chaikin, & Vijay Goli
Gentamicin Bladder Irrigation to Reduce UTIs - Anne Cameron
Male UCPPS is NOT Prostatitis - Jeannette Potts
Driving Excellence in the Management of Nocturia - Scott MacDiarmid
A Legend and His Contributions to Urology Perspectives On His Journey - Ananias Diokno
The International CURE-UAB Initiative - Michael Chancellor
Management of Nocturia- Mikel Gray
Nocturia: Physiology and Pathophysiology - Mikel Gray
Research Outcomes in Urinary Tract Infections in Woman - Jean Wyman
Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium - Tamara Bavendam
The Use of Acupuncture in Women with Incontinence - Sandy Engberg
Overview of Catheter Associated Urinary Tract Infections and Prevention Strategies - Shannon Novosad
Group Learning Achieves Decreased Incidence of Lower Urinary Symptoms - Interview with Tomas Griebling
Surgical Interventions for Stress Urinary Incontinence and Pelvic Organ Prolapse - Ariana Smith
A Midwife Perspective on Preserving the Pelvic Floor - Lisa Kane Low
A Paradigm Shift in the Treatment of Nocturia - David Sussman
Evolution in the Treatment of Patients with Prostatitis - Jeannette Potts
Surgical Management of Female Stress Urinary Incontinence: 22-Year Population-Level Trends - Christopher Wallis
Demographics of the Nocturia Patient - Jeffrey Weiss
What to Look Forward to - 48th Annual International Continence Society ICS - Alan Wein
Defining Bladder Health - Ariana Smith
Female Urology, Incontinence, LUTS, Voiding Dysfunction - Christopher Payne
Welcome to the Pelvic Health Center of Excellence - Diane Newman
Causes and Treatments of Nocturia - Jeannette Potts
The State of BPS/IC: "The Emperor Has No Clothes" - Christopher Payne
Physician-Scientist Review Articles
State of the Evidence Review Articles
Intermittent Catheters
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization is the method of bladder management in patients with urinary retention caused by a neurogenic bladder.  Neurogenic bladder can be caused by 1) upper motor neuron disease (for example, central nervous system lesions, including stroke, Parkinson’s disease, and multiple sclerosis [MS]);
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization (IC) is the “gold standard” for individuals with bladder dysfunction caused by neurologic or non-neurologic causes, a significant and growing population in the United States.  Intermittent catheterization is the recommended method for individuals who are unable to void or completely empty the bladder.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization (IC) is the preferred procedure for individuals with incomplete bladder emptying from non-neurogenic or neurogenic lower urinary tract dysfunction (NLUTD). IC is now considered the gold standard for bladder emptying in individuals following spinal cord injury (SCI) who have sufficient manual dexterity (Groen et al., 2016; Wyndaele et al, 2012).
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 29, 2021
Patients may be concerned about the discomfort associated with intermittent catheterization(IC), the need to maintain privacy, the fear of performing the catheterization, and the inability to find a clean and appropriate toilet or bathroom for catheterization when traveling outside their home. Clinicians need to consider these patient concerns in their teaching and recommend possible strategies.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 29, 2021
The number of catheter types and designs has increased with the advancement of new technology. This has added complexity to the catheterization process for both the nurse and the patient. Catheter types are now gender specific, acknowledging the anatomical differences in urethral length between men and women.
Indwelling Catheters
Written by Diane K. Newman DNP, ANP-BC, FAAN
May 28, 2024
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 25, 2021
The 2009 Centers for Disease Control and Prevention (CDC) guidelines for the prevention of catheter-associated urinary tract infections (UTIs) recommends catheter use only for appropriate indications.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
November 16, 2021

There are other non-infectious IUC-related adverse effects that occur the longer an indwelling urinary catheter (IUC), particularly a transurethral IUC, is used for bladder drainage. They include catheter blockage, urine bypassing, bladder spasms, accidental catheter dislodgement, and non-deflating balloons.

Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 25, 2021
Each year, urinary catheters are inserted in more than 5 million patients in acute care hospitals and long-term care (LTC) facilities. Historically, indwelling urinary catheters (IUC) have been used in the chronically, medically compromised older adults.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 21, 2021
In this resource article, Diane Newman, DNP, ANP-BC, FAAN provides best practices for the management of indwelling urinary catheters starting with documenting in the patient’s medical record all procedures involving the catheter or drainage system.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 21, 2021
A catheter is inserted for continuous drainage of the bladder for two common bladder dysfunction : urinary incontinence (UI) and urinary retention. Indwelling urinary catheters are either inserted transurethrally or suprapubically.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 21, 2021
Catheters are semi-rigid but flexible tubes. They drain the bladder but block the urethra.

The challenge is to produce a catheter that matches as closely as possible to the normal physiological and mechanical characteristics of the voiding system.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 21, 2021
In this resource article, Diane K. Newman, DNP, ANP-BC, FAAN provides techniques and procedures for use of indwelling catheters including appropriate urinary catheter use, examples of appropriate indications for indwelling urethral catheter use and more.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 21, 2021
Catheter related problems due to an indwelling urinary catheter (IUC) have existed as long as urinary catheters have been utilized.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
October 21, 2021
Indwelling urinary catheters (IUCs) are semi-rigid, flexible tubes. They drain the bladder but block the urethra. IUCshave double lumens, or separate channels, running down it lengthwise.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 5, 2020

Adherence to general infection control principles: Hand hygiene - the most important factor in preventing nosocomial infections, Aseptic catheter insertion, Proper Foley catheter maintenance, education, and care by nursing staff, Foley catheter use surveillance and feedback.

Written by Diane K. Newman DNP, ANP-BC, FAAN
October 21, 2021
Suprapubic Catheters
Written by Diane K. Newman, DNP, ANP-BC, FAAN
May 17, 2023
The initial insertion of a suprapubic catheter (SPC), a procedure referred to as a suprapubic cystostomy, can be performed under local or general anesthesia with a trocar system, using cystoscopic or ultrasound guidance. SPC insertion is an aseptic procedure that can be performed in an outpatient or office setting
Written by Diane K. Newman, DNP, ANP-BC, FAAN
May 17, 2023
The complication rate for cystostomy (surgical procedure for insertion of a suprapubic catheter (SPC)) ranges from 1.6% to 2.4%. The first few catheter changes after the initial SPC insertion should be performed using a guidewire as acute complications can occur.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
May 17, 2023
Suprapubic catheters are often placed for a short time following certain surgical procedures as they can contribute to patients’ improved recovery times, compared with urethral catheterization. They can provide stable bladder drainage before and after complex urethral reconstructions.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
May 17, 2023
Description: A urinary catheter valve, sometimes referred to as a “catheter plug” is a tap-like device fitted into the end of an indwelling urethral catheter (IUC) or suprapubic catheter (SPC). It allows the bladder to fill and then be emptied into a toilet or container at regular intervals during the day (e.g. 4-5 times/day). This mimics the physiologic function of the bladder. A catheter valve may be used in those patients who may have other options for future bladder management,
Written by Diane K. Newman, DNP, ANP-BC, FAAN
May 17, 2023
Background: Suprapubic catheterization (SPC) is placement of a hollow tube, a urinary catheter, into the bladder through a small incision in the avascular midline of the rectus sheath in the lower abdominal wall just above (3 cm) the symphysis of the pubic bone and below the naval. These 2 Figures show an SPC inserted in a female and a male. Like an indwelling urethral catheter (IUC), the catheter is there to drain the bladder and is secured in the bladder by a balloon inflated with fluid.
External Urinary Collection Devices
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
The shape and material of external urine collection devices (EUCD) have changed over the past 20 years. Historically, most EUCDs were made from latex that allowed for flexibility but also increased the risk of an allergic reaction. Latex-based sheath devices are still available but more recent ones are constructed from non-allergenic silicone.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
An EUCD may be external and less invasive, but they are not free of risks. Complications and adverse effects include skin lesion/ulceration and breakdown from pressure necrosis and moisture, urethral fistula or very rarely, gangrene of the penis. The majority of complications involve perineal/genital skin issues, primarily occurring in 15-30% of male patients and involve external penile shaft problems.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 10, 2020
The use of an external urine collection device (EUCD) is an effective way to manage and collect urine leakage in men and women who have urinary incontinence. However, these devices are not indicated for the management of urinary obstruction or urinary retention.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
An external urine collection device (EUCD) is defined as a catheter or product that attaches to the perineum. These collection systems drain urine via tubing attached to a bag or via tubing that suctions urine to a container. EUCDs are primarily used in men or women with urinary incontinence.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 10, 2020
External urinary catheters (EUC) are used as collection devices or systems (referred in the UroToday reference center as external urine collection devices [EUCD]) for collecting and containing urine via tubing that relies on gravity to drain urine away from the penis or perineum into a drainage bag or suction that pulls urine into a container.
Physician-Scientist Commentaries
Peer-reviewed Abstract Supplemental Commentaries
Written by Charles B. Foster, MD
Center for Pediatric Infectious Diseases, Cleveland Clinic Children’s
Catheter-associated urinary tract infections (CAUTIs) are a major cause of harm in hospitalized children.

Catheter Resource Guides

Catheter guides provided by the ANA and AHRQ
...
Streamlined Evidence-Based RN Tool: Catheter Associated Urinary Tract Infection (CAUTI) Prevention

Nurse-Driven CAUTI Prevention: Saving Lives, Preventing Harm and Lowering Cost. Key Practice Strategies to Reduce CAUTI: 1) Fewer Catheters Used, 2) Timely Removal and 3) Insertion, Maintenance, and Post-Removal Care. Informed by Guidelines for Prevention of Catheter-Associated Urinary Tract Infections (CDC, 2017).

Download PDF
...
AHRQ Safety Program for Reducing CAUTI in Hospitals

This guide and the appended tools are designed to support implementation of evidence-based practices and elimination of catheter-associated urinary tract infections (CAUTI) in your hospital unit.

Download PDF
...
How to Use an External Male Catheter

An external catheter is used by a man to collect urine that leaks from the bladder (called “urinary incontinence”). These catheters are also called “urisheath or sheath” or “condom” or “Texas” catheters. This catheter is used on the outside of the body. It fits over the penis and connects to a drainage bag.

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AHRQ-2022 Update for clinicians
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Frank Martens
This presentation reported on data from the initial 500 patients from 20 centers who reached one-year follow-up in the EAU Research Foundation prospective registry SATURN (Surgery for mAle incontinence with artificial Urinary sphincters and slings) which was established to assess the efficacy of male stress urinary incontinence (SUI) surgery in daily practice. SATURN’s overall goal is to analyze 1000 patients undergoing male SUI surgery with 10-year follow-up from 29 implanting centers in 9 European countries. The group has defined “cured” as the absence of pad use or only 1 security pad.
Presented by Nina Harke, MD
When was the last time you learned about a randomized controlled trial that demonstrated a statically and clinically significant difference in continence rates after robot-assisted radical prostatectomy (RARP)?
Presented by Sandip Vasavada, MD
The AUA and SUFU initially released a joint guideline for non-neurogenic overactive bladder (OAB) in 2012, which was then updated in 2015. 1,2 This year there is a new update that has been announced. Dr. Vasavada presented on the latest updates to the OAB guidelines at today’s afternoon plenary session.
Presented by Nina Harke, MD
Dr. Harke presented their prospective study comparing different catheters for a different duration of time after robotic radical prostatectomy (RALP). This study won the best poster award at the ERUS 2018 meeting.
Presented by Shannon Novosad, MD, MPH
Philadelphia, PA (UroToday.com) Shannon Novosad, MD, medical officer at the Centers for Disease Control and Prevention (CDC) has opened Educational Course on Clinical Directions in Continence care by providing an overview
Presented by  Anne Pelletier-Cameron, MD
Anne Pelletier-Cameron, MD, provided a State-of-the-Art lecture at CUA 2018, discussing what every urologist should know about neurogenic bladder.
Presented by Brian S. Schwartz, Tomas Lindor Griebling, Timothy Averch, and Ben Chew
San Francisco, CA USA (UroToday.com) Brian S. Schwartz, MD (UCSF) moderated the Plenary session on “Catheter-Associated UTIs” with Dr. Tomas Griebling (University of Kansas), Dr. Timothy Averch (University of Pittsburg), and Dr. Ben Chew (University of British Columbia) as the panelists.