Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals

Proteus mirabilis UreR coordinates cellular functions required for urease activity

A hallmark of Proteus mirabilis infection of the urinary tract is the formation of stones. The ability to induce urinary stone formation requires urease, a nickel metalloenzyme that hydrolyzes urea. This reaction produces ammonia as a byproduct, which can serve as a nitrogen source and weak base that raises the local pH. The resulting alkalinity induces the precipitation of ions to form stones. Transcriptional regulator UreR activates expression of urease genes in a urea-dependent manner. Thus, urease genes are highly expressed in the urinary tract where urea is abundant. Production of mature urease also requires the import of nickel into the cytoplasm and its incorporation into the urease apoenzyme. Urease accessory proteins primarily acquire nickel from one of two nickel transporters and facilitate incorporation of nickel to form mature urease. In this study, we performed a comprehensive RNA-seq to define the P. mirabilis urea-induced transcriptome as well as the UreR regulon. We identified UreR as the first defined regulator of nickel transport in P. mirabilis. We also offer evidence for the direct regulation of the Ynt nickel transporter by UreR. Using bioinformatics, we identified UreR-regulated urease loci in 15 Morganellaceae family species across three genera. Additionally, we located two mobilized UreR-regulated urease loci that also encode the ynt transporter, implying that UreR regulation of nickel transport is a conserved regulatory relationship. Our study demonstrates that UreR specifically regulates genes required to produce mature urease, an essential virulence factor for P. mirabilis uropathogenesis.

IMPORTANCE

Catheter-associated urinary tract infections (CAUTIs) account for over 40% of acute nosocomial infections in the USA and generate $340 million in healthcare costs annually. A major causative agent of CAUTIs is Proteus mirabilis, an understudied Gram-negative pathogen noted for its ability to form urinary stones via the activity of urease. Urease mutants cannot induce stones and are attenuated in a murine UTI model, indicating this enzyme is essential to P. mirabilis pathogenesis. Transcriptional regulation of urease genes by UreR is well established; here, we expand the UreR regulon to include regulation of nickel import, a function required to produce mature urease. Furthermore, we reflect on the role of urea catalysis in P. mirabilis metabolism and provide evidence for its importance.

Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters

BACKGROUND

Prior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender-specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long-term outcomes.

METHODS

Our study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity-scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub-distribution proportional hazards model to compare between the Foley and non-Foley groups. Sensitivity analyses were conducted with different matching ratios.

RESULTS

In the study, the non-Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub-distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85-7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98-5.05), and men without catheterization (1.58, 95% CI: 1.39-1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections.

CONCLUSIONS

The evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen

BACKGROUND

Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter.

METHODS

An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study.

RESULTS

The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education.

CONCLUSION

Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Prediction of Catheter-Associated Urinary Tract Infections Among Neurosurgical Intensive Care Patients: A Decision Tree Analysis

BACKGROUND

Catheter-associated urinary tract infections (CAUTIs) are the most common device-associated infections in hospitals and can be prevented. To identify the risk factors and develop a risk prediction model for CAUTIs among neurosurgical intensive care unit (NICU) patients.

METHODS

All patients admitted to the NICU of a tertiary hospital between January 2019 and January 2020 were enrolled. Two decision tree models were applied to analyze the risk factors associated with CAUTIs in NICU patients. The performance of the decision tree model was evaluated.

RESULTS

A total of 537 patients admitted to the NICU with indwelling catheters were recruited for this study. The rate of CAUTIs was 4.44 per 1000 catheter days, and Escherichia coli was the predominant pathogen causing CAUTIs among indwelling catheter patients. The classification and regression tree model displayed good power of prediction (area under the curve : 0.920). Nine CAUTI risk factors (age ≥60 years (P = 0.004), Glasgow Coma Scale score ≤8 (P = 0.009), epilepsy at admission (P = 0.007), admission to the hospital during the summer (P < 0.001), ventilators use (P = 0.007), receiving less than 2 types of antibiotics (P < 0.001), albumin level <35 g/L (P = 0.002), female gender (P = 0.002), and having an indwelling catheter for 7-14 days (P = 0.001) were also identified.

CONCLUSION

We developed a novel scoring model for predicting the risk of CAUTIs in patients with neuro-critical illness in daily clinical practice. This model identified several risk factors for CAUTI among NICU patients, novel factors including epilepsy and admission during the summer, can be used to help providers prevent and reduce the risk of CAUTI among vulnerable groups.

Development and validation of a user-friendly risk nomogram for the prediction of catheter-associated urinary tract infection in neuro-intensive care patients

OBJECTIVE

This study aimed to develop a user-friendly nomogram model to evaluate the risk of catheter-associated urinary tract infections in neuro-critically ill patients.

METHODS

A retrospective cohort analysis was conducted on 537 patients with indwelling catheters admitted to the neuro-intensive care unit. Patients' general information, laboratory examination findings, and clinical characteristics were collected. Multivariate regression analysis was applied to develop the nomogram for the prediction of catheter-associated urinary tract infections in this group of patients. The discriminative capacity, calibration ability, and clinical effectiveness of the nomogram were evaluated.

RESULTS

The occurrence of catheter-associated urinary tract infections was 3.91 % and Escherichia coli was the major causative pathogen. Multivariate regression analysis showed that age ≥ 60 years (odds ratio: 35.2, 95 % confidence interval: 2.3-550.8), epilepsy (39.3, 5.1-301.4), a length of neuro-intensive care stay > 30 days (272.2, 8.3-8963.5), and low albumin levels (<35 g/L) (12.1, 2.1-69.9) were independent risk factors associated with catheter-associated urinary tract infection in neuro-intensive care patients. The nomogram demonstrated good calibration and discrimination in both the training and the validation sets. The model exhibited good clinical use since the decision curve analysis covered a large threshold probability.

CONCLUSIONS

We developed a user-friendly nomogram to predict catheter-associated urinary tract ibfection in neuro-intensive care patients. The nomogram incorporated clinical variables collected on admission (age, admission diagnosis, and albumin levels) and the length of stay and enabled the effective prediction of the likelihood of catheter-associated urinary tract infections.

Knowledge, Practice and Associated Factors of Health Care Workers on Prevention of Catheter-Associated Urinary Tract Infections in South Wollo Zone Public Hospitals, Northeast Ethiopia

Introduction

Health care providers are responsible for inserting and maintaining urinary catheters. Hence, it is very important that health care professionals need to be skillful and knowledgeable to prevent urinary tract infection for those patients undergoing indwelling catheter. Thus, this study aimed to assess knowledge, practice and associated factors of health care workers on prevention of catheter-associated urinary tract infections in South Wollo zone public hospitals, Northeast Ethiopia.

Methods

An institution-based cross-sectional study design was employed by using a simple random sampling technique among 413 health care workers. Data were entered into Epi-Data version 4.6 and were exported to SPSS version 26 for analysis. Bivariable logistic regression analyses were performed, and variables with P-value less than 0.25 were fitted to multivariable logistic regression. In multivariable regression analysis, variables having p-value <0.05 were declared as significant factors for outcome variable.

Results

Out of the total 413 health care workers, 298 (72.2%) had adequate knowledge and 233 (56.4%) had adequate level of practice towards catheter-associated urinary tract infection prevention. Received training [AOR = 2.33, 95% CI: 1.404–3.889] and being bachelor degree holder [AOR = 1.90, 95% CI: 1.084–3.359] were significantly associated with adequate knowledge. On the other hand, being master and doctor [AOR = 4.71, 95% CI: 1.768–12.56], adequate level of knowledge [AOR = 2.90, 95% CI: 1.785–4.723], received training [AOR = 2.09, 95% CI: 1.315–3.338] and work experience ≥20 years [AOR = 5.82, 95% CI: 1.497–22.69] were significantly associated with adequate level of practice.

Conclusion

A substantial proportion of health care workers had inadequate knowledge and practice towards catheter-associated urinary tract infection prevention. Therefore, health care workers should strictly follow infection prevention guidelines and should update their knowledge and practice by taking short and long term training.

Knowledge, practice and associated factors of nurses towards prevention of catheter-associated urinary tract infection in intensive care unit of public hospitals administered by Federal Government in Addis Ababa, Ethiopia: a cross-sectional institutional-based study

Background

Urinary catheterization is one of the most common procedures performed in hospitals specifically, in the intensive care units and is associated with a high risk for acquired urinary tract infections. More than 70% of acquired urinary tract infections are due to catheter use. Nurses are the primary healthcare providers responsible for inserting and maintaining urinary catheters. The data regarding nurses’ knowledge, practice and associated factors towards prevention of catheter-associated urinary tract infections are limited in Ethiopia. Therefore, this study aimed to assess the knowledge, practice, and associated factors of nurses towards prevention of catheter-associated UTIs in the Intensive Care Unit (ICU) of public hospitals in Addis Ababa, Ethiopia.

Methods

An institutional-based descriptive cross-sectional study was conducted from March 01 to April 15, 2021, among nurses working in the ICU of public hospitals in Addis Ababa, Ethiopia. All 204 nurses working in the ICU of four public hospitals were included in the study using the census sampling method. Data were collected using a pretested self-administered semi-structured questionnaire. Data were cleaned and entered into Epi data version 4.6 and analyzed using Statistical Package for Social Sciences version 26.0. Pearson Chi-square and Fischer exact tests were performed to see the association between independent and dependent variables. The level of significance is considered at P-value less than 0.05.

Results

A total of 184 nurses participated in the study, making a response rate of 90.2%. The mean (±SD) age of the study participant was 29.07(±4.78). The study findings showed that more than half (63.04%) of nurses had poor knowledge and 88(47.83%) of nurses had poor practice towards prevention of catheter-associated UTIs. In this study, there was a statistically significant association between professional work experience and nurses’ knowledge in preventing catheter-associated UTIs (at P-value = 0.031).

Conclusion

In this study, nurses’ knowledge and practice towards the prevention of catheter-associated urinary tract infection was relatively poor. Professional work experience had a significant statistical association with the level of knowledge. Therefore, increasing the knowledge of nurses through appropriate educational programs and training on the preventive measures of device-associated infections was recommended to prevent catheter-associated UTIs.

Retardation of Bacterial Biofilm Formation by Coating Urinary Catheters with Metal Nanoparticle-Stabilized Polymers

Urinary catheter infections remain an issue for many patients and can complicate their health status, especially for individuals who require long-term catheterization. Catheters can be colonized by biofilm-forming bacteria resistant to the administered antibiotics. Therefore, this study aimed to investigate the efficacy of silver nanoparticles (AgNPs) stabilized with different polymeric materials generated via a one-step simple coating technique for their ability to inhibit biofilm formation on urinary catheters. AgNPs were prepared and characterized to confirm their formation and determine their size, charge, morphology, and physical stability. Screening of the antimicrobial activity of nanoparticle formulations and determining minimal inhibitory concentration (MIC) and their cytotoxicity against PC3 cells were performed. Moreover, the antibiofilm activity and efficacy of the AgNPs coated on the urinary catheters under static and flowing conditions were examined against a clinical isolate of Escherichia coli. The results showed that the investigated polymers could form physically stable AgNPs, especially those prepared using polyvinyl pyrrolidone (PVP) and ethyl cellulose (EC). Preliminary screening and MIC determinations suggested that the AgNPs-EC and AgNPs-PVP had superior antibacterial effects against E. coli. AgNPs-EC and AgNPs-PVP inhibited biofilm formation to 58.2% and 50.8% compared with AgNPs-PEG, silver nitrate solution and control samples. In addition, coating urinary catheters with AgNPs-EC and AgNPs-PVP at concentrations lower than the determined IC50 values significantly (p < 0.05; t-test) inhibited bacterial biofilm formation compared with noncoated catheters under both static and static and flowing conditions using two different types of commercial Foley urinary catheters. The data obtained in this study provide evidence that AgNP-coated EC and PVP could be useful as potential antibacterial and antibiofilm catheter coating agents to prevent the development of urinary tract infections caused by E. coli.

Management and Prevention of Nosocomial Urinary Tract Infections

BACKGROUND: Nosocomial infections are the leading cause of mortality, due to acquired nosocomial infections. Nosocomial urinary tract infections occur during or after hospitalization in patients who did not have an incubation phase of the infection at the time of admission to the hospital. AIM: In this study, we aim to define and manage nosocomial urinary tract infections in intensive care at University Hospital Center “Mother Teresa” Tirana. MATERIALS AND METHODS: 1350 patients were included in the study, of which 115 patients resulted in nosocomial nosocomial infections. The mean age of patients was 62 ± 16.6 years. RESULTS: Out of 1350 patients hospitalized in the Intensive Care during the period October 2019 - December 2020, 4% of patients result in urinary tract infections or 45% of the total for 115 cases of nosocomial infections. We see that men have a higher percentage than women of being affected by urinary tract infections, it is significant (p < 0.001). The etiological cause of nosocomial urinary tract infections was Escherichia coli in 61.5% of cases. For nosocomial urinary tract infections, patients are monitored for fever, examination of urine complete, and uroculture. The mean hospital stay for patients without nosocomial infection of the urinary tract was 4 days, while that of those with urinary tract infection was 18.49 ± 27.68 (from 5 to 180 days). In comparison to the mean mentioned above, it is significant (p < 0.0001). CONCLUSIONS: Nosocomial urinary tract infections are common in patients admitted to intensive care. Key recommendations should be given on diagnostic strategies, testing, selection of antibiotics as well as duration of treatment. We also need to collect data on how to prevent nosocomial infections in general and nosocomial urinary tract infections in particular.

The impact of guidelines on sterility precautions during indwelling urethral catheterization at two acute-care hospitals in Sweden - a descriptive survey

BACKGROUND

To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide how to perform the catheterization. The aim of this descriptive survey was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyze factors affecting conformity with sterility precautions in the EAUN-guidelines.

METHODS

A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher's exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyze variables associated with practicing the sterility precautions in the EAUN-guidelines.

RESULTS

Answers were obtained from 852 persons (91.5%). Most of the participants called their insertion technique "non-sterile". Regardless of designation of the technique the participants said that the indwelling urinary catheter (IUC) should be kept sterile during procedure. Despite that not everyone used sterile equipment to maintain sterility of the catheter. The nurses´ conformity with all the sterility precautions in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.35, 95% CI 1.69-3.27), use of sterile set for catheterization (OR 2.06, 95% CI 1.42-2.97), use of sterile drapes for dressing on insertion area (OR 1.91, 95% CI 1.24-2.96) and using the term "sterile technique" for indwelling urethral catheterization (OR 1.64, 95% CI 1.11-2.43).

CONCLUSIONS

Only 55-74% of the nurses practiced one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Adherence to the guidelines was associated with factors that facilitated an aseptic performance such as using a sterile set and sterile drapes. Healthcare-settings should ensure education and skill training including measures to ensure that the IUC is kept sterile during insertion.

A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program

BACKGROUND AND OBJECTIVES

The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment.

RESEARCH DESIGN AND METHODS

Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. After critical appraisal, 43 articles were included.

RESULTS

Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. Specialized older adult care, a key feature of NICHE programs, resulted in improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. NICHE program adoption and refinement focuses on the methods used to improve care, implementation and adoption of the NICHE program, and measuring its impact.

DISCUSSION AND IMPLICATIONS

The evidence about the NICHE program in caring for older adults is promising but more studies examining patient outcomes and the impact on health care professionals are needed.

Electronic Health Record Adoption and Rates of In-hospital Adverse Events

OBJECTIVE

Nationwide initiatives have focused on improving patient safety through greater use of health information technology. We examined the association of hospitals' electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients.

METHODS

We conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System. The sample included patients age 18 and older that were hospitalized for one of 3 conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and postprocedural events. Adverse event rates and patient exposure to a fully electronic EHR were determined through chart abstraction.

RESULTS

Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13.0% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, patient exposure to a fully electronic EHR was associated with 17% to 30% lower odds of any adverse event for cardiovascular (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.72-0.90), pneumonia (OR, 0.70; CI, 0.62-0.80), and surgery (OR, 0.83; CI, 0.72-0.96) patients. The associations of EHR adoption and adverse events varied by event type and by medical condition.

CONCLUSIONS

Cardiovascular, pneumonia, and surgery patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.

Effect of a Female External Urinary Catheter on Incidence of Catheter-Associated Urinary Tract Infection

Background Catheter-associated urinary tract infections (CAUTIs) can be fatal, and are a source of avoidable expense for patients and hospitals. Prolonged catheterization increases infection risk, and avoiding catheters is crucial for infection prevention. Male external urinary catheters are recommended as a tool to prevent the need for indwelling catheterization. Female external urinary catheters (FEUCs) have intermittently been marketed without wide adoption; one has recently become available but published data is limited. Objective This retrospective observational study was conducted to investigate the effect of FEUCs on indwelling catheter use and female CAUTIs. Methods FEUCs were introduced to intensive care units. CAUTI rates and indwelling catheter days were obtained before and after the introduction of the devices. Results  CAUTI rates decreased from 3.14 per 1000 catheter days to 1.42 per 1000 catheter days (p=0.013). Female indwelling catheter days decreased, while overall intensive care patient days increased. Conclusions Introduction of a FEUC was associated with a statistically significant decrease in CAUTI rate among female intensive care patients. The FEUC may prevent the need for indwelling catheters in some situations.

An Examination of the Barriers to and Facilitators of Implementing Nurse-Driven Protocols to Remove Indwelling Urinary Catheters in Acute Care Hospitals

BACKGROUND

Urinary catheter nurse-driven protocols (UCNDPs) for removal of indwelling urinary catheters (IUCs) can potentially prevent catheter-associated urinary tract infections (CAUTIs). However, they are used inconsistently. The objective of this study was to examine the barriers to and facilitators of implementation of UCNDPs in acute care hospitals.

METHODS

Between September 2017 and January 2019, researchers interviewed 449 frontline staff (nurses, physicians), managers, and executives from 17 US hospitals to better understand their experiences implementing, using, and overseeing use of UCNDPs. Our semistructured interview guide included questions about management practices and policies regarding enactment of a UCNDP.

RESULTS

Although the features of UCNDPs differed across hospitals, the analysis revealed that hospitals experienced common issues related to implementing and consistently using UCNDPs as a result of three major barriers: (1) nurse deference to physicians, (2) physician push-back, and (3) miscommunication about IUC removal. Interviewees also described several important facilitators to help overcome these barriers: (1) training care team members to use the UCNDP, (2) discussing IUC necessity and UCNDP use during rounds, (3) reminding care team members to follow UCNDPs, and (4) developing buy-in for UCNDP use across the hospital.

CONCLUSION

Although UCNDPs are fundamental in efforts to reduce and prevent CAUTIs, hospitals can proactively support their implementation and use by developing the skills that care team members need to enact UCNDPs when patients meet the clinical indications for removal, and increasing awareness about the value and importance of such protocols for reducing CAUTIs and improving patient safety.

Effectiveness of two bed bath methods in removing microorganisms from hospitalized patients: A prospective randomized crossover study

BACKGROUND

Few studies have compared the effectiveness of washing with either soap and water or disposable wet wipes. The objective of this study was to compare the effectiveness of washing with either soap and water or disposable wet wipes in reducing microorganisms in the groin and perineum of hospitalized patients, which could potentially reduce the risk of hospital-acquired urinary tract infections.

METHODS

In this crossover, block-randomized trial, skin swabs from the groin and perineum areas of patients were obtained before and after these areas were washed with either soap and water or disposable wet wipes. Columbia agar plates and CHROMagar Orientation Medium (Becton Dickinson; Franklin Lakes, NJ) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry procedures were used to identify species of microorganisms.

RESULTS

Fifty-eight paired skin swabs were obtained. Both washing methods resulted in a statistically significant reduction in the amount of all microorganisms, including microorganisms with the potential to cause urinary tract infections. New species were observed after using both washing methods. No statistically significant difference in the removal of microorganisms was observed between the two washing methods.

CONCLUSIONS

The two washing methods appear to be equally efficient in removal of microorganisms in the groin and perineum areas, including microorganisms that potentially could cause hospital-acquired urinary tract infections.

PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTION: WHAT IS THE GAP IN CLINICAL PRACTICE?

ABSTRACT Objective: to identify the gap in the prevention of catheter-associated urinary tract infection. Method: an observational study conducted by an audit of process indicators in relation to the recommendations for preventing catheter-associated urinary tract infection during its maintenance and handling. The collection was carried out between July and September of 2017 in an adult intensive care unit located in the State of Minas Gerais, Brazil. The observations were made with the help of a developed instrument for the present study and the data were analyzed by means of descriptive statistics. Results: 451 evaluations were performed related to maintenance of the urinary catheter with a focus on its fixation, the collector bag maintenance, and volume and urinary flow of the drainage system. Regarding clinical practice gaps, inadequate fixation of the urinary catheter and drainage pocket were found, with more than three-quarters of its capacity filled (97.7% and 3.5%, respectively). Regarding the handling of 556 urinary catheters, there was non-conformity in the hygiene of the urethral meatus in 22.9% of the situations, and non-adherence to hands hygiene before and after handling the urinary catheter was 94.2% and 66.5%, respectively (p=0.002). Conclusion: isolated measures had good adherence rates, but prevention of catheter-associated urinary tract infection should be based on adherence to several measures simultaneously. The prevention gap is in the awareness of health professionals that the recognized prevention measures of catheter - associated urinary tract infection should be adopted collectively in order to guarantee patient and clinical practice safety.

Clinical outcomes and prognostic factors in patients directly transferred to the intensive care unit from long-term care beds in institutions and hospitals: a retrospective clinical study

Background

There has been a steady increase in the aging population and an increase in the need for long-term care beds in institutions and hospitals (LTCHs) in Korea. The aim of this study was to investigate prognosis and to identify factors contributing to mortality of critically ill patients with respiratory problems who were directly transferred to intensive care units (ICU) from LTCHs.

Methods

Following a retrospective review of clinical data and radiographic findings between July 2009 and September 2016, we included 111 patients with respiratory problems who had visited the emergency room (ER) transferred from LTCHs due to respiratory symptoms and who were then admitted to the ICU.

Results

The mean age of the 111 patients was 79 years, and 71 patients (64%) were male. Pneumonia developed in 98 patients (88.3%), pulmonary thromboembolism in 4 (3.6%) and pulmonary tuberculosis in 3 (2.7%). Overall mortality was 19.8% (22/111). Multiple-drug-resistant (MDR) pathogens (odds ratio [OR], 17.43; 95% confidence interval [CI], 1.96–155.40) and serum albumin levels < 2.15 g/dL, which were derived through ROC (sensitivity, 72.7%; specificity, 85.4%) (OR, 28.05; 95% CI, 5.47–143.75), were independent predictors for mortality. The need for invasive ventilation (OR, 2.74; 95% CI, 1.02–7.32) and history of antibiotic use within the 3 months (OR, 3.23; 95% CI, 1.32–7.90) were risk factors for harboring MDR pathogens.

Conclusions

The presence of MDR pathogens and having low serum albumin levels may be poor prognostic factors in patients with respiratory problems who are admitted to the ICU from LTCHs. A history of antibiotic use within the 3 months and the need for invasive ventilation can be helpful in choosing the appropriate antibiotics to combat MDR pathogens at the time of admission.

Breaking the Chain of Infection in Older Adults: A Review of Risk Factors and Strategies for Preventing Device-Related Infections

Device-related infections (DRIs) are a significant cause of morbidity and mortality among older adults. Indwelling devices (urinary catheters, percutaneous feeding tubes, and central venous catheters) are frequently used in this vulnerable population. Indwelling devices provide a portal of entry for pathogenic organisms to invade a susceptible host and cause infection and are an important target for infection prevention and antimicrobial stewardship efforts. Within the "Chain of Infection" that leads to DRIs in older adults, multiple opportunities exist to implement interventions that "break the links" and reduce colonization with multidrug-resistant organisms, reduce infections, and improve antimicrobial use.

Implementing clinical guidelines to prevent catheter-associated urinary tract infections and improve catheter care in nursing homes: Systematic review

BACKGROUND

Catheter-associated urinary tract infection is the most common health care-associated infection, is considered avoidable, and has cost implications for health services. Prevalence is high in nursing homes, but little research has been undertaken to establish whether implementing clinical guidelines can reduce infection rates in long-term care or improve quality of urinary catheter care.

METHODS

Systematic search and critical appraisal of the literature.

RESULTS

Three studies evaluated the impact of implementing a complete clinical guideline. Five additional studies evaluated the impact of implementing individual elements of a clinical guideline.

CONCLUSIONS

Prevention of catheter-associated urinary tract infection in nursing homes has received little clinical or research attention. Studies concerned with whole guideline implementation emerged as methodologically poor using recognized criteria for critically appraising epidemiologic studies concerned with infection prevention. Research evaluating the impact of single elements of clinical guidelines is more robust, and their findings could be implemented to prevent urinary infections in nursing homes.

[Recurrent and catheter-associated urinary tract infections : Prophylaxis and prevention]

Urinay tract infection (UTI) as one of the most frequent bacterial infections in humans is of utmost relevance. Because of the rising prevalence of antimicrobial resistance, urinalysis should always include urine culture and a resistogram in order to avoid an unspecific selection and overuse of antibiotics. Prevention of recurrent UTI must first of all rule out predisposing uropathogenic conditions. Nowadays, a great variety of drugs, behavioral, and supportive treatment options can effectively minimize UTI recurrence. The growing importance of vaccines (immunotherapy), probiotics (lactobacilli), and standardized herbal preparations meets the need of reducing antibiotic use and the development of antimicrobial resistance. Around 80% of all nosocomial UTIs (nUTIs) are associated with indwelling urinary catheters. It is estimated that up to 70% of all nUTIs occurring in Germany may be avoided by using appropriate preventative measures. Therefore, profound knowledge about the basics of catheter-associated nUTIs and the correct management of urinary catheters are of utmost individual and socioeconomic importance.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers

Objective

To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers.

Material and Methods

Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confident”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self-Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content).

Results

The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers.

Conclusion

The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

A review of the recent advances in antimicrobial coatings for urinary catheters

More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of hospitalized patients. Among other purposes, urinary catheters are primarily used for draining urine after surgeries and for urinary incontinence. During catheter-associated urinary tract infections, bacteria travel up to the bladder and cause infection. A major cause of catheter-associated urinary tract infection is attributed to the use of non-ideal materials in the fabrication of urinary catheters. Such materials allow for the colonization of microorganisms, leading to bacteriuria and infection, depending on the severity of symptoms. The ideal urinary catheter is made out of materials that are biocompatible, antimicrobial, and antifouling. Although an abundance of research has been conducted over the last forty-five years on the subject, the ideal biomaterial, especially for long-term catheterization of more than a month, has yet to be developed. The aim of this review is to highlight the recent advances (over the past 10years) in developing antimicrobial materials for urinary catheters and to outline future requirements and prospects that guide catheter materials selection and design.

STATEMENT OF SIGNIFICANCE

This review article intends to provide an expansive insight into the various antimicrobial agents currently being researched for urinary catheter coatings. According to CDC, approximately 75% of urinary tract infections are caused by urinary catheters and 15-25% of hospitalized patients undergo catheterization. In addition to these alarming statistics, the increasing cost and health related complications associated with catheter associated UTIs make the research for antimicrobial urinary catheter coatings even more pertinent. This review provides a comprehensive summary of the history, the latest progress in development of the coatings and a brief conjecture on what the future entails for each of the antimicrobial agents discussed.

Isolation and Antibiotic Susceptibility Pattern of Escherichia coli from Urinary Tract Infections in a Tertiary Care Hospital of North Eastern Karnataka

Introduction:

Clinical management of the urinary tract infections (UTI) is influenced by the antimicrobial vulnerability patterns.

Objective:

The study aimed to analyse the resistance pattern of the Escherichia coli (E. coli) causing UTI in patients over a period of 4 years from 2012 to 2015.

Materials and Methods:

1000 samples from patients suspected of having urinary tract infections were collected and processed for culture and antimicrobial drug susceptibility as per the routine microbiological techniques.

Results:

Of the total 1000 samples, 395 cases were culture-positive for E. coli. These isolates were tested for antibiotic susceptibility by disk diffusion method. Of the total 395 E. coli isolates, 170 (43%) were multi drug resistant (MDR). The isolates showed high level of resistance to Ampicillin (82.53%), Cefuroxime (72.41%), Amoxycillin-clavulinic acid (71.90%), Ceftriaxone (66.58%), Ciprofloxacin (65.82%) and Cefepime (57.47%). The isolates were sensitive to Imipenem (96.71%), Nitrfurantion (92.41%), Amikacin (90.89%), Chloramphenicol (85.82%), Piperacillin-tazobactum (80.76%), Gentamicin (59.24%), Azetreonam (54.43%) and Norfloxacin (53.67%).

Conclusion:

We conclude that a significant number of the urinary tract infections in our study subjects were caused by multiple drug resistant E. coli. The sensitivity pattern showed a continued decline from 2012 to 2015, with Imipenem being currently the most effective antibiotic.

Urinary Catheter Management for Nonurologists: A Resident Driven Educational Initiative

INTRODUCTION

Prevention of catheter associated urinary tract infection relies on timely catheter removal and care of indwelling catheters. Educational and quality improvement initiatives to prevent catheter associated urinary tract infection should address the basics of urinary catheter placement and management. Internal medicine residents are an appropriate target for these efforts and they may lack formal training in these issues. We developed a resident driven orientation session that covers basic Foley catheter management principles called the TIPS (Troubleshooting, Indications and Practice Sessions) program.

METHODS

Urology residents at our institution were queried on common consultations for urinary catheter related issues. The incoming intern internal medicine class at our institution completed a pre-TIPS survey that evaluated their baseline urological experience and knowledge. A 1-hour didactic session led by urology residents was followed by hands-on directed practice with mannequins. The web based survey was repeated 1 month later.

RESULTS

Of the total of 60 residents 54 (90%) completed the initial survey. In medical school 38 of 54 residents (70%) had never rotated in urology. Upon repeating the survey at 1 month the response rate was 34 of 60 residents (57%). The proportion of residents confident in their ability to troubleshoot catheter problems increased from 50% to 88% (p <0.05). Knowledge of indications, clot retention and proper catheter technique also improved (p <0.05).

CONCLUSIONS

A focused educational session about common urological catheter management scenarios resulted in improved internal medicine resident confidence in catheter troubleshooting and knowledge of basic urinary catheter placement indications. These educational sessions may be a method to improve nonurology resident education and awareness of common urological issues.

External Collection Devices as an Alternative to the Indwelling Urinary Catheter: Evidence-Based Review and Expert Clinical Panel Deliberations

Multiple evidence-based guidelines have suggested clinicians consider external collection devices (ECD) as alternatives to indwelling catheters. Nevertheless, there is a dearth of evidence-based resources concerning their use. An expert consensus panel was convened to review the current state of the evidence, indications for ECDs as an alternative to an indwelling urinary catheter, identify knowledge gaps, and areas for future research. This article presents the results of the expert consensus panel meeting and a systematic literature review regarding ECD use in the clinical setting.

How and when nurses collect urine cultures on catheterized patients: A survey of 5 hospitals

BACKGROUND

Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Evaluating nurses' knowledge regarding appropriate reasons and methods to obtain urine culture specimens are the first steps to improving practice.

METHODS

Nurses at 5 hospitals completed a 40-question survey regarding their knowledge, training, and practices of appropriate reasons for obtaining urine cultures. The survey included different scenarios of patients with urinary catheters and when they would expect to obtain urine cultures. A 12-point scoring system calculated responses regarding urine collection appropriateness.

RESULTS

There were 394 nurses who responded to the survey. Of them, 76.1% reported receiving education on CAUTI risk reduction within the last 12 months. Although 327 (83%) of all nurses surveyed reported that they never collect urine samples by draining directly from the drainage bag, only 58.4% viewed others to be fully compliant with that standard (P < .001). Nurses who considered their knowledge to be above average to excellent had similar knowledge assessment scores (out of 12 points) for triggers to obtain urine cultures (mean score, 4.9 ± 1.72) compared with those that reported average to poor knowledge (mean score, 4.64 ± 1.78; P = .15).

CONCLUSIONS

Important opportunities exist for nurses to optimize the decisions to obtain urine cultures and the process for obtaining them. Addressing nurses' knowledge and practice may lead to more appropriate use of urine cultures.

Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital

BACKGROUND

It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization.

METHODS

This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16.

RESULTS

The mean age of the patients was 50.54±22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%.

CONCLUSION

The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended.

Risk Factors for Catheter Associated Urinary Tract Infections in a Pediatric Institution

PURPOSE

Catheter associated urinary tract infections are an essential measure for health care quality improvement that affects reimbursement through hospital acquired condition reduction programs in adult patients. With the mounting importance of preventing such infections we evaluated risk factors for acquiring catheter associated urinary tract infections in pediatric patients.

MATERIALS AND METHODS

All catheter associated urinary tract infections were identified at 1 pediatric institution from September 2010 to August 2014 from a prospective database maintained by the infection control office. To identify risk factors patients with a catheter associated urinary tract infection were individually matched to control patients with a urinary catheter but without infection by age, gender, date and the hospital location of the infection in 1:2 fashion.

RESULTS

A total of 50 patients with catheter associated urinary tract infection were identified and matched to 100 control patients. Compared to controls the patients with infection were more likely to have a catheter in place for longer (2.9 days, OR 1.08, 95% CI 1.01, 1.15, p = 0.02). They were also more likely to be on contact precautions (OR 4.00, 95% CI 1.73, 9.26, p = 0.001), and have concurrent infections (OR 3.04, 95% CI 1.39, 6.28, p = 0.005) and a history of catheterization (OR 3.24, 95% CI 1.55, 6.77, p = 0.002). Using a conditional multivariate regression model the 3 most predictive variables were duration of catheter drainage, contact isolation status and history of catheterization.

CONCLUSIONS

Longer duration of urinary catheter drainage, positive contact precautions status and a history of catheterization appear to be associated with a higher risk of catheter associated urinary tract infection in hospitalized pediatric patients. Physicians should attempt to decrease the duration of catheterization, especially in patients who meet these criteria, to minimize the risk of catheter associated urinary tract infection.

A Trial of electronic surveillance feedback for quality improvement at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) risk is directly related to duration of indwelling urinary catheters (IUCs), rising beyond 2 days of catheterization.

METHODS

We conducted a cluster randomized study in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Electronic surveillance data were used in an audit and feedback intervention for frontline nurses to reduce IUC duration. Multivariable methods were used to identify the difference in average IUC duration and proportion of patients with IUC duration <3 days between patients in an early intervention group and a delayed intervention group, adjusting for patient, unit, and hospital characteristics.

RESULTS

A total of 24 units at 19 NICHE hospitals reported 13,499 adult patients with IUCs over 18 months. Early and delayed intervention groups had important baseline differences in IUC utilization. Use of evidence-based CAUTI prevention measures increased during study participation. In multivariable analysis, the average IUC duration and proportion of patients with IUC duration <3 days were not improved in the early intervention group compared with the delayed intervention group.

CONCLUSION

The impact of the audit and feedback intervention was not significant despite the uptake of evidence-based CAUTI prevention practices.

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

The extent to which the use of catheter care bundles and other interventions has led to a reduction in urinary catheterisation rates is unknown. We aimed to determine current urinary catheterisation rates in care homes with residents over 65 years old, and determine the extent to which residents are discharged from the hospital setting with urinary catheters. A point prevalence questionnaire survey was used in care homes that looked after residents over 65 years in six UK health boards or primary care trusts, to determine urinary catheterisation rates, and where these catheters were inserted. Questionnaires for 445 of 461 care homes (96.5%) were completed, 425 of 445 care homes cared for residents over 65 years; 888 (6.9%) of 12,827 residents had a urethral (82.5%) or supra-pubic (17.5%) urinary catheter. Over half of all catheters (both urethral and suprapubic, 57.4%, 509 of 888 catheters), and 3.1% of all residents had a catheter inserted while the residents were hospital inpatients, and then discharged back to the care home still catheterised. There was a significant variation in urinary catheterisation rates in the care homes surveyed, and rates remain similar to previous English surveys in 2003 and 2009. More still needs to be done to understand the variation in urinary catheterisation rates in care homes and reduce these rates, including the numbers of residents that are discharged from hospital with a urinary catheter.

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

BACKGROUND

Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use.

METHODS

To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation.

RESULTS

30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; p<0.001) but not in reminder studies (SMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs.

CONCLUSIONS

UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

First step to reducing infection risk as a system: evaluation of infection prevention processes for 71 hospitals

BACKGROUND

Hospitals can better focus their efforts to prevent health care-associated infections (HAIs) if they identify specific areas for improvement.

METHODS

We administered a 96-question survey to infection preventionists at 71 Ascension Health hospitals to evaluate opportunities for the prevention of catheter-associated urinary tract infection, central line-associated bloodstream infection, ventilator-associated pneumonia, and surgical site infection.

RESULTS

Seventy-one (100%) infection preventionists completed the survey. The majority of hospitals had established policies for urinary catheter placement and maintenance (55/70, 78.6%), central venous catheter maintenance (68/71, 95.8%), and care for the mechanically ventilated patient (62/66, 93.9%). However, there was variation in health care worker practice and evaluation of competencies and outcomes. When addressing device need, 55 of 71 (77.5%) hospitals used a nurse-driven evaluation of urinary catheter need, 26 of 71 (36.6%) had a team evaluation for central venous catheters on transfer out of intensive care, and 53 of 57 (93%) assessed daily ventilator support for continued need. Only 19 of 71 (26.8%) hospitals had annual nursing competencies for urinary catheter placement and maintenance, 29 of 71 (40.8%) for nursing venous catheter maintenance, and 38 of 66 (57.6%) for appropriate health care worker surgical scrubbing.

CONCLUSION

We suggest evaluating infection prevention policies and practices as a first step to improvement efforts. The next steps include implementing spread of evidence-based practices, with focus on competencies and feedback on performance.

Postoperative Urinary Tract Infection and Short-Term Outcomes and Costs in Head and Neck Cancer Surgery

Objectives

Catheter-associated urinary tract infections (UTIs) have been identified as a preventable “never event” by the Centers for Medicare & Medicaid Services. We sought to determine the relationship between UTI and in-hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery.

Study Design

Cross-sectional analysis using cross-tabulations and multivariate regression modeling.

Setting

The Nationwide Inpatient Sample database.

Subjects and Methods

Discharge data for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003-2008 were analyzed.

Results

Urinary tract infection was diagnosed in 2% of patients, with catheter-associated UTI coded in only 20 patients. Patients with UTI were more likely to be older than 80 years (odds ratio [OR], 3.3; P = .008), be female (OR, 1.9; P < .001), have advanced comorbidity (OR, 1.8; P < .012), undergo major surgical procedures (OR, 1.7; P = .001), and have predisposing bladder and prostate conditions (OR, 3.8; P < .001), surgical complications (OR, 2.3; P < .001), and acute medical complications (OR, 3.1; P < .001). Urinary tract infection was associated with significantly increased length of hospitalization and hospital-related costs, after controlling for all other variables.

Conclusion

Urinary tract infection is unusual in HNCA surgical patients but is more common with extent of surgery and age and is significantly associated with postoperative complications, length of hospitalization, and hospital-related costs. Catheter-associated UTI is likely underestimated because of difficulty in distinguishing between a catheter-associated UTI and postoperative UTI in patients undergoing major surgical procedures, who routinely undergo perioperative urinary catheterization. Patients with HNCA are a high-risk group for this “never event,” particularly as the population ages.