Running head : Catheter Associated Urinary Tract Infections
Catheter Associated Urinary Tract Infections
Elizabet Iankova
University of South Florida
1
Catheter Associated Urinary Tract Infections
Urinary Tract Infections
A urinary tract infection or UTI is a common infection that occurs due to the entry of bacteria or
fungi into the genitourinary tract at the urethra. A primary bacterium that accounts for almost 90% of
infections is Escherichia coli that colonizes in the urinary tract and produces an inflammatory response.
Females are at a much higher risk for developing UTI’s due to their natural anatomical variations of a
shorter urethra than that of a male, thus making them more susceptible for infections. Men secrete
prostatic fluid that serves as an antibacterial defense; however as aging occurs and the prostate gland
enlarges their risk of infection increases. Catheterization is a predisposing factor for both men and
women after surgery for urethral damage. The use of indwelling catheters in critical care units plays a
major role in hospital acquired urinary tract infections.
Pathogenesis
Although, just the mere detection of bacteria in the urinary tract does not mean an infection.
Some asymptomatic bacteria do not require treatment, even with catheterization. An organism may
cause a catheter associated urinary tract infection by either extraluminal ascending infection or
intraluminal infection. In an extraluminal ascending infection, organisms of the perineal area, such as
Staphylococcus aureus, move upward by the capillary action in the thin mucous film that coats the
external surface of the catheter at the time of insertion or later on. In contract, intraluminal infection is
caused by organisms reaching the lumen of the catheter either from failure of closed drainage or urine
in the collecting bag getting contaminated. In most cases, extraluminal ascension is the most common
method of obtaining the catheter associated UTI but both routes are important to be aware of.
According to Parida and Mishra (2013), “A CAUTI occurs when a patient with an indwelling
urinary catheter develops 2 or more signs or symptoms of a UTI such as hematuria, fever, suprapubic or
flank pain, change in urine character, and altered mental status. CAUTI is classified as a complicated
2
Catheter Associated Urinary Tract Infections
UTI.” (p. 370). Furthermore, a patient developing positive urine cultures that present 10 colony forming
units or 2 microorganisms identified after 48 hours in the ICU are deemed to have a true CAUTI. If a
patient does not show positive urine cultures, a dipstick test for leucocyte esterase and/or nitrate may
be ordered with the presence of two or more signs or symptoms to accurately diagnosis a patient as a
precaution. This is extremely important to help distinguish between asymptomatic catheter associated
bacteriuria or candiduria, that rarely need treatment or cause any serious adverse outcomes versus a
complicated UTI. There are many risk factors for catheter- associated UTI’s such as prolonged
catheterization, elevated creatinine levels, Diabetes Mellitus, and use of systemic antibiotics.
Clinical Reference
With CAUTI’s having incidences of close to 2 million cases a year, some health insurance
companies have defined it as a “never event” and limited reimbursement to acute care hospitals (Vaca,
2013,p. 78). Thus, trying to limit the occurrence of CAUTI’s has been on the rise and many hospitals
have begun to promote education and prevention of this infection rate to diminish. Parida and Mishra
(2013) found the following: “The single most important maneuver which can reduce the incidence of
CAUTI is to use indwelling urinary catheters only when justified”. An indwelling catheter should not be
used to measure urinary incontinence, nor should it be left longer in a patient then needed. A nurse
should use preventative measures and not tamper with an indwelling catheter so that the system will
not be exposed, he or she should also encourage the patient to drink plenty of fluids and avoid irrigation
of the bladder. Proper sterile techniques when inserting a catheter reduce the occurrence of
microorganisms gaining access to the sensitive area, as well. Hand washing frequently is an integral
component in the overall prevention of spreading bacteria and is highly effective in preventing catheter
associated UTI’s or complicating them more.
Catheter Associated Urinary Tract Infections
Other preventative measures include placing the collection system below the level of the
bladder, not having it touch the floor and never using the same collection system for more than one
patient. According to a recent article, a neurological intensive care unit spent an adequate amount of
time and research trying to find successful measures to reduce the amount of CAUTI occurrences in their
unit.
Vacca’s (2013) study found the following: implementation of a formalized rounding
process in the ICU decreases device- related infections and increases nurses’
satisfaction. Using this idea as the foundation for our initiative, we developed a
new proactive approach to CAUTI prevention that incorporated a formalized
rounding process (p.79).
The team of nurses would assess their patients with indwelling catheters at least once or twice a
shift mindful of any signs of infection. They had a set of CAUTI prevention bundles that needed to be
assessed that included: making sure the catheter was secured to the patient’s thigh and tubing was not
kinked, drainage bag off the floor, drainage bag not overfilled and maintenance of a closed drainage
system (Vacca, 2013, p. 79). Based on my recent clinical observations and training, I have not seen a
prominent “gap” between research findings and practice. Nurses frequently assess their patients room
to room on voiding, and the status of their indwelling catheter. Adequate hand washing before and after
leaving patients room is very well enforced, thus they are mindful of the spread of bacteria to other
patients. If these preventative measures continue to be utilized, the goal is to further reduce urinary
tract infections from indwelling catheters, successfully.
3
Catheter Associated Urinary Tract Infections
References
M. Vacca & D.Angelos. (2013, December 1). Critical Care Nurse Elimination of Catheter
Associated Urinary Tract Infection in a Adult Neurological Intensive Care Unit. 33(6), 78-79. Retrieved
from http://eds.a.ebscohost.com.ezproxy.lib.usf.edu/eds/pdfviewer/pdfviewer?sid=36089091-ea6e4203-aa44-21ed3176ea5d%40sessionmgr4003&vid=5&hid=4111
S. Parida & S.K.Mishra (2013, November 1). Indian Journal of Critical Care Medicine Urinary
Infections of the Critical Care Unit – A brief Review. 370-374. Retrieved from
http://eds.b.ebscohost.com.ezproxy.lib.usf.edu/eds/pdfviewer/pdfviewer?sid=11bfe476-95e3-45deb5db-0e32b377de41%40sessionmgr198&vid=7&hid=115
Sommers, M., Brunner, L., (2013). Disease and Disorders: A Nursing Therapeutics Manual
(Fourth Edition). Retrieved from Unbound Medicine mobile platform