Infection Control

CATHETER ASSOCIATED

URINARY TRACT INFECTION

[CAUTI]

SENIOR INFECTION CONTROL PRACTITIONER

Infection Control

Infection Control

Source of the bacteraemia

37%

29%

19%

10%5%

Soft Tissue Urinary tract Resp. tract Unknown Soft tiss/UTI

Infection Control

STANDARD INFECTION

CONTROL PRINCIPLES

•Hand washing

•Personal Protective Equipment [PPE]

Infection Control

ENTRY POINTS FOR BACTERIA

Contributory factors• Perineal colonisation

–� with age and in females

• Abnormal bladder emptying

• Poor fluid intake

• Underlying uropathology

• Duration of catheterisation– Risk ↑ 3-6% for each day of catheterisation

– 50% of patients with catheter for 10 days will have bacteriuria

Infection Control

COMMUNITY STUDIES

• 10% Care Home residents have urinary catheters [McNulty 2008]

• Prevalence Care Homes varies 0-47%[114 Care Homes]. 57% catheters insitu prior to admission [McNulty et al 2008]

• Audit in patient homes [Kneil et al 2008]. 10% no care plan, standard of care generally good.

Infection Control

BIOFILM• A film of proteins and micro-organisms that adhere to the

surface of foreign material by secreting a substance called glycocalyx. May form on the internal lumen wall of catheter

• Biofilm can become so thick that it obstructs the flow of urine

• Bacteria embedded in the biofilm may be protected from antimicrobials, therefore the catheter should be changed if treatment commenced

• Do not use catheter maintenance solutions to prevent CAUTI

Catheter type

Long-term catheters block– Biofilms form on catheter material

– Alkaline urine increases formation of crystals

– Re-catheterisation associated with risk of bacteraemia

Latex coated– Minimise irritancy with coating

– Hydophilic; silicone

Silver coated– ? reduce risk of UTI – but poor quality studies

– May be useful for long term catheterised

BACTERIURIA• Bacteria can colonise the urinary tract

without invading the tissues

• Bacteriuria occurs within 10-20 days catheterisation

• 30% develop symptoms UTI

ORGANISMS SPECIFIC TO

THE URINARY TRACT• 80% Coliforms [gut organisms]

• 10% Enterococcus

• 5% Pseudomonas

• 5% Others [Staph, MRSA]

New trends

• Multi-resistant E Col – causing UTI in community, no oral antibiotics

• Healthcare- associated – more resistant organisms eg MRSA, Multi-resistant Klebsiella

Infection Control

ANTIBIOTICSANTIBIOTICSThe more antibiotics used the greater the chance of:

� Selection for resistant organisms� Side effects from antibiotics

C.difficile can be a life threatening illness

Cure (bacteria from the urine) is not possible whilst a urinary catheter remains insitu

Restrict antibiotics to true episodes of infection

Antibiotic prophylaxis when changing catheters –– given for history CAUTIs following catheter change [NICE 2008]

Refer to PCT antibiotic guidelines on Intranet

Infection Control

CATHETER SPECIMEN URINE • Do not dipstick CSU

• Only send if patient symptomatic

• Treat the patient not the result

• Do not send for blocked catheter, smelly urine, leaks

• Use aseptic technique

• Microbiology form - clearly state details

• Transport container – rigid UN5573

Catheter selection: options

• Intermittent (lower risk of UTI)

• Supra-pubic

• Indwelling

• Penile sheath

• Catheter valves instead of drainage bags?

Maintenance of drainage system• Maintain sterile closed system

• Avoid unnecessary breaches e.g.

disconnection of bag

– Platt et al 1983 –sealed units �mortality by 30%

• Hang to allow free-flow of urine into bag

– Roberts 1960’s - Surface tension in

bubbles

• Avoid bag touching floor

– Bag contamination reaches bladder

• Change bag as little as possible

Preventing cross infection

• Decontaminate hands and wear CLEAN

gloves to empty/handle

• Decontaminate hands after ANY contact

with drainage system

• Use CLEAN container – avoid contact

with bag

• Avoid disconnecting system

Infection Control

ESSENTIAL STEPS

Infection Control

Infection Control

Urinary Catheter Ongoing Care Audit

60%70%80%90%

100%

All Elements for 15 Wards (Observations in brackets) This M onths Average (97.3%) Reporting M onth: M arch 12

Urinary Catheters and Infection• Most patients with catheters become

infected

• 3% of catheterised patients will develop septicaemia

• 1% will die

• What’s the best way toprevent catheter associated infection?

•Haematuria

•Urinary Obstruction

•Urology surgery

•Open wounds and Decubitus ulcers in incontinent patients

•Input-output monitoring for haemodynamic stability

•Patient who are Not for resuscitation, comfort care

•Immobility due to physical constraints

HOUDINI -the urinary catheter disappearing act

Infection Control

AVAILABLE GUIDELINES• Core Learning Unit 2009 E-learning programme: Reducing HCAI associated short and long term

urinary catheters

• EPIC2 2007: National evidence-based guidelines for preventing healthcare associated infections in

NHS hospitals’ Pratt et al •‘NICE 2012 (March): prevention of healthcare-

associated infection in Primary and Community Care

• Winning Ways DH 2003• DH 2007 Essential steps to safe, clean care’

• SIGN 2006 Management of suspected bacterial UTI in adults. Chapter 5