1
|
Cassone M, Ameling J, Mody L, Patel S, Muyanja NS, Meddings J. Impact of external female urinary catheter use on urine chemistry test results. Am J Infect Control 2024; 52:919-924. [PMID: 38552717 DOI: 10.1016/j.ajic.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND We aimed to evaluate how urine chemistry tests are impacted by collection using a female external urinary catheter employing wicking and suction, to assess this catheter's potential as an alternative to transurethral catheters for collecting urine samples from incontinent patients. METHODS We obtained 50 random 40 mL refrigerated urine specimens from excess volume submitted to the Michigan Medicine Biochemical Laboratory. Specimens were split into a 10 mL "control" sample simulating voided urine, and a 30 mL paired "wicked" sample applied dropwise to and collected from a fresh PureWick system simulating collection from an incontinent patient. Each sample pair was tested for glucose, sodium, potassium, creatinine, urea, total protein, and derived ratios of sodium/creatinine, urea/creatinine, and protein/creatinine, then compared using Pearson correlation coefficients. Wicking materials were imaged via absorption contrast tomography on a laboratory X-ray microscope, to study the structure through which urine passes. RESULTS Control and wicked urine samples had very similar results for all chemical tests evaluated: strong Pearson correlation coefficients ranging from 0.955 (potassium) to 0.997 (glucose). Microscopic assessment of the amorphous wicking materials demonstrated an average pore spacing of 95.38 µm. CONCLUSIONS Common urine chemistry tests were unaltered by collection using the PureWick female external catheter system. This external device can be used to collect urine for chemistry tests as an alternative to transurethral catheters.
Collapse
Affiliation(s)
- Marco Cassone
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Lona Mody
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI; Medicine Service, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Geriatric Research Education and Clinical Center, Ann Arbor, MI
| | - Sanjeevkumar Patel
- Medicine Service, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Nancy S Muyanja
- Michigan Center for Materials Characterization, University of Michigan College of Engineering, Ann Arbor, MI
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI; Medicine Service, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare Center, Ann Arbor, MI.
| |
Collapse
|
2
|
Lopez C, Trautner BW, Kulkarni PA. Managing External Urinary Catheters. Infect Dis Clin North Am 2024; 38:343-360. [PMID: 38599895 DOI: 10.1016/j.idc.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This narrative review explores the use of external urinary catheters. These devices are available in various types and materials for male and female patients. The indications for the use of external urinary catheters include managing incontinence linked to overactive bladder and neurogenic lower urinary tract dysfunction. Contraindications to the use of external urinary catheters include urinary obstruction. Proper skin care and proactive infection control measures are necessary to prevent complications. The collection of a urine specimen for culture requires a standardized technique to prevent contamination. Clinician-led patient education on catheter management plays a important role in ensuring patient comfort and safety.
Collapse
Affiliation(s)
- Corina Lopez
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Prathit A Kulkarni
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Mailstop: MCL-111, Houston, TX 77030, USA; Department of Medicine, Infectious Diseases Section, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
3
|
Pryor N, Wang J, Young J, Townsend W, Ameling J, Henderson J, Meddings J. Clinical outcomes of female external urine wicking devices as alternatives to indwelling catheters: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2024:1-9. [PMID: 38706216 DOI: 10.1017/ice.2024.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Female patients using indwelling urinary catheters (IUCs) are disproportionately at risk for developing catheter-associated urinary tract infections (CAUTIs) compared to males. Female external urine wicking devices (FEUWDs) have emerged as potential alternatives to IUCs for incontinence management. OBJECTIVES To assess the clinical risks and benefits of FEUWDs as alternatives to IUCs. METHODS Ovid MEDLINE, Embase, Scopus, Web of Science Core Collection, CINAHL Complete, and ClinicalTrials.gov were searched from inception to July 10, 2023. Included studies used FEUWDs as an intervention and reported measures of urinary tract infections and secondary outcomes related to incontinence management. RESULTS Of 2,580 returned records, 50 were systematically reviewed. Meta-analyses assessed rates of indwelling CAUTIs and IUC utilization. Following FEUWD implementation, IUC utilization rates decreased 14% (RR = 0.86, 95% CI = [0.76, 0.97]) and indwelling CAUTI rates nonsignificantly decreased up to 32% (IRR = 0.68, 95% CI = [0.39, 1.17]). Limited only to studies that described protocols for implementation, the incidence rate of indwelling CAUTIs decreased significantly up to 54% (IRR = 0.46, 95% CI = [0.32, 0.66]). Secondary outcomes were reported less routinely. CONCLUSIONS Overall, FEUWDs nonsignificantly reduced indwelling CAUTI rates, though reductions were significant among studies describing FEUWD implementation protocols. We recommend developing standard definitions for consistent reporting of non-indwelling CAUTI complications such as FEUWD-associated UTIs, skin injuries, and mobility-related complications.
Collapse
Affiliation(s)
- Nicholas Pryor
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - JiCi Wang
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jordan Young
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Townsend
- University of Michigan Taubman Health Sciences Library, Ann Arbor, MI, USA
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - James Henderson
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Duque-Sanchez L, Qu Y, Voelcker NH, Thissen H. Tackling catheter-associated urinary tract infections with next-generation antimicrobial technologies. J Biomed Mater Res A 2024; 112:312-335. [PMID: 37881094 DOI: 10.1002/jbm.a.37630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
Urinary catheters and other medical devices associated with the urinary tract such as stents are major contributors to nosocomial urinary tract infections (UTIs) as they provide an access path for pathogens to enter the bladder. Considering that catheter-associated urinary tract infections (CAUTIs) account for approximately 75% of UTIs and that UTIs represent the most common type of healthcare-associated infections, novel anti-infective device technologies are urgently required. The rapid rise of antimicrobial resistance in the context of CAUTIs further highlights the importance of such preventative strategies. In this review, the risk factors for pathogen colonization in the urinary tract are dissected, taking into account the nature and mechanistics of this unique environment. Moreover, the most promising next-generation preventative strategies are critically assessed, focusing in particular on anti-infective surface coatings. Finally, emerging approaches in this field and their likely clinical impact are examined.
Collapse
Affiliation(s)
- Lina Duque-Sanchez
- Department of Manufacturing, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Yue Qu
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nicolas H Voelcker
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Melbourne Centre for Nanofabrication, Victorian Node of the Australian National Fabrication Facility, Materials Science and Engineering, Monash University, Clayton, Victoria, Australia
| | - Helmut Thissen
- Department of Manufacturing, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, Australia
| |
Collapse
|
5
|
Fogli A, Buhagiar TM, Salas MK, Pombo K, Perryman C, Sanga S, Tuatagaloa A, Jappy C. External urinary catheter devices: A multisite project involving point prevalence. Geriatr Nurs 2024; 56:14-17. [PMID: 38181485 DOI: 10.1016/j.gerinurse.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
External urinary catheter devices used in hospitals can offer an alternative to indwelling urinary catheters. Prevalence and patient outcomes are not well understood. This multisite project involved point prevalence of device use in patients with labia on acute care units. All patients on included units with corresponding anatomy were observed for presence of device in addition to review of indication of use and chart audit. Device use was 28.8 %. Immobility was the leading indication, and most patients had severe dysfunction as to mobility. For most patients, level of mobility remained the same from admission to discharge. Many patients were either potentially physically able to mobilize out of bed to urinate or were likely continent. There was variation in suction setting and chart documentation. The project lacked a comparison group and collected limited patient information. Areas for future inquiry include prevalence and impact on mobility, continence, and skin integrity.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Colette Jappy
- 2425 Geary Street, Room 6333, San Francisco, CA 94115, USA.
| |
Collapse
|
6
|
Steakin L. Male External Catheter Care and Maintenance. Rehabil Nurs 2023; 48:186-189. [PMID: 37934516 DOI: 10.1097/rnj.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
|
7
|
Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms 2023; 11:1614. [PMID: 37375116 DOI: 10.3390/microorganisms11061614] [Citation(s) in RCA: 83] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Biofilm is complex and consists of bacterial colonies that reside in an exopolysaccharide matrix that attaches to foreign surfaces in a living organism. Biofilm frequently leads to nosocomial, chronic infections in clinical settings. Since the bacteria in the biofilm have developed antibiotic resistance, using antibiotics alone to treat infections brought on by biofilm is ineffective. This review provides a succinct summary of the theories behind the composition of, formation of, and drug-resistant infections attributed to biofilm and cutting-edge curative approaches to counteract and treat biofilm. The high frequency of medical device-induced infections due to biofilm warrants the application of innovative technologies to manage the complexities presented by biofilm.
Collapse
Affiliation(s)
- Satish Sharma
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
| | - James Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Supriya D Mahajan
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Stanley A Schwartz
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Medicine, VA Western New York Healthcare System, Buffalo, NY 14215, USA
| | - Liana Bruggemann
- Department of Biomedical Informatics, University at Buffalo, Buffalo, NY 14260, USA
| | - Ravikumar Aalinkeel
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Medicine, VA Western New York Healthcare System, Buffalo, NY 14215, USA
| |
Collapse
|
8
|
Claassen DO. Multiple System Atrophy. Continuum (Minneap Minn) 2022; 28:1350-1363. [DOI: 10.1212/con.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Jasperse N, Hernandez-Dominguez O, Deyell JS, Prasad JP, Yuan C, Tomy M, Kuza CM, Grigorian A, Nahmias J. A single institution pre-/post-comparison after introduction of an external urinary collection device for female medical patients. J Infect Prev 2022; 23:149-154. [PMID: 37256156 PMCID: PMC10226054 DOI: 10.1177/17571774211060423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/31/2021] [Indexed: 09/20/2023] Open
Abstract
Background External urinary collection devices (EUCDs) may serve as an alternative to indwelling urinary catheters (IUCs) and decrease the rate of catheter associated urinary tract infections (CAUTIs). PureWick® is a novel female EUCD; however, no study has definitively proven benefit regarding reduction of CAUTIs. Aim We sought to compare the CAUTI rate and IUC days before and after availability of the PureWick® EUCD at a single institution. We provide a descriptive analysis of female medical patients receiving an EUCD. Methods A retrospective review of adult female patients admitted to a single institution on a medical service who received an IUC and/or an EUCD was performed. Patients who received an IUC in the 3 months before EUCD availability (PRE) were compared to patients who received an IUC and/or EUCD in the 12 months after (POST). Results Out of 848 female patients, 292 received an EUCD in the POST cohort and overall, 656 received an IUC (259 (100%) PRE vs. 397 (67.4%) POST). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs 2 days, p = 0.001) and a higher rate of CAUTI (infections per 1000 catheter days, 9.3 vs 2.3, p = 0.001). The rate of UTI associated with EUCD use was 9.8 infections per 1000 device days. Discussion While EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre-/post-analysis found that both the number of IUC days and the CAUTI rate increased after introduction of a female EUCD.
Collapse
Affiliation(s)
- Nathan Jasperse
- Department of Emergency Medicine, Los Angeles County Harbor-UCLA Medical
Center, Torrance, CA, USA
| | | | - Jacob S Deyell
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Janani P Prasad
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Charlene Yuan
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Meril Tomy
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Catherine M Kuza
- Department of Anesthesia, University of Southern California, Los Angeles, CA, USA
| | - Areg Grigorian
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| |
Collapse
|
10
|
Effect of external urinary collection device implementation on female surgical patients. Infect Dis Health 2022; 27:227-234. [PMID: 35753991 DOI: 10.1016/j.idh.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention reports that catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infection. Female external urinary collection devices (EUCDs) may be an alternative to indwelling urethral catheters (IUCs), thereby decreasing CAUTIs. However, no study has demonstrated that EUCDs can help reduce CAUTIs in female surgical patients. We sought to compare CAUTI rate and the median number of days an IUC was used before and after availability of this female EUCD for surgical patients. METHODS A retrospective analysis of adult female surgical patients admitted to a single academic institution who received an IUC and/or EUCD was performed. Patients who received an IUC three months before (PRE) EUCD availability (08/2017-10/2017) were compared to patients receiving an IUC and/or EUCD 12 months after (POST) (11/2017-11/2018). RESULTS From 906 surgical patients receiving an IUC/EUCD, 127 received an EUCD in the POST cohort. Compared to the PRE, the POST had a higher rate of CAUTIs (infections per 1000 catheter days, 11.2 vs. 4.6, p = 0.017) and overall UTI rate (infections per 1000 catheter days, 5.4 vs. 4.8, p = 0.036), whereas IUC days were similar between cohorts (median, two vs. two days, p = 0.18). The POST cohort rate of EUCD UTI was 4.6 infections per 1000 device days. CONCLUSION While EUCDs appear to be a promising alternative to IUCs for female surgical patients, this study found increased CAUTIs after introduction of an EUCD. Further research is needed to clarify if female EUCDs are effective in decreasing CAUTI prior to widespread adoption.
Collapse
|
11
|
Rao VU, Bhasin A, Vargas J, Arun Kumar V. A multidisciplinary approach to heart failure care in the hospital: improving the patient journey. Hosp Pract (1995) 2022; 50:170-182. [PMID: 35658810 DOI: 10.1080/21548331.2022.2082776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite advancements in care for patients with heart failure (HF), morbidity and mortality remain high. Hospitalizations and readmissions for HF have been the focus of significant attention among health care providers and payers, with an eye towards reducing health care costs. However, considerable variability exists with regard to inpatient workflows and management for patients with HF, which represents a significant opportunity to improve care. Here we provide a summary of optimal inpatient management strategies for HF, focusing on the multidisciplinary team of emergency medicine providers, admitting hospitalists, cardiovascular consultants, pharmacists, nurses, and social workers. The patient journey serves as the template for this review article, from the initial presentation in the emergency department, to decongestion and stabilization, optimization of guideline-directed medical therapy, and discharge and appropriate disposition. Lastly, this review aims not to be proscriptive but rather to provide best practices that are clinically relevant and actionable, with the goal of improving care for patients during the sentinel hospitalization for HF.
Collapse
Affiliation(s)
- Vijay U Rao
- Indiana Heart Physicians,Franciscan Health, Indianapolis, IN, USA
| | - Atul Bhasin
- Department of Internal Medicine, CentraState Medical Center, Freehold, and Hackensack Meridian Health Hospice, Wall, NJ, USA
| | - Jesus Vargas
- University of Pennsylvania Medical Center Harrisburg Hospital, Harrisburg, PA, USA
| | - Vijaya Arun Kumar
- Department of Emergency Medicine, Wayne State University, School of Medicine, Detroit, MI, USA
| |
Collapse
|
12
|
Evaluating the incidence of bacteriuria in female patients before and after implementation of external urinary collection devices. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e44. [PMID: 36310796 PMCID: PMC9614887 DOI: 10.1017/ash.2022.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
External urinary collection devices (ECDs) are increasingly used in female patients, however, their impact on bacteriuria and antimicrobial use is unclear. Comparing the periods before and after the implementation of an ECD use policy, we found an overall decrease in bacteriuria but no significant decrease in trend of monthly rates. Antimicrobial use for genitourinary indications did not change.
Collapse
|
13
|
Agwu N, Umar A, Oyibo U. Review article: Urethral catheters and catheterization techniques. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|
14
|
Van Decker SG, Bosch N, Murphy J. Catheter-associated urinary tract infection reduction in critical care units: a bundled care model. BMJ Open Qual 2021; 10:bmjoq-2021-001534. [PMID: 34949580 PMCID: PMC8705224 DOI: 10.1136/bmjoq-2021-001534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/26/2021] [Indexed: 11/08/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical Center (BMC) began an initiative to decrease CAUTI rates within its intensive care units (ICUs). A CAUTI taskforce convened and reviewed process maps and gap analyses. Based on Centers for Disease Control and Prevention (CDC) and Institute for Healthcare Improvement (IHI) guidelines, and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, all BMC ICUs sequentially implemented plan–do–study–act cycles based on which measures were most easily adaptable and believed to have the highest impact on CAUTI rates. Implementation of five care bundles spanned 5 years and included (1) processes for insertion and maintenance of foley catheters; (2) indications for indwelling foley catheters; (3) appropriate testing for CAUTIs; (4) alternatives to indwelling devices; and (5) sterilisation techniques. Daily rounds by unit nursing supervisors and inclusion of foley catheter necessity on daily ICU checklists held staff accountable on a daily basis. With these interventions, the total number of CAUTIs at BMC decreased from 53 in 2013 to 9 in 2017 (83% reduction) with a 33.8% reduction in indwelling foley catheter utilisation during the same time period. Adapted protocols showed success in decreasing the CAUTI rate and indwelling foley catheter usage in all of the BMC ICU’s. While all interventions had favourable and additive trends towards decreasing the CAUTI rate, the CAUTI awareness education, insertion and removal protocols and implementation of PureWick female incontinence devices had clear and significant effects on decreasing CAUTI rates. Our project provides a framework for improving HAIs using rapid cycle testing and U-chart data monitoring. Targeted education efforts and standardised checklists and protocols adapted sequentially are low-cost and high yield efforts that may decrease CAUTIs in ICU settings.
Collapse
Affiliation(s)
| | - Nicholas Bosch
- Department of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Jaime Murphy
- Department of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Habib MH, Arnold RM. Urinary Incontinence in Palliative Care Settings: Part 2: Management #426. J Palliat Med 2021; 24:1734-1735. [PMID: 34726520 DOI: 10.1089/jpm.2021.0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
16
|
Bagley K, Severud L. Preventing Catheter-Associated Urinary Tract Infections with Incontinence Management Alternatives: PureWick and Condom Catheter. Nurs Clin North Am 2021; 56:413-425. [PMID: 34366161 DOI: 10.1016/j.cnur.2021.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Catheter-associated urinary tract infections (CAUTI) have a high financial and human impact on patients and society at large, making CAUTI prevention strategies essential. A shift has occurred where nurses play an increased role in infection prevention. Nurses promote staff and patient education on CAUTI prevention, identification of appropriate urinary incontinence management, and implementation of bundles and patient care strategies to minimize complications from urinary incontinence management. Because they understand the severity of CAUTI and current recommendations, nurses at the bedside are in the best position to identify appropriate indications of indwelling urinary catheters and external urine collection devices for patients.
Collapse
Affiliation(s)
- Kimberly Bagley
- Critical Care Medicine, Duke Health, Duke Raleigh Hospital, ATTN: DRAH ICU, 3400 Wake Forest Road, Raleigh, NC 27609, USA; Duke University School of Nursing, Durham, NC, USA.
| | - Lindsey Severud
- Intensive Care Unit, Duke Raleigh Hospital, ATTN: DRAH ICU, 3400 Wake Forest Road, Raleigh, NC 27609, USA
| |
Collapse
|
17
|
Millard JW, Howell CK, Palasik BN. Asymptomatic But Altered? When Urinalysis Holds the Key. Sr Care Pharm 2021; 36:381-386. [PMID: 34311816 DOI: 10.4140/tcp.n.2021.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Altered mental status (AMS) is a common symptom in geriatric patients, especially in the long-term care setting. Traditionally, AMS has been associated with urinary tract infections (UTIs) in older people. However, data correlating UTIs with AMS are lacking. For this reason, asymptomatic bacteriuria (ASB) guidelines do not recommend using non-specific symptoms, such as AMS, to indicate a potential diagnosis of UTI. It is important to distinguish between colonization and infection, which can be done through proper interpretation of a urine analysis in the presence of UTI-specific symptomatology. In the absence of UTIspecific symptoms, alternative diagnoses for AMS should be explored. Consultant pharmacists are a key stakeholder and partner in ensuring appropriate antimicrobial prescribing practices, including identification of ASB in older patients.
Collapse
|
18
|
Effect of an external urinary collection device for women on institutional catheter utilization and catheter-associated urinary tract infections. Infect Control Hosp Epidemiol 2020; 42:619-621. [PMID: 33138871 DOI: 10.1017/ice.2020.1259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
External urinary collection devices (EUCDs) may reduce indwelling catheter usage and catheter-associated urinary tract infections (CAUTIs). In this retrospective quasi-experimental study, we demonstrated that EUCD implementation in women was associated with significantly decreased indwelling catheter usage and a trend (P = .10) toward decreased CAUTI per 1,000 patient days.
Collapse
|
19
|
Interventions Post Catheter Removal (iPCaRe) in the Acute Care Setting. J Wound Ostomy Continence Nurs 2020; 47:601-618. [DOI: 10.1097/won.0000000000000704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Zavodnick J, Harley C, Zabriskie K, Brahmbhatt Y. Effect of a Female External Urinary Catheter on Incidence of Catheter-Associated Urinary Tract Infection. Cureus 2020; 12:e11113. [PMID: 33240709 PMCID: PMC7682542 DOI: 10.7759/cureus.11113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jillian Zavodnick
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Caitlin Harley
- Department of Nursing, Thomas Jefferson University, Philadelphia, USA
| | - Kelly Zabriskie
- Department of Infection Control, Thomas Jefferson University, Philadelphia, USA
| | - Yasmin Brahmbhatt
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, USA
| |
Collapse
|
21
|
Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Meddings J. Transforming use of two catheters: from accessory to hazard. THE LANCET. INFECTIOUS DISEASES 2020; 20:764-766. [PMID: 32151331 DOI: 10.1016/s1473-3099(20)30155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jennifer Meddings
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48108, USA.
| |
Collapse
|
23
|
The case for a population standardized infection ratio (SIR): A metric that marries the device SIR to the standardized utilization ratio (SUR). Infect Control Hosp Epidemiol 2019; 40:979-982. [DOI: 10.1017/ice.2019.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractBackground:The device standardized infection ratio (SIR) is used to compare unit and hospital performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities.Methods:We calculated the device SIR (calculated based on actual device days) and population SIR (defined as Σ observed events divided by Σ predicted events based on predicted device days), adjusting for the facility SUR for both central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 84 hospitals from a single system for calendar years 2016 and 2017.Results:The central-line SUR was 1.02 for 801,172 central-line days, with a device SIR of 0.76 and a population SIR of 0.78, a 1.6% relative increase. On the other hand, the urinary catheter SUR was 0.90 for 757,504 urinary catheter days, with a device SIR of 0.84 and a population SIR of 0.76, a 10.0% relative decrease. The cumulative attributable difference for CAUTI to a target SIR of 1 was −135.4 for the device SIR compared to −203.66 for the population SIR, a 50.8% increase in prevented events.Conclusion:Population SIR accounts for predicted device utilization; thus, it is an attractive metric with which to address overall risk of infection or harm to a patient population. It also reduces the risk of selection bias that may impact the device SIR with interventions to reduce device use.
Collapse
|
24
|
Scientific and Clinical Abstracts From WOCNext 2019. J Wound Ostomy Continence Nurs 2019. [DOI: 10.1097/won.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics? Infect Control Hosp Epidemiol 2019; 40:681-685. [PMID: 30915925 DOI: 10.1017/ice.2019.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.
Collapse
|
26
|
Abstract
BACKGROUND: Strategies to decrease use of female indwelling urinary catheters and catheter-associated urinary tract infections are challenging due to the limited availability of proper fitting external collection devices. Female urinary incontinence predisposes the skin to potential pain, itching, burning, infection, or pressure injuries. CASE STUDIES: This article discusses 3 patients' trajectory of care with use of an external female urinary collection device. All of these females were incontinent of urine after the indwelling urinary catheter was removed and managed with an external female urinary collection device. CONCLUSIONS: The use of an external female urinary collection device is a feasible alternative to an indwelling urinary catheter as well as managing urinary incontinence.
Collapse
|
27
|
Amorone Leiva JL, María Agüero D, Caballero González C, Cecilia Postiglione M. [Total penile necrosis due to inappropriate care of condom catheter]. Rev Esp Geriatr Gerontol 2018; 54:57-58. [PMID: 29887285 DOI: 10.1016/j.regg.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 10/14/2022]
Affiliation(s)
- José Luis Amorone Leiva
- Sección de Urogeriatría, Servicio de Urología, Hospital Mariano y Luciano de la Vega, Moreno, Argentina.
| | - Dora María Agüero
- Sección de Nefrogeriatría, Servicio de Nefrología, Hospital Mariano y Luciano de la Vega, Moreno, Argentina
| | | | | |
Collapse
|
28
|
Parker V, Giles M, Graham L, Suthers B, Watts W, O'Brien T, Searles A. Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC Health Serv Res 2017; 17:314. [PMID: 28464815 PMCID: PMC5414128 DOI: 10.1186/s12913-017-2268-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/26/2017] [Indexed: 12/20/2022] Open
Abstract
Background Urinary tract infection (UTI) as the most common healthcare-associated infection accounts for up to 36% of all healthcare-associated infections. Catheter-associated urinary tract infection (CAUTI) accounts for up to 80% of these. In many instances indwelling urinary catheter (IDC) insertions may be unjustified or inappropriate, creating potentially avoidable and significant patient distress, embarrassment, discomfort, pain and activity restrictions, together with substantial care burden, costs and hospitalisation. Multifaceted interventions combining best practice guidelines with staff engagement, education and monitoring have been shown to be more effective in bringing about practice change than those that focus on a single intervention. This study builds on a nurse-led initiative that identified that significant benefits could be achieved through a systematic approach to implementation of evidence-based practice. Methods The primary aim of the study is to reduce IDC usage rates by reducing inappropriate urinary catheterisation and duration of catheterisation. The study will employ a multiple pre-post control intervention design using a phased mixed method approach. A multifaceted intervention will be implemented and evaluated in four acute care hospitals in NSW, Australia. The study design is novel and strengthened by a phased approach across sites which allows for a built-in control mechanism and also reduces secular effects. Feedback of point prevalence data will be utilised to engage staff and improve compliance. Ward-based champions will help to steward the change and maintain focus. Discussion This study will improve patient safety through implementation and robust evaluation of clinical practice and practice change. It is anticipated that it will contribute to a significant improvement in patient experiences and health care outcomes. The provision of baseline data will provide a platform from which to ensure ongoing improvement and normalisation of best practice. This study will add to the evidence base through enhancing understanding of interventions to reduce CAUTI and provides a prototype for other studies focussed on reduction of hospital acquired harms. Study findings will inform undergraduate and continuing education for health professionals. Trial registration ACTRN12617000090314. Registered 17 January 2017. Retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2268-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vicki Parker
- School of Nursing, University of New England, Armidale, NSW, Australia, 2351
| | - Michelle Giles
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, Australia, 2300.
| | - Laura Graham
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, Australia, 2300
| | - Belinda Suthers
- Respiratory and General Medicine, John Hunter Hospital, Locked Bag 1 HRMC, New Lambton Heights, NSW, Australia, 2310
| | - Wendy Watts
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, Australia, 2300
| | - Tony O'Brien
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia, 2308
| | - Andrew Searles
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia, 2305
| |
Collapse
|
29
|
Rippon M, Colegrave M, Ousey K. Incontinence-associated dermatitis: reducing adverse events. ACTA ACUST UNITED AC 2016; 25:1016-1021. [PMID: 27734729 DOI: 10.12968/bjon.2016.25.18.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Incontinence-associated dermatitis (IAD) is a common problem in patients with faecal and/or urinary incontinence. Urine alters the normal skin flora and increases permeability of the stratum corneum and faecal enzymes on the skin contribute to skin damage. Faecal bacteria can then penetrate the skin, increasing the risk of secondary infection. However, IAD can be prevented and healed with timely and appropriate skin cleansing and skin protection. This includes appropriate use of containment devices. This article also looks at HARTMANN incontinence pads that have been developed to absorb the fluids that cause IAD and maintain the skin's acidic pH. The acidic pH of the skin contributes to its barrier function and defence against infection. Therefore, maintaining an acidic pH will help protect the skin from damage.
Collapse
Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Fellow, School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| | | | - Karen Ousey
- Professor and Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| |
Collapse
|
30
|
External Collection Devices as an Alternative to the Indwelling Urinary Catheter. J Wound Ostomy Continence Nurs 2016. [DOI: 10.1097/won.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|