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Catheter Associated Urinary Tract Infections
WHO’S AT RISK?
Any patient with a urinary catheter is at risk for a urinary tract infection (UTI). One of the most important risk factors for UTI is duration of catheterization. Within hours, a biofilm develops on the surface of an indwelling catheter and the drainage system. This biofilm has been linked to persistent bacteriuria; as the duration of catheterization increases, so does the prevalence of bacteriuria and risk of infection.
Symptoms of UTI
Every bedside nurse should recognize these common symptoms of UTI:
• Back or lower abdominal pain
• Fever
• Cloudy or bloody urine
• Mucous discharge
• Suprapubic pain
• Worsening mental function
Treatment for Symptomatic Patients
Many catheterized patients will develop bacteriuria but never display symptoms of UTI. Antibiotic treatment is recommended only in the presence of symptoms.
A catheter should be replaced in a patient presenting symptoms, and the sample drawn from the new catheter. Removing the biofilm-laden catheter from the patient assures that any pathogens cultured came from the urinary tract, not the previous catheter.
Pathogens Associated with UTI
• Escherichia coli
• Klebsiella
• Candida albicans
• Enterococcus
• Pseudomonas
• Proteus
• Enterobacter
• Staphylococcus
CDC Guidelines for Prevention of Catheter-Associated Urinary Tract Infections
Summary of Major Recommendations
Category I. Strongly Recommended for Adoption
• Educate personnel in correct techniques of catheter insertion and care.
• Catheterize only when necessary.
• Emphasize handwashing.
• Insert catheter using aseptic technique and sterile equipment.
• Secure catheter properly.
• Maintain closed sterile drainage.
• Obtain urine samples aseptically.
• Maintain unobstructed urine flow.
Category II. Moderately Recommended for Adoption
• Periodically re-educate personnel in catheter care.
• Use smallest suitable bore catheter.
• Avoid irrigation unless needed to prevent or relieve obstruction.
• Refrain from daily meatal care with either of the regimens discussed in text.
• Do not change catheters at arbitrary fixed intervals.
Category III. Weakly Recommended for Adoption
• Consider alternative techniques of urinary drainage before using an indwelling urethral catheter.
• Replace the collecting system when sterile closed drainage has been violated.
• Spatially separate infected and uninfected patients with indwelling catheters.
• Avoid routine bacteriologic monitoring.
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