A nurse in a nursing home care facility observed that there is an increasing incidence of urinary tract infection (UTI) among its elderly residents. Most of those who got infected happened to be using catheters. Thinking that the UTI may be caused by catheter-associated urinary tract infections (CAUTI), the nurse looked up the Internet to see if there are ways to minimize the incidence of CAUTI among the residents. The nurse discovered that CAUTI is one of the types of infections in long-term health care facilities that are most common (Nicolle, 2014; Matthews & Lancaster, 2011).
Fortunately, the nurse saw an evidence-based strategy by the Michigan Health and Hospital Association Keystone Center for Patient Safety & Quality for preventing or minimizing CAUTI. It uses the “ABCDE” technique of the Keystone Bladder Bundle Initiative launched in 2007 (Meddlings et al., 2012; Sanjay, et al., 2013):
adherence to techniques that help prevent infections such as proper education, hand washing and use of aseptic techniques
bladder ultrasound can prevent the use of an indwelling catheter
condom catheters and other comparable alternatives should be used only if found suitable to the patient’s case
do not put indwelling catheter unless it is really needed
early removal of the catheter must have a protocol to remind the health staff involved.
Stop orders or catheter reminders have also been found by meta-analysis and multiple systematic reviews to reduce CAUTI by 25%-53%(Meddlings et al., 2012; Sanjay et al. 2013). Current randomized controlled trials also show that using antimicrobial catheters has no significant effect in decreasing the CAUTI (Meddlings et al., 2012; Pickard, R. et al., 2012).
In conclusion, CAUTI, though common in long-term care facilities, can significantly be reduced with the usage of the Keystone Bladder Bundle Initiative. This is a more cost-saving strategy than using expensive antimicrobial catheters, which showed no significant effect in reducing CAUTI at all.
References
Matthews, J. & Lancaster, J. (2011). Urinary Tract Infections in the Elderly Population. The
American Journal of Geriatric Pharmacotherapy.9(5), 286–309.
doi:10.1016/j.amjopharm.2011.07.002
Meddlings, J. et al. (2012). Reducing unnecessary urinary catheter use and other strategies to
prevent catheter-associated urinary tract infection: An integrative review. BMJ Quality &
Safety. doi:10.1136/bmjqs-2012-001774
Nicolle, L. (2014). Catheter associated urinary tract infections. BioMed
Central.DOI: 10.1186/2047-2994-3-23
Pickard, R. et al.(2012). Antimicrobial catheters for reduction of symptomatic urinary tract
infection in adults requiring short-term catheterisation in hospital: a
multicentrerandomised controlled trial. The Lancet. 380(9857), 1927–1935.
doi:10.1016/S0140-6736(12)61380-4
Sanjay, S. et al. (2013). Preventing Catheter-Associated Urinary Tract Infection in the
United States: A National Comparative Study. JMA Internal Medicine.173(10), 874-
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