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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.
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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.
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2
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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.
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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
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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.
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Affiliation(s)
| | | | | | | | | | | | | | - Colette Jappy
- 2425 Geary Street, Room 6333, San Francisco, CA 94115, USA.
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Saint S, Greene MT, Krein SL, Fowler KE, Linder KA, Ratz D, Meddings J. What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: Results from a national survey in the United States. Infect Control Hosp Epidemiol 2023; 44:1913-1919. [PMID: 37259703 PMCID: PMC10755151 DOI: 10.1017/ice.2023.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The ways that device-associated infection prevention practices changed during the coronavirus disease 2019 (COVID-19) pandemic remain unknown. We collected data mid-pandemic to assess the use of several infection prevention practices and for comparison with historical data. DESIGN Repeated cross-sectional survey. SETTING US acute-care hospitals. PARTICIPANTS Infection preventionists. METHODS We surveyed infection preventionists from a national random sample of 881 US acute-care hospitals in 2021 to estimate the current use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated events (VAE). We compared the 2021 results with those from surveys occurring every 4 years since 2005. RESULTS The 2021 survey response rate was 47%; previous survey response rates ranged from 59% to 72%. Regular use of most practices to prevent CLABSI (chlorhexidine gluconate for site antisepsis, 99.0%, and maximum sterile barrier precautions, 98.7%) and VAE (semirecumbent positioning, 93.4%, and sedation vacation, 85.8%) continued to increase or plateaued in 2021. Conversely, use of several CAUTI prevention practices (portable bladder ultrasound scanner, 65.6%; catheter reminders or nurse-initiated discontinuation, 66.3%; and intermittent catheterization, 37.3%) was lower in 2021, with a significant decrease for some practices compared to 2017 (P ≤ .02 for all comparisons). In 2021, 42.1% of hospitals reported regular use of the newer external urinary collection devices for women. CONCLUSIONS Although regular use of CLABSI and VAE preventive practices continued to increase (or plateaued), use of several CAUTI preventive practices decreased during the COVID-19 pandemic. Structural issues relating to care during the pandemic may have contributed to a decrease in device-associated infection prevention practices.
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Affiliation(s)
- Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - M. Todd Greene
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Sarah L. Krein
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Karen E. Fowler
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Kathleen A. Linder
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
- Infectious Disease Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Jennifer Meddings
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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Won P, Craig J, Nevarez C, Gillenwater TJ, Yenikomshian HA. Use of Female External Urinary Catheters in a Burn Intensive Care Unit: Benefits and Challenges. Crit Care Nurse 2023; 43:38-43. [PMID: 37257876 DOI: 10.4037/ccn2023317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Burn patients have a relatively high rate of indwelling Foley catheter use because of their need for complex fluid management and wound care. However, Foley catheter use is associated with risks, including urinary tract infection. For female patients, an external urinary catheter is an alternative. OBJECTIVES To evaluate the use of female external urinary catheters in a burn intensive care unit and to develop a standard protocol. METHODS This study involved female patients admitted to a burn intensive care unit from 2017 to 2020. An initiative to increase the use of female external urinary catheters was begun in 2019. A retrospective review of medical records was used to determine rates of indwelling and external catheter use and of catheter-associated urinary tract infection before and after implementation of the initiative. RESULTS Of 77 female burn patients admitted to the unit between 2019 and 2020, 56 (73%) required indwelling Foley catheterization, a significant decrease from 94% before the initiative (P = .002). The mean duration of indwelling Foley catheter use decreased significantly from 19.4 days to 10.47 days (P = .049). Female external urinary catheters were used in 21 patients (27%). No patients with female external urinary catheters contracted urinary tract infections, compared with 9 patients with indwelling Foley catheters. CONCLUSION The use of female external urinary catheters may help reduce the risk of urinary tract infection in female burn patients. Further research is needed to refine the protocol for use of these devices and determine their safety profile.
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Affiliation(s)
- Paul Won
- Paul Won is a fourth-year medical student, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Jasmine Craig
- Jasmine Craig is a plastic and reconstructive surgery intern, University of Wisconsin School of Medicine and Public Health, Division of Plastic and Reconstructive Surgery, Madison
| | - Claudia Nevarez
- Claudia Nevarez is a senior burn nurse, Los Angeles County University of Southern California Medical Center, Los Angeles
| | - T Justin Gillenwater
- T. Justin Gillenwater is Director of the Southern California Regional Burn Center, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles
| | - Haig A Yenikomshian
- Haig A. Yenikomshian is Chief of Plastic Surgery in the Division of Plastic and Reconstructive Surgery, University of Southern California
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Beeson T, Pittman J, Davis CR. Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections. J Wound Ostomy Continence Nurs 2023; 50:137-141. [PMID: 36867037 PMCID: PMC9990593 DOI: 10.1097/won.0000000000000951] [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: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to examine the effectiveness of an external female urinary management system (external urinary device for female anatomy [EUDFA]) in critically ill women unable to self-toilet and to identify rates of indwelling catheter use, catheter-associated urinary tract infections (CAUTIs), urinary incontinence (UI), and incontinence-associated dermatitis (IAD) before and after the introduction of the EUDFA. DESIGN Prospective, observational, and quasi-experimental design. SUBJECTS AND SETTING The sample comprised 50 adult female patients in 4 critical/progressive care units using an EUDFA at a large academic hospital in the Midwestern United States. All adult patients in these units were included in the aggregate data. METHODS Prospective data collected from the adult female patients over 7 days included urine diverted from the device to a canister and total leakage. Aggregate unit rates of indwelling catheter use, CAUTIs, UI, and IAD were retrospectively examined during 2016, 2018, and 2019. Means and percentages were compared using t tests or chi-square tests. RESULTS The EUDFA successfully diverted 85.5% of patients' urine. Indwelling urinary catheter use was significantly lower in 2018 (40.6%) and 2019 (36.6%) compared with 2016 (43.9%) (P < .01). The rate of CAUTIs was lower in 2019 than in 2016, but not significantly (1.34 per 1000 catheter-days vs 0.50, P = .08). The percentage of incontinent patients with IAD was 69.2% in 2016 and 39.5% in 2018-2019 (P = .06). CONCLUSIONS The EUDFA was effective in diverting urine from critically ill female incontinent patients and indwelling catheter utilization.
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Affiliation(s)
- Terrie Beeson
- Correspondence: Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, 1030 West Michigan St, Indianapolis, IN, 46202 ()
| | - Joyce Pittman
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, Indianapolis
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Carmen R. Davis, MSN, RN, CCRN, CNS-BC, Indiana University Health Academic Health Center, Indianapolis
| | - Carmen R. Davis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, Indianapolis
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Carmen R. Davis, MSN, RN, CCRN, CNS-BC, Indiana University Health Academic Health Center, Indianapolis
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7
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201, US.
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8
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Cilluffo S, Terzoni S, Destrebecq A, Lusignani M. Efficacy, effectiveness, usability and acceptability of devices for female urinary incontinence: A scoping review. J Clin Nurs 2022. [DOI: 10.1111/jocn.16457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Silvia Cilluffo
- ASST Grande Ospedale Metropolitano Niguarda Milan Italy
- University of Rome Tor Vergata Rome Italy
| | | | - Anne Destrebecq
- Department of Biomedical Sciences for Health University of Milan Milan Italy
| | - Maura Lusignani
- ASST Grande Ospedale Metropolitano Niguarda Milan Italy
- Department of Biomedical Sciences for Health University of Milan Milan Italy
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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.
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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
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10
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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.
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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: 0] [Impact Index Per Article: 0] [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.
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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
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Qindeel M, Barani M, Rahdar A, Arshad R, Cucchiarini M. Nanomaterials for the Diagnosis and Treatment of Urinary Tract Infections. NANOMATERIALS (BASEL, SWITZERLAND) 2021; 11:546. [PMID: 33671511 PMCID: PMC7926703 DOI: 10.3390/nano11020546] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
The diagnosis and treatment of urinary tract infections (UTIs) remain challenging due to the lack of convenient assessment techniques and to the resistance to conventional antimicrobial therapy, showing the need for novel approaches to address such problems. In this regard, nanotechnology has a strong potential for both the diagnosis and therapy of UTIs via controlled delivery of antimicrobials upon stable, effective and sustained drug release. On one side, nanoscience allowed the production of various nanomaterial-based evaluation tools as precise, effective, and rapid procedures for the identification of UTIs. On the other side, nanotechnology brought tremendous breakthroughs for the treatment of UTIs based on the use of metallic nanoparticles (NPs) for instance, owing to the antimicrobial properties of metals, or of surface-tailored nanocarriers, allowing to overcome multidrug-resistance and prevent biofilm formation via targeted drug delivery to desired sites of action and preventing the development of cytotoxic processes in healthy cells. The goal of the current study is therefore to present the newest developments for the diagnosis and treatment of UTIs based on nanotechnology procedures in relation to the currently available techniques.
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Affiliation(s)
- Maimoona Qindeel
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.Q.); (R.A.)
| | - Mahmood Barani
- Department of Chemistry, Shahid Bahonar University of Kerman, Kerman 76169-14111, Iran;
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 538-98615, Iran
| | - Rabia Arshad
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.Q.); (R.A.)
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg. 37, D-66421 Homburg, Germany
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Root N, Horigan AE, Lough ME. External Female Urinary Catheter: Implementation in the Emergency Department. J Emerg Nurs 2020; 47:131-138. [PMID: 33187721 DOI: 10.1016/j.jen.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency department in catheter-associated urinary tract infection prevention has been overlooked. The use of an external female urinary catheter is an alternative to placing an indwelling urinary catheter for female patients in the emergency department who are incontinent of urine or are immobile. The purpose was to describe the implementation of an initiative to decrease the number of indwelling urinary catheters and increase the use of external urinary female catheters in non-critically ill women who visited the emergency department at a 451-bed Magnet-designated community hospital in the Southeast. For this clinical implementation project, the Plan, Do, Check, Act framework was used to develop the initiative, and outcome data were collected retrospectively and included an indirect calculation of the number of indwelling urinary catheters placed in the emergency department. A total of 187 external catheters were used in place of indwelling catheters in female patients over a 3-month period. No skin irritation or breakdown was observed. This project demonstrated the initial staff acceptability and feasibility of external female urinary catheter use in the ED setting.
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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.
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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]
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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.
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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
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