What you should know about CAUTI

February 1, 2010
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What is the prevalence and incidence of catheter-associated urinary tract infections (CAUTI)?

Catheter-associated urinary tract infections are one of the most frequent infections today: The daily risk of developing CAUTI is 3% to 7% in an acute care setting and comprise 40% of all institutionally acquired infections.

Does the type of catheter used impact infections?

Currently, there is limited evidence regarding the incidence of CAUTI in long-term suprapubic catheter users compared to urethral catheter users.

How is a CAUTI diagnosed?

The diagnosis of CAUTI is based on finding bacteriuria, along with an elevated white blood cell count (WBC) on a urinalysis examination. Additionally, in some cases, an elevated serum WBC and two or more of the following signs/symptoms may be present: pain or burning in the region of the bladder, urethra, or flank; fever or chills; malaise; offensive urine odor; change in color or character of urine, including cloudy urine or increased sediment; hematuria; bladder spasms/leakage; catheter obstruction; increased weakness or spasticity; change in mental status; or bacteremia.

What are the factors that may contribute to CAUTI?

Certain individuals are more prone to developing CAUTI. Some catheter management techniques can also contribute to increased risks for developing CAUTI. Catheter factors that contribute to CAUTI include: leaving a catheter in place for more than six days, inserting the catheter in a place other than an operating room, using the catheter to measure urinary output, not positioning the catheter correctly, and allowing the level of the drainage tubing to be above the bladder or below the level of the drainage bag. Patients who are female, pregnant, malnourished, or those who have diabetes mellitus, azotemia, or a ureteral stent, are at a higher risk for CAUTI.

How is a symptomatic CAUTI treated?

The first step in treating CAUTI is to identify the microorganism causing infection and differentiate that species from other bacteria found in the existing catheter. Initial treatment may be empirical, but the choice of therapy with oral or parenteral antimicrobial drugs should be based on results of culture and sensitivity testing. Urosepsis is the most serious complication of indwelling catheter use and requires aggressive antibiotic therapy, supportive care, and may require hospitalization.

How can CAUTI be prevented?

A key component of any plan for the prevention of bacteriuria or symptomatic urinary tract infection (UTI) involves prompt removal of the catheter, whenever possible, and use of an alternative method of bladder drainage (e.g., spontaneous voiding, clean intermittent catheterization [CIC], or external condom). If catheter removal is not an option, other effective UTI prevention strategies can be implemented such as using a sterile procedure for catheter insertion, using a catheter with the smallest size lumen and balloon possible, minimizing the duration of the catheterization, maintaining a closed drainage system, keeping the collection device below the level of the bladder/tubing, and engaging in routine perineal care.

What are the commonly used, but unproven, strategies to prevent UTI?

Research points to a number of practices that are used, but have not been proven to prevent UTI with indwelling catheter use. These include: instilling antibiotics or other additives to the drainage bag, applying antibiotic compounds to the meatus, using specific agents for meatal cleansing, systemic antibiotics for prophylaxis, and cranberry juice. Cranberry juice may be helpful in preventing recurring UTI in noncatheterized persons, but there is insufficient evidence to support this practice to prevent CAUTI.

For more information or to view the full CAUTI Fact Sheet, go to http://www.wocn.org.

Kathleen Ozella, BS, RN, CWOCN, is a certified wound, ostomy, continence Nurse at St. Vincent Hospital in Worcester, Massachusetts. She also serves as Chair of the Marketing Committee for the Wound, Ostomy and Continence Nurses Society.

To send your comments to the editor, e-mail mhrehocik@vendomegrp.com.

Long-Term Living 2010 February;59(2):14

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