BEST EVIDENCE FOR PREVENTING URINARY TRACT INFECTIONS IN PATIENT WITH FOLEY CATHETERS IN THE INTENSIVE CARE UNIT

Martin Ibeawuchi
Zebida Lisso

URINARY TRACT INFECTIONS (UTI)

Millions of Americans undergo Urinary bladder catheterization annually.
25% of hospitalized patients have a urinary catheter placed during hospital stay and 5% to 15% of Nursing home residents have urinary catheters.
Urinary catheters are the proximate cause of the vast majority of health-care associated UTIs.
Catheter-related UTIs (CA-UTIs) are the second most common cause of nosocomial bloodstream infection (after vascular catheters)

Darouiche, et al. (2006)

Research Article #1 Cranberries for preventing UTI’s.

Type of Study: Systematic review
Level of Study: Level 1.
Sample size: Ten studies, 1049 Participants.
Cranberry juice, cranberry capsules, water and placebo juice were used in the studies.
Findings:
*No clear evidence as to amount of juice that needs to be consumed, Study Period and Large number of dropouts.
Result: The result of all trials showed that cranberry products significantly reduces the incidence of UTIs.
Craig, J., & Jepson, R. (2008)

Research Article # 2 Antimicrobial Catheters.

Type of Study: Systematic review
Level of Study: Level 1
*8 randomized & 4 Quasi-randomized trials
*Sample size=13, 392
*Previous meta-analyses from 1993-2000
*Trials compared different antimicrobial catheters
Nitrofurazone and silver alloy-coated catheters vs. latex and silicon catheter
Analyses limited to secondary outcomes
↓Ca-UTI (asymptomatic) during short-term stay (30 days)


Murphy, D., Francis, K., Litzenberger, M., & Luvente, K. (2007)

Research Article # 3 Catheter Securing Device

Stat-lock securing device vs. Traditional approaches (tape, Velcro strap, etc)
Level 2: Prospective randomized trial
Sample size=118 (60-experimental; 58-control)
Results
*Associated with 45%↓ in symptomatic UTI in patients with catheter dependent neurogenic bladder
*No significant differences in rates of UTI in experimental (stat- lock) vs. control (other devices): both groups showed a ↓ in CA-UTI.
Recommendations
*Further studies needed to demonstrate anti-infective efficacy of StatLock securing devices

Darouiche et al., (2006)

Research Article # 4 Condom versus Indwelling Urinary catheter: A randomized trial.

Type of study: A randomized control led trial
Level of Evidence: Experimental Level 2
Sample size: Hospitalized men, age 40 and older, seventy-five subjects were randomized, 34 received a condom catheter, 41 received an Indwelling catheter.
Limitations:
* Single hospital site used which might affect generalization
* Specific condom catheter used
Result: The trial found that the use of condom catheters in male patients was associated with a lower risk of
bacteuria symptomatic UTI.

Saint, S., Kaufman, S., Rogers, M., et al.(2006)

Research Article # 5 Best-practice Strategic Prevention

Level 5: Clinical guidelines
* Utilizing guidelines as best prevention strategy.
UTI rates in ICU
*↓ in cardiothoracic surgery patients
*↑ neurosurgical, burn, or patients with indwelling catheters ˃ 20 days.
CDC Guidelines: UTI Prevention Bundle
Antimicrobial catheters
Evidence into practice
“Learn it, Deliver it, Measure it, and Improve it”

Argon, D., & Sole, M. L. (2006)

Research Article # 6 Reducing the risk of catheter-related UTI

Type of Study: Literature review
Level of Evidence: Level 5. Based on research findings.
What can be done to reduce risk: Assessing need for catheterization, selecting catheter type, aseptic catheter insertion, catheter maintenance.
Silver alloy coated catheter: A recent Cochrane review showed a significant infection reduction rates when this catheter remained in situation for less than 7 days.
Expensive, but cost effective when cost of infection is taken into account.
Result: Silver alloy catheters reduce risk of infection when short- term catheterization is indicated.

Nazarko, L. (2008)

References

Argon, D., & Sole, M. L. (2006). Implementing best practice strategies to prevent infection in the ICU. The Critical Care Nursing Clinics of North America, 18, 441-452.
Craig, J., & Jepson, R. (2008). Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Review, 32,128-135.
Darouiche, R., Goetz, L., Kaldis, T., Cerra-Stewart, C., AlSharif, A., & Priebe, M. (2006). Impact of StatLock securing device on symptomatic catheter-related urinary tract infection: A prospective, randomized, multicenter clinical trial. The American Journal of Infection Control, 34(9), 555-560.
Johnson, J. R., Kuskowski, M. A., & Wilt, T. R. (2006). Systematic review: Antimicrobial urinary catheters to prevent catheter- associated urinary tract infection in hospitalized Patients. Annals of Internal Medicine, 144(2), 116-126.
Nazarko, L. (2008). Reducing the risk of catheter-related urinary tract infection. British Journal of Nursing, 17(16), 56-58.
Saint, S., Kaufman, S., Rogers, M., et al. (2006). Condon versus indwelling urinary catheters. A randomized trial. The American Geriatrics Association, 310, 15-21.