Urinary Catheter-associated infection

Guide lines

Risk factors

 

female sex,

significant comorbid conditions (especially diabetes mellitus),

age older than 50 years,

lack of systemic antibiotic,

and high a serum creatinine level.

 

Catheter-associated bacteriuria usually resolves after the catheter is removed; however, one third may have symptoms, and bacteremia is the most serious complication

 

Short-term catheters

 

            Placed for a mean duration of 2-4 days.

 

Indications :

 

1.acute illnesses,

2. output measurement,

3. perioperative for major surg.&high risk pt.,

4. acute retention.

 

Approximately 15% of patients develop bacteriuria, usually with a single organism (E coli). Approximately 10-30% develop a fever.

 

The risk of postoperative wound infection associated with bacteriuria is increased.

 

Long-term catheters

 

Indications:

 

Placed for chronic medical or neurologic  problems, including :

chronic urinary retention &incontinence.

All patients develop bacteriuria, which may be polymicrobial in up to 95% of cases. New pathogens often emerge.

Catheter obstruction may occur via an interaction between bacteria, the glycocalyx, protein, and crystals; Proteus mirabilis is a potent producer of urease, which alkalinizes the urine, precipitating struvite and apatite.

 

Preoperative antibiotics can reduce complications in a preoperative indwelling catheter

Regimens for high-risk patients include ampicillin (or vancomycin) plus gentamicin. Ampicillin is given as 2000 mg IM or IV within 30 minutes of starting the procedure; 6 hours later, 1000 mg of ampicillin (or amoxicillin PO) is given once.

. Gentamicin is dosed at 1.5 mg/kg IV or IM (not to exceed 120 mg) and is given only once with the first dose of ampicillin. For patients allergic to ampicillin, 1000 mg of vancomycin is given

 

IV over 1-2 hours only once; it should be completed within 30 minutes of starting the procedure.

 

At least 11 steps can be taken to prevent catheter-associated UTIs; these steps can postpone a UTI for weeks but will not be totally successful in patients with long-term catheterization :

 

1.Catheterization should be avoided when not required (catheters were found to be unnecessary in 41-58% of patient)

 

2.Only use for the shortest period and remove as soon as possible; if you insert to monitor effective blood volume remove the catheter as soon as the patient is haemodynamically stable.

 

3. Short term catheter is safer than long term catheters.

 

4. Use clean aseptic catheterization.

 

5. Daily cleansing of urethral area.

 

6. Increase fluid intake if possible.

 

7. Prevent constipation and   impacted  stool.

 

8. Use closed drainage sterile systems.

 

 

9. Prevent catheter kinking.

 

10.Urinary catheters coated with silver also reduce the risk.

 

11.Because many of these infections occur in clusters, good handwashing before and after catheter care is essential

Most hospitalized patients already are receiving antibiotics for other reasons; risks include creating resistant organisms.

 

The following are of little benefit:

 

(1) instillation of antimicrobial agents into the bladder (unidirectional flow from the bladder to the bag is the best),

(2) placing antimicrobials in the urine-drainage bag (which breaks the closed-drainage system),

(3) rigorous meatal cleansing.

 

Notify if the patient develop any of the following:

The urine has strong smell or becomes thick &/or cloudy.

Urethral swelling around the catheter.

Bleeding into or aroung the catheter.

Catheter draining little or no urine.

Leakage around the catheter.