Prevention of Urinary Catheter-Associated Infection in ICU Patients

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Table of Contents

Introduction
Findings
Discussion
Concluding Remarks
References

Introduction

General Notions

The Health of human beings has always been threatened by various diseases that develop and evolve together with the improvement of methods people find to fight them. Considering the relevant literature, one can find numerous pieces of evidence about the diseases and infections that attack almost any part of the human organism, and the urinary tract is not an exception. This part of the human body functioning is subject to numerous urinary tract infections (UTIs) that might have different causes, develop in a variety of ways, and be treated through the use of different clinical approaches (Mateucci, Walsh, and Pravikoff, 2009, p. 1; Jain et al., 2006, p. 233).

Clinical Issue Background

In more detail, urinary tract infections (UTIs) are observed rather often among countries and regions. According to Mateucci, Walsh, and Pravikoff (2009), alone in the USA specialists record the average of 1 million UTIs annually, and the major reasons for the bulk of these infections are the improperly carried out process of catheterization and its negative consequences for the human health conditions (p. 1). At the same time, Smith and Pravikoff (2009) consider catheterization as one of the basic ways to treat UTIs caused by urine retention or incontinence (p. 2). Given these seemingly opposite viewpoints, one cannot ignore the fact that UTIs are common health issues for intensive care unit (ICU) patients, and scholars like Elpern et al. (2009), Randolph et al. (2005, p. 20), and Jain et al. (2006, p. 234) connect this fact to the routine use of catheters, especially indwelling ones, in ICUs.

Research Question

Thus, the above introductory remarks and the background of the clinical issue under consideration allow seeing that UTIs are a serious health care problem of today, especially for ICU patients. Therefore, if such a problem exists and scholars like Beaver (2008), Volkar (2010), Mateucci, Walsh, and Pravikoff (2009), etc. admit this fact, one cannot ignore the need to find the solution to this problem. Based on this need, the research question of the current paper can be formulated:

Q: How can catheter-associated urinary tract infections (UTIs) be prevented or treated in ICU patients?

Findings

Key Terms

Further on, for a better understanding of the topic and for being able to find the answers to the research question, it is necessary to define the key terms used in the area of urinary tract treatment, UTIs, and the specificity of these issues for ICU patients:

A urinary catheter – Smith, and Pravikoff (2009) define it as “any tube system placed in the body to drain and collect urine from the bladder” (p. 2);
A short-term catheter – a system placed into the body intermittently and removed as soon as it helps empty the bladder from urine (Mateucci, Walsh, and Pravikoff, 2009, p. 2);
A long-term catheter (or indwelling catheter) – a system used permanently, mainly for patients suffering from urine, retention, incontinence, or both disorders combined (Mateucci, Walsh, and Pravikoff, 2009, p. 2);
A urinary tract infection (UTI) – an infection that results from a critical illness or continued and improper use of catheters for treatment (Bagshaw and Laupland, 2006, p. 68); it is usually provoked by the introduction of bacteriuria and pyuria bacteria into the bladder through the urinary tract and urethra (Mateucci, Walsh, and Pravikoff, 2009, p. 3).
A catheter-associated urinary tract infection (CAUTI) – the above-defined infection caused directly by or associated with the use of a catheter for treatment of urine retention, incontinence, or related issues (Prevention of catheter-associated urinary tract infections, 2008, p. 86).
An intensive care unit (ICU) – a medical facility where patients with critical or urgent conditions are taken care of and treated; use of supportive devices is common for ICUs, and this is especially relevant for urinary tract issues where catheterization is a common practice (Elpern et al., 2009; Randolph et al., 2005, p. 19; Rosenthal et al., 2010).

Clinical Issue Details

Thus, after the key terms in the topic of CAUTIs in ICU patients are defined, it is now possible to explain the very clinical issue in detail. First of all, it should be stated clearly that a UTI is catheter-associated because it is observed in a patient during or after the process of catheterization being used for the treatment of his/her urine retention, incontinence, and other issues (Mateucci, Walsh, and Pravikoff, 2009, p. 1). CAUTI is only one of the catheter use complications, while the set of others includes bladder stones, hematuria, urethral injury, and even bladder cancer (Smith and Pravikoff, 2009, pp. 3 – 4).

According to Stockowski (2010), catheter-associated urinal tract infections amount to 40% of all so-called nosocomial infections, and the bulk of them is caused by the use of indwelling long-term catheters. At the same time, Stockowski (2010) considers UTI to be a minor disorder that has no serious consequences. This opinion is confronted by the views of Elpern et al. (2009), who list “sepsis, prolonged hospitalization, additional hospital costs, and mortality” among the major results of UTIs caused by prolonged improper use of urine catheters. The interesting fact is that regular interventions carried out during catheterization with indwelling devices can substantially reduce the risk and the actual occurrence of UTIs in ICU patients (Elpern et al., 2009).

Further on, it is proven empirically that the risk of a catheter-associated urinary tract infection grows by 5% with every day of urine catheter use. This approximate meaning is developed by Saint et al. (2010), who notice that the amount of bacteriuria and pyuria bacteria in the bladder increases by an average of 5% for every day of ICU urine catheterization. Finally, the groups of patients that are subject to the highest rates of UTIs’ risks are female and elderly patients, although the reasons for female patients to be more endangered by UTI risks than the male ones is still not considerably studied by scholars.

Accompanying risk factors for UTI development, in both male and female patients of all ages also include “Pre-existing chronic illness, malnutrition, diabetes, renal insufficiency, and insertion of the catheter outside the operating room or late in hospitalization” (Crosby, 2005).

Thus, the above-presented details on the catheter-associated urinary tract infections (CAUTI/UTI) in ICU patients allow formulating the major profile of the clinical issue in the following way:

Catheter-associated urinary tract infections in ICU patients develop during the procedures of catheterization;
The riskiest catheterization is the one that presupposes the use of the long-term indwelling catheters as it has a permanently growing risk of UTI’s development;
Patients in intensive care units (ICUs) are subjected to the highest risks of UTIs’ development as far as long-term indwelling catheterization is a routine procedure in such medical facilities for respective patients;
Female and elderly patients are the major risk groups for UTIs’ development;
Pre-existing health issues, malnutrition, untimely, and/or improper catheter insertion are the main UTI risk factors for all groups of patients without exceptions.

Discussion

Accordingly, the above-detailed discussion of catheter-associated UTIs and their causes for ICU patients allows developing the set of UTI prevention policies. The first point to address is the use of catheterization as such for health care purposes. As noted above in the Introduction section, catheterization is a source of numerous health care problems, but it is at the same time a method of treating urine retention, incontinence, and related issues. Therefore, specialists analyze the pros and cons of catheterization and often conclude that the use of antimicrobials can be a quite effective alternative, although fully applicable to symptomatic UTIs only (Nicolle, 2005, p. 635).

Further on, the high risk of using the long-term indwelling catheters for UTIs’ development is another serious issue associated with ICU patients’ protection from urinary problems. In brief, ICU patients are commonly exposed to indwelling catheterization on the regular basis, which results in 40% of ICU patients having UTIs (Stockowski, 2010). To solve this problem, two ways are seemingly the best nowadays. The first one is the use of properly designed indwelling catheters, while the second one is the use of regular interventions to monitor catheterization procedures.

In more detail, Mateucci, Walsh, and Pravikoff (2009) argue that the use of a catheter made out of a proper material that fits every specific patient might be a solution. Some patients are allergic to latex, and the use of catheters of this material can increase the UTI risk, while silicon, Teflon, and silver catheters reduce this risk by their antiseptic properties. One more approach to the issue is to use coated catheters that reduce bacteria adherence rates (Mateucci, Walsh, and Pravikoff, 2009, pp. 2 – 3). In addition to this, Elpern et al. (2009) argue that control over catheterization in ICUs should be exercised on the regular basis to ensure the proper design of the procedure and to reduce its UTI risk for ICU patients.

Another important point is the set of UTI risk groups and risk factors for ICU patients. Female and elderly patients are considered to be at the highest risk due to the peculiarities of the urinary system of the former and the weakening of the urinary systems and “host immune response” of the latter. Again, the ideas by Nicolle (2005) can be of great help for solving the issue, as the author insists on an individual approach to antimicrobials’ use that can weaken an already exhausted immunity of a patient with a developed UTI (p. 637).

Finally, scholars like Crosby (2005), Srinivasan et al. (2006), and Beaver (2008) stress the importance of an individualized approach to the overall procedure of urinary treatment at both pre-catheterization and post-catheterization stages. In more detail, should make sure to study the pre-existing peculiarities of every patient as well as his/her allergic reactions. The second point in this individualized approach is more generally applicable as far as it is all about providing timely, proper, and sterile catheterization to prevent or at least reduce, the risk of UTI development in ICU patients. Education and professional responsibility development are the two basic concepts for the effective development of the above-listed initiatives.

Concluding Remarks

Conclusions

Thus, the above discussion allows concluding that catheter-associated urinary tract disease (CAUTI/UTI) is one of the most serious health care issues of today amounting to 1 million annual occurrences alone in the USA. Improper catheterization accompanied by pre-existing conditions, malnutrition, and belonging to one of the two major risk groups, i. e. female and elderly patients, are all UTI-friendly factors. So, proper catheterization practices, educated medical staff, and professional responsibility are the qualities needed to fight UTIs.

Recommendations

Drawing from the above-presented arguments and support from relevant scholarly works, the following set of recommendations for the expected improvement of UTIs’ prevention and treatment can be formulated. Thus, to fight UTIs medical professionals should:

Be educated, professionally qualified, and responsible;
Try to prevent UTIs instead of fighting their consequences;
If facing UTIs, use an individualized approach to every single patient;
Study pre-existing conditions and allergic reactions of a patient;
Use the equipment, i. e. urine catheters in this case, that fits the patients in every particular case.

References

Bagshaw, S. and Laupland, K. (2006). Sexually transmitted diseases and urinary tract infections: Epidemiology of intensive care unit-acquired urinary tract infections. Current Opinion in Infectious Diseases, 19(1), 67 – 71. Web.

Beaver, M. (2008). CMS Reimbursement Changes Put Spotlight on Prevention of Catheter-Related Infections. Web.

Crosby, C. (2005). Prevention of catheter-associated urinary tract infections. Retrieved April 28, 2010, from Healthcare Purchasing News: Web.

Elpern, E. et al. (2009). Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections. Web.

Jain, M. et al. (2006). Quality improvement report: Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Quality Sage Health Care, 15, 232 – 239. Web.

Mateucci, R., Walsh, K., and Pravikoff, D. (2009). Urinary Catheter Use and Prevention of Infection. CINAHL Nursing Guide, 11(13), 1 – 9. Retrieved April 28, 2010, from CINAHL Information Systems Database.

Nicolle, L. (2005). Catheter-Related Urinary Tract Infection. Drugs and Aging, 22(8), 627 – 639. Web.

Prevention of catheter-associated urinary tract infections. (2008). In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Prevention and control of healthcare-associated infections in Massachusetts. Part 1: final recommendations of the Expert Panel (pp. 83-9). Boston (MA): Massachusetts Department of Public Health. Web.

Randolph, A. et al. (2005). Definitions of Specific Infections: Identification of central venous catheter-related infections in infants and children. Pediatric Critical Care Medicine, 6(3), 19 – 24. Web.

Rosenthal, V. et al. (2010). Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries. Web.

Saint, S. et al. (2010). Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes. Web.

Smith, N. and Pravikoff, D. (2009). Urinary Catheter Insertion and Care. CINAHL Nursing Guide, 12(11), 1 – 13. Web.

Srinivasan, A. et al. (2006). A Prospective Trial of a Novel, Silicone-Based, Silver-Coated Foley Catheter for the Prevention of Nosocomial Urinary Tract Infections. Infection Control and Hospital Epidemiology, 27(1), 1. Web.

Stockowski, L. (2009). Preventing Catheter-Associated Urinary Tract Infections. Web.

Volkar, G. (2010). Urinary Catheter Infection Prevention. Web.

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