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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.
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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.
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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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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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Goodfellow M, Thompson ER, Tingle SJ, Wilson C. Early versus late removal of urinary catheter after kidney transplantation. Cochrane Database Syst Rev 2023; 7:CD013788. [PMID: 37449968 PMCID: PMC10347544 DOI: 10.1002/14651858.cd013788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The optimal treatment for end-stage kidney disease is kidney transplantation. During the operation, a catheter is introduced into the bladder and remains in place postoperatively to allow the bladder to drain. This decreases tension from the cysto-ureteric anastomosis and promotes healing. Unfortunately, urinary catheters can pose an infection risk to patients as they allow bacteria into the bladder, potentially resulting in a urinary tract infection (UTI). The longer the catheter remains in place, the greater the risk of developing a UTI. There is no consensus approach to the time a catheter should remain in place post-transplant. Furthermore, the different timings of catheter removal are thought to be associated with different incidences of UTI and postoperative complications, such as anastomotic breakdown. OBJECTIVES This review aimed to compare patients who had their catheter removed < 5 days post-transplant surgery to those patients who had their catheter removed ≥ 5 days following their kidney transplant. Primary outcome measures between the two groups included: the incidence of symptomatic UTIs, the incidence of asymptomatic bacteriuria and the incidence of major urological complications requiring intervention and treatment. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 13 April 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs comparing timing of catheter removal post-transplantation were eligible for inclusion. All donor types were included, and all recipients were included regardless of age, demographics or type of urinary catheter used. DATA COLLECTION AND ANALYSIS Results from the literature search were screened by two authors to identify if they met our inclusion criteria. We designated removal of a urinary catheter before five days (120 hours) as an 'early removal' and anything later than this as a 'late removal.' The studies were assessed for quality using the risk of bias tool. The primary outcome of interest was the incidence of asymptomatic bacteriuria. Statistical analyses were performed using the random effects model, and results were expressed as relative risk (RR) with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Two studies (197 patients) were included in our analysis. One study comprised a full-text article, and the other was a conference abstract with very limited information. The risk of bias in the included studies was generally either high or unclear. It is uncertain whether early versus late removal of the urinary catheter made any difference to the incidence of asymptomatic bacteriuria (RR 0.89, 95% Cl 0.17 to 4.57; participants = 197; I2 = 88%; very low certainty evidence). Data on other outcomes, such as the incidence of UTI and the incidence of major urological complications, were lacking. Furthermore, the follow-up of patients across the studies was short, with no patients being followed beyond one month. AUTHORS' CONCLUSIONS A high-quality, well-designed RCT is required to compare the effectiveness of early catheter removal versus late catheter removal in patients following a kidney transplant. At the present time, there is insufficient evidence to suggest any difference between early and late catheter removal post-transplant, and the studies investigating this were generally of poor quality.
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Affiliation(s)
- Michael Goodfellow
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Emily R Thompson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Samuel J Tingle
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Colin Wilson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
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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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Tesini BL, Dumyati G. Health Care-Associated Infections in Older Adults: Epidemiology and Prevention. Infect Dis Clin North Am 2023; 37:65-86. [PMID: 36805015 DOI: 10.1016/j.idc.2022.11.004] [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: 02/17/2023]
Abstract
Health care-associated infections (HAIs) are a global public health threat, which disproportionately impact older adults. Host factors including aging-related changes, comorbidities, and geriatric syndromes, such as dementia and frailty, predispose older individuals to infection. The HAI risks from medical interventions such as device use, antibiotic use, and lapses in infection control follow older adults as they transfer among a network of interrelated acute and long-term care facilities. Long-term care facilities are caring for patients with increasingly complex needs, and the home-like communal environment of long-term care facilities creates distinct infection prevention challenges.
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Affiliation(s)
- Brenda L Tesini
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Ghinwa Dumyati
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
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John G, Arcens M, Berra G, Garin N, Carballo D, Carballo S, Stirnemann J. Risks and benefits of urinary catheterisation during inpatient diuretic therapy for acute heart failure: a retrospective, non-inferiority, cohort study. BMJ Open 2022; 12:e053632. [PMID: 37129085 PMCID: PMC9362793 DOI: 10.1136/bmjopen-2021-053632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Patients with acute congestive heart failure (HF) regularly undergo urinary catheterisation (UC) at hospital admission. We hypothesised that UC has no clinical benefits with regard to weight loss during inpatient diuretic therapy for acute congestive HF and increases the risk of urinary tract infection (UTI). Design Retrospective, non-inferiority study. Setting Geneva University Hospitals’ Department of Medicine, a tertiary centre. Participants In a cohort of HF patients, those catheterised within 24 hours of diuretic therapy (n=113) were compared with non-catheterised patients (n=346). Primary and secondary outcome measures The primary endpoint was weight loss 48 hours after starting diuretic therapy. Secondary endpoints were time needed to reach target weight, discontinuation of intravenous diuretics and resolution of respiratory failure. Complications included the time to a first UTI, first hospital readmission and death. Results A total of 48-hour weight loss was not statistically different between groups and the adjusted difference was below the non-inferiority boundary of 1 kg (0.43 kg (95% CI: −0.03 to 0.88) in favour of UC, p<0.01 for non-inferiority). UC was not associated with time to reaching target weight (adjusted HR 1.0; 95% CI: 0.7 to 1.5), discontinuation of intravenous diuretics (aHR 0.9; 95% CI: 0.7 to 1.2) or resolution of respiratory failure (aHR 1.1; 95% CI: 0.5 to 2.4). UC increased the risk of UTI (aHR 2.5; 95% CI: 1.5 to 4.2) but was not associated with hospital readmission (aHR 1.1; 95% CI: 0.8 to 1.4) or 1-year mortality (aHR 1.4; 95% CI: 1.0 to 2.1). Conclusion In this retrospective study, with no obvious hourly diuresis-based diuretic adjustment strategy, weight loss without UC was not inferior to weight loss after UC within 24 hours of initiating diuretic treatment. UC had no impact on clinical improvement and increased the risk of UTI. This evidence, therefore, argues against the systematic use of UC during a diuretic therapy for HF.
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Affiliation(s)
- Gregor John
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Internal Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marc Arcens
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gregory Berra
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Nicolas Garin
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David Carballo
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sebastian Carballo
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jerome Stirnemann
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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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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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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10
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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.
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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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Abstract
Catheter-associated urinary tract infection (CAUTI) remains one of the most prevalent, but preventable, health care-associated infections and predominantly occurs in patients with indwelling urinary catheters. Duration of urinary catheterization is the most important modifiable risk factor for development of CAUTI. Alternatives to indwelling catheters should be considered in appropriate patients. If indwelling catheterization is necessary, proper aseptic practices for catheter insertion and maintenance and use of a closed catheter collection system are essential for preventing CAUTI. The use of intervention bundles and collaboratives helps in the effective implementation of CAUTI prevention measures.
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Affiliation(s)
- Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, F4141 South University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5226, USA.
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O'Connor E, Nic An Riogh A, Karavitakis M, Monagas S, Nambiar A. Diagnosis and Non-Surgical Management of Urinary Incontinence - A Literature Review with Recommendations for Practice. Int J Gen Med 2021; 14:4555-4565. [PMID: 34429640 PMCID: PMC8378928 DOI: 10.2147/ijgm.s289314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Urinary incontinence (UI) is a bothersome symptom with population studies suggesting a prevalence of 13.1% in women and 5.4% in men. While a significant cohort of patients with this complaint may ultimately require surgical management to achieve complete continence, a number of non-surgical measures exist to improve symptoms and quality of life. A range of guidelines exist on this topic, including those published by the European Association of Urology (EAU), the International Continence Society (ICS), the American Urological Association (AUA) and the UK's National Institute for Health and Care Excellence (NICE). The aim of our study is to provide an overview of the initial assessment of patients with UI including history taking, examination and basic investigations. Our review outlines non-surgical management strategies for UI, including conservative measures, behavioral and physical therapies and drug treatment. We shall also examine the above guidelines and present a narrative overview of the literature surrounding the diagnosis and non-surgical management of urinary incontinence.
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Affiliation(s)
- Eabhann O'Connor
- Department of Urology, Beaumont University Hospital, Dublin, Ireland
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Irakleio, Greece
| | - Serenella Monagas
- Department of Urology, San Agustín University Hospital, Avilés, Spain
| | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
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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.
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Subudhi M, T. Jagatheeswary PA, Sahu S, Das S, Subudhi KB, Rout R. Incidence and variation of microbiological profile of catheter-associated urinary tract infection in precise comorbidities associated with tribal sickle cell anemic patients of medical intensive care unit in a tribal tertiary care center. JOURNAL OF APPLIED HEMATOLOGY 2021. [DOI: 10.4103/joah.joah_184_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Goodfellow M, Thompson ER, Tingle SJ, Wilson CH. Early versus late removal of urinary catheter after kidney transplantation. Hippokratia 2020. [DOI: 10.1002/14651858.cd013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Goodfellow
- Institute of Transplantation; The Freeman Hospital; Newcastle upon Tyne UK
| | - Emily R Thompson
- Institute of Transplantation; The Freeman Hospital; Newcastle upon Tyne UK
| | - Samuel J Tingle
- Institute of Transplantation; The Freeman Hospital; Newcastle upon Tyne UK
| | - Colin H Wilson
- Institute of Transplantation; The Freeman Hospital; Newcastle upon Tyne UK
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Treatment of urinary tract infections in the old and fragile. World J Urol 2020; 38:2709-2720. [PMID: 32221713 DOI: 10.1007/s00345-020-03159-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/04/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population. METHODS Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed. RESULTS 64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI. CONCLUSION UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.
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What do patients say about their experience with urinary catheters and peripherally inserted central catheters? Am J Infect Control 2019; 47:1130-1134. [PMID: 31324486 DOI: 10.1016/j.ajic.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices. METHODS As part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral. RESULTS Positive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other. CONCLUSIONS Our findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs.
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Saint S, Krein SL, Fowler KE, Colozzi J, Ratz D, Lescinskas E, Chrouser K, Trautner BW. Condom Catheters versus Indwelling Urethral Catheters in Men: A Prospective, Observational Study. J Hosp Med 2019; 14:E1-E4. [PMID: 30897057 PMCID: PMC7839072 DOI: 10.12788/jhm.3180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To assess complications of condom catheters compared with indwelling urethral catheters, we conducted a prospective cohort study in two Veterans Affairs hospitals. Male patients who used a condom catheter or indwelling urethral catheter during their hospital stay were followed for one month by interview and medical record review. Participants included 36 men who used condom catheters and 44 who used indwelling urethral catheters. At least one catheter-related complication was reported by 80.6% of condom catheter users and 88.6% of indwelling catheter users (P = .32), and noninfectious complications (eg, leaking urine, pain, or discomfort) were more common than infectious complications in both groups. Condom catheter patients were significantly less likely than indwelling catheter patients to report complications during catheter placement (13.9% vs 43.2%; P < .001). Patients reported approximately three times more noninfectious complications than the number recorded in the medical record.
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Affiliation(s)
- Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - Sarah L. Krein
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - Karen E. Fowler
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - John Colozzi
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - David Ratz
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | | | - Kristin Chrouser
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Barbara W. Trautner
- Department of Medicine, Baylor College of Medicine
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
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Bo M, Porrino P, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bianchetti A, Musicco M, Ferrari A, Ferrara N, Filippini C, Trabucchi M, Morandi A, Bellelli G. The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015". Aging Clin Exp Res 2019; 31:411-420. [PMID: 29858986 DOI: 10.1007/s40520-018-0974-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
BACKROUND Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. AIM This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. METHODS Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). RESULTS Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. DISCUSSION We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. CONCLUSION Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence.
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Affiliation(s)
- Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza, Molinette, Corso Bramante, 88, 10126, Torino, Italy
| | - Paola Porrino
- Section of Geriatrics, Città della Salute e della Scienza, Molinette, Corso Bramante, 88, 10126, Torino, Italy.
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Fondation S Lucia, Via Ardeatina, 306-354, 00179, Roma, Italy
| | - Andrea Mazzone
- Redaelli Geriatric Institute, Via Bartolomeo d'Alviano, 78, 20146, Milano, Italy
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Via della Montagnola, 81, 60127, Ancona, Italy
| | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and AziendaOspedaliero-UniversitariaCareggi, Largo Brambilla, 3a, 50134, Firenze, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, IstitutoClinico S. Anna, Via del Franzone, 31, 25127, Brescia, Italy
| | - Massimo Musicco
- Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, Segrate, 20090, Milano, Italy
- Italian Society of Neurology for Dementia (SINDEM), via del Rastrello, 7, 53100, Siena, Italy
| | - Alberto Ferrari
- Italian Society of Hospital and Community Geriatrics (SIGOT), Roma, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Corso Umberto I 40, 80138, Napoli, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin, Corso Bramante, 88, 10126, Torino, Italy
| | - Marco Trabucchi
- Geriatric Research Group, via Fratelli Lombardi, 2, 25121, Brescia, Italy
- Italian Psychogeriatric Association (AIP), Via Fratelli Lombardi, 2, 25121, Brescia, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Via Aselli, 14, 26100, Cremona, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, Italy
- Geriatric Unit, San Gerardo University Hospital, Via G. B. Pergolesi, 33, 20900, Monza, Italy
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Lucas E. Medical Management of Neurogenic Bladder for Children and Adults: A Review. Top Spinal Cord Inj Rehabil 2019; 25:195-204. [PMID: 31548786 PMCID: PMC6743750 DOI: 10.1310/sci2503-195] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurogenic bladder is a chronic condition affecting patients of all ages with significant medical and quality of life implications. Goals of treatment consist of protection of the upper urinary tract and promotion of reliable urinary continence. Successful management involves medications and most often bladder drainage via clean intermittent catheterization. This article reviews current literature on medical management to achieve goals of treatment.
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Abstract
Catheter-associated urinary tract infection remains one of the most prevalent, yet preventable, health care-associated infections. General prevention strategies include strict adherence to hand hygiene and antimicrobial stewardship. Duration of urinary catheterization is the most important modifiable risk factor. Targeted prevention strategies include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives should be considered. If catheterization is necessary, proper aseptic practices for insertion and maintenance and closed catheter collection systems are essential for prevention. The use of bladder bundles and collaboratives aids in the effective implementation of prevention measures.
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Affiliation(s)
- Emily K Shuman
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4007 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA; Department of Infection Prevention and Epidemiology, Michigan Medicine, 300 North Ingalls Building 8B06, Ann Abror, MI 48109-5479, USA.
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4007 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA; Antimicrobial Stewardship Program, Michigan Medicine, F4141 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA
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Breaking the Chain of Infection in Older Adults: A Review of Risk Factors and Strategies for Preventing Device-Related Infections. Infect Dis Clin North Am 2018; 31:649-671. [PMID: 29079154 DOI: 10.1016/j.idc.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Abrantes-Figueiredo JI, Ross JW, Banach DB. Device Utilization Ratios in Infection Prevention: Process or Outcome Measure? Curr Infect Dis Rep 2018; 20:8. [DOI: 10.1007/s11908-018-0616-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. Actas Urol Esp 2018; 42:5-16. [PMID: 28413135 DOI: 10.1016/j.acuro.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.
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Borau A, Adot J, Allué M, Arlandis S, Castro D, Esteban M, Salinas J. A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.acuroe.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Catheter-associated urinary tract infection (CAUTI) remains one of the most prevalent, yet preventable, health care-associated infections and predominantly occurs in patients with indwelling urinary catheters. Targeted strategies for prevention of CAUTI include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives to indwelling catheters should be considered in appropriate patients. If indwelling catheterization is necessary, proper aseptic practices for catheter insertion and maintenance and closed catheter collection system is essential for preventing CAUTI. The use of "bladder bundles" and collaboratives aids in the effective implementation of CAUTI prevention measures.
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Affiliation(s)
- Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Sanjay Saint
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, 2800 Plymouth Road, Building 16, Room 430 West, Ann Arbor, MI 48109-2800, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Bremer J, Domurath B, Böthig R, Kaufmann A, Geng V. [Medical quality standards for selected urological aids and devices : Consensus for patients with neurogenic urinary bladder dysfunction]. Urologe A 2017; 57:155-163. [PMID: 28707096 DOI: 10.1007/s00120-017-0457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Using the CE mark of therapeutic appliances is, on its own, not sufficient enough for their appropriate and effective application. In order to treat the patient successfully, not jeopardizing the success of the treatment, medical quality criteria for therapeutic appliances care are necessary to acceptably compensate for a patient's disabilities. OBJECTIVES Medical quality criteria are formulated for the most frequently used urological aids and devices, considering hygienic requirements, international literature and the practical experience of physicians and nurses with regard to the care of patients with neurogenic urinary bladder dysfunction. METHODS An expert group of urologists, surgeons, rehabilitation physicians and nurses has developed medical quality criteria via a structured consensus procedure. Developing these criteria, the group has taken into account current jurisprudence, the current resource directory of neurourological relevant aids, data from international literature and hygiene requirements. RESULTS Medical quality requirements are discussed and defined for selected groups of urological devices (single use catheters, indwelling catheters, external catheters, urine bags, templates and diapers as well as devices for the electrostimulation of nerves). CONCLUSION The presented quality requirements offer the possibility to stabilize quality of care with neurourological relevant therapeutic appliances. The catalogue of therapeutic appliances must be urgently updated. Urinal catheters for single use must be classified as an individual product group. Devices for anterior root stimulation and neuromodulation must be included in the resource directory. The incontinence severity classification needs to be reviewed.
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Affiliation(s)
- J Bremer
- BDH-Klinik Greifswald, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Deutschland
| | - B Domurath
- Kliniken Beelitz GmbH, Paracelsus-Ring 6A, 14547, Beelitz, Deutschland.
| | - R Böthig
- BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland
| | - A Kaufmann
- Krankenhaus St. Franziskus, Viersener Str. 450, 41063, Mönchengladbach, Deutschland
| | - V Geng
- Manfred Sauer Stiftung, Neurott 20, 74931, Lobbach, Deutschland
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Nydahl P, Dewes M, Dubb R, Hermes C, Kaltwasser A, Krotsetis S, von Haken R. Survey among critical care nurses and physicians about delirium management. Nurs Crit Care 2017; 23:23-29. [DOI: 10.1111/nicc.12299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Peter Nydahl
- Department of Nursing Research; University Hospital of Schleswig-Holstein; Campus Kiel, Brunswiker Str. 10, Kiel Germany
| | - Michael Dewes
- Department of Critical Care; Centre Hospitalier Emile Mayrisch; Esch-sur-Alzette Luxembourg
| | - Rolf Dubb
- Nursing Education District Hospital of Reutlingen GmbH; Reutlingen Germany
| | | | - Arnold Kaltwasser
- Nursing Education; District Hospital of Reutlingen GmbH; Reutlingen Germany
| | - Susanne Krotsetis
- Department of Nursing Research; University Hospital of Schleswig-Holstein; Campus Lübeck Germany
| | - Rebecca von Haken
- Department of Anesthesia and Critical Care; University Hospital Heidelberg; Heidelberg Germany
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Girard R, Gaujard S, Pergay V, Pornon P, Martin-Gaujard G, Bourguignon L. Risk factors for urinary tract infections in geriatric hospitals. J Hosp Infect 2017; 97:74-78. [PMID: 28526270 DOI: 10.1016/j.jhin.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is the most frequent nosocomial infection in geriatric units. An understanding of risk factors for infection may help to identify prevention strategies. AIM Identification of the risk factors for UTI in elderly patients. METHODS Retrospective analysis of three prospective cohorts. All hospitalized patients present in, or admitted to, a geriatric unit from June 1st to June 28th, for the years 2009, 2012, and 2015 were included and followed until discharge or until June 30th of the year concerned. For each patient, type and dates of stay, type and dates of catheter, risk factors, and nosocomial UTI (NUTI) data were collected. Univariate and multivariate (Cox model) analyses were made using SPSS software. FINDINGS A total of 4669 patients were included and were followed for a total of 83,068 days. There were 189 NUTIs (4.0% patients). NUTIs were significantly more frequent among female patients, in rehabilitation units, in immunosuppressed patients, among those with acute retention, post-void residual, history of urinary tract infection in the previous six months, and in case of dependency. NUTIs were significantly more frequent among those who had a catheter (Z-test, P < 0.001). NUTIs were more frequent among patients with intermittent, indwelling, or suprapubic catheters. They were also more frequent in acute/subacute care or rehabilitation units, in women, in immunosuppressed patients, and in those with a history of previous UTI; they were less frequent in dementia patients. CONCLUSION The occurrence of NUTI is an important issue in both catheterized and non-catheterized patients; prevention programmes should be widened to include non-catheterized patients.
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Affiliation(s)
- R Girard
- Service Hygiène et Prévention, Institut du vieillissement, Hospices Civils de Lyon, Lyon, France.
| | - S Gaujard
- Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - V Pergay
- Service Hygiène et Prévention, Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - P Pornon
- Service Hygiène et Prévention, Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - G Martin-Gaujard
- Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - L Bourguignon
- Hôpital Pierre Garraud, UMR CNRS 5558, Laboratoire de biométrie et biologie évolutive, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
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Meddings J, Saint S, Krein SL, Gaies E, Reichert H, Hickner A, McNamara S, Mann JD, Mody L. Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents. J Hosp Med 2017; 12:356-368. [PMID: 28459908 PMCID: PMC5557395 DOI: 10.12788/jhm.2724] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid. PURPOSE Systematic literature review of strategies to reduce UTIs in nursing home residents. DATA SOURCES Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015. STUDY SELECTION Interventional studies with a comparison group reporting at least 1 outcome for: catheter-associated UTI (CAUTI), UTIs not identified as catheter-associated, bacteriuria, or urinary catheter use. DATA EXTRACTION Two authors abstracted study design, participant and intervention details, outcomes, and quality measures. DATA SYNTHESIS Of 5794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre-post nonrandomized interventions, and 1 nonrandomized intervention with concurrent controls. Quality (range, 8-25; median, 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; 9 studies employed general infection prevention strategies (eg, improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The 19 studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); 9 studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly). LIMITATIONS Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes. CONCLUSIONS Several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or CAUTI in nursing home residents. Journal of Hospital Medicine 2017;12:356-368.
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Affiliation(s)
- Jennifer Meddings
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- Department of Pediatrics and Communicable Diseases, Division of General
Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sanjay Saint
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sarah L. Krein
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | - Heidi Reichert
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
| | - Andrew Hickner
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- Cushing/Whitney Medical Library, Yale University, New Haven,
Connecticut
| | - Sara McNamara
- Department of Internal Medicine, Division of Geriatric and Palliative
Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason D. Mann
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
| | - Lona Mody
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Geriatric and Palliative
Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Zubkoff L, Neily J, King BJ, Dellefield ME, Krein S, Young-Xu Y, Boar S, Mills PD. Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2016; 42:485-AP2. [DOI: 10.1016/s1553-7250(16)42091-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
Asymptomatic bacteriuria is very common. In healthy women, asymptomatic bacteriuria increases with age, from <1% in newborns to 10% to 20% of women age 80 years, but is uncommon in men until after age 50 years. Individuals with underlying genitourinary abnormalities, including indwelling devices, may also have a high frequency of asymptomatic bacteriuria, irrespective of age or gender. The prevalence is very high in residents of long-term-care facilities, from 25% to 50% of women and 15% to 40% of men. Escherichia coli is the most frequent organism isolated, but a wide variety of other organisms may occur. Bacteriuria may be transient or persist for a prolonged period. Pregnant women with asymptomatic bacteriuria identified in early pregnancy and who are untreated have a risk of pyelonephritis later in pregnancy of 20% to 30%. Bacteremia is frequent in bacteriuric subjects following mucosal trauma with bleeding, with 5% to 10% of patients developing severe sepsis or septic shock. These two groups with clear evidence of negative outcomes should be screened for bacteriuria and appropriately treated. Asymptomatic bacteriuria in other populations is benign and screening and treatment are not indicated. Antimicrobial treatment has no benefits but is associated with negative outcomes including reinfection with antimicrobial resistant organisms and a short-term increased frequency of symptomatic infection post-treatment. The observation of increased symptomatic infection post-treatment, however, has led to active investigation of bacterial interference as a strategy to prevent symptomatic episodes in selected high risk patients.
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Gray M, Skinner C, Kaler W. External Collection Devices as an Alternative to the Indwelling Urinary Catheter: Evidence-Based Review and Expert Clinical Panel Deliberations. J Wound Ostomy Continence Nurs 2016; 43:301-7. [PMID: 26974963 PMCID: PMC4870965 DOI: 10.1097/won.0000000000000220] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Mikel Gray
- Correspondence: Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, PO Box 800422, Charlottesville, VA 22902 ()
| | - Claudia Skinner
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia School of Medicine, Charlottesville, Virginia
- Claudia Skinner, DNP, RN, CCRN, CNML, NE-BC, St. Joseph's Health, Irvine, California
- Wendy Kaler, MPH, Center of Excellence, Dignity Health, San Francisco, California
| | - Wendy Kaler
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia School of Medicine, Charlottesville, Virginia
- Claudia Skinner, DNP, RN, CCRN, CNML, NE-BC, St. Joseph's Health, Irvine, California
- Wendy Kaler, MPH, Center of Excellence, Dignity Health, San Francisco, California
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Inpatient Housestaff Discontinuity of Care and Patient Adverse Events. Am J Med 2016; 129:341-7.e21. [PMID: 26704696 DOI: 10.1016/j.amjmed.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/06/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022]
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Abstract
Both urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) are common problems among elderly adults and represent a significant health care burden. Despite their frequency, differentiating between ASB and true UTI remains controversial among health care providers. Several challenges exist in the evaluation of urinary symptoms in the elderly patient. Symptoms of UTI are variable; problems are encountered in the collection, testing, and interpretation of urine specimens; and results of urinalysis are often misinterpreted and mishandled. Multiple studies have shown no morbidity or mortality benefit to antibiotic therapy in either community or long-term care facility residents with ASB.
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Affiliation(s)
- Keri Detweiler
- Touro University College of Osteopathic Medicine - California, 1310 Club Drive, Vallejo, CA 94592, USA
| | - Daniel Mayers
- Touro University College of Osteopathic Medicine - California, 1310 Club Drive, Vallejo, CA 94592, USA
| | - Sophie G Fletcher
- Kaiser Permanente Northern California, 401 Bicentennial Way, Santa Rosa, CA 95403, USA.
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Risk factors of urethral diverticula in male patients with spinal cord injury. Spinal Cord 2015; 53:803-6. [PMID: 26123209 DOI: 10.1038/sc.2015.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/19/2015] [Accepted: 05/08/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments. OBJECTIVES To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated. SETTING Toledo, Spain. METHODS Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol. RESULTS The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra. CONCLUSION According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.
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Murphy C, Prieto J, Fader M. "It's easier to stick a tube in": a qualitative study to understand clinicians' individual decisions to place urinary catheters in acute medical care. BMJ Qual Saf 2015; 24:444-50. [PMID: 26065467 DOI: 10.1136/bmjqs-2015-004114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians' decisions need to be better understood. OBJECTIVE To explore why clinicians decide to place IUCs in acute medical care. METHODS We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used. RESULTS Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals. CONCLUSIONS These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.
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Affiliation(s)
- Catherine Murphy
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jacqui Prieto
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mandy Fader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Meddings J, Saint S, Fowler KE, Gaies E, Hickner A, Krein SL, Bernstein SJ. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 162:S1-34. [PMID: 25938928 DOI: 10.7326/m14-1304] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Interventions to reduce urinary catheter use involve lists of "appropriate" indications developed from limited evidence without substantial multidisciplinary input. Implementing these lists, however, is challenging given broad interpretation of indications, such as "critical illness." To refine criteria for appropriate catheter use-defined as use in which benefits outweigh risks-the RAND/UCLA Appropriateness Method was applied. After reviewing the literature, a 15-member multidisciplinary panel of physicians, nurses, and specialists in infection prevention rated scenarios for catheter use as appropriate, inappropriate, or of uncertain appropriateness by using a standardized, multiround rating process. The appropriateness of Foley catheters, intermittent straight catheters (ISCs), and external condom catheters for hospitalized adults on medical services was assessed in 299 scenarios, including urinary retention, incontinence, wounds, urine volume measurement, urine sample collection, and comfort. The scenarios included patient-specific issues, such as difficulty turning and catheter placement challenges. The panel rated 105 Foley scenarios (43 appropriate, 48 inappropriate, 14 uncertain), 97 ISC scenarios (15 appropriate, 66 inappropriate, 16 uncertain), and 97 external catheter scenarios (30 appropriate, 51 inappropriate, 16 uncertain). The refined criteria clarify that Foley catheters are appropriate for measuring and collecting urine only when fluid status or urine cannot be assessed by other means; specify that patients in the intensive care unit (ICU) need specific medical indications for catheters because ICU location alone is not an appropriate indication; and recognize that Foley and external catheters may be pragmatically appropriate to manage urinary incontinence in select patients. These new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use.
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Affiliation(s)
- Jennifer Meddings
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Sanjay Saint
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Karen E. Fowler
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Elissa Gaies
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Andrew Hickner
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Sarah L. Krein
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Steven J. Bernstein
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
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Hartley SE, Valley SC. Prevention of Catheter-Associated Urinary Tract Infections in the Hospital. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ehmc.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Najjar YW, Hdaib MT, Al-Momany SM. Improvement in Knowledge Level of Associate Degree Nursing Students in Zarqa University College Regarding Care for Patients With Indwelling Urinary Catheters After Joining an Educational Session. Glob J Health Sci 2015; 7:39-45. [PMID: 26153177 PMCID: PMC4803903 DOI: 10.5539/gjhs.v7n6p39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/01/2015] [Indexed: 11/30/2022] Open
Abstract
Background: Care for patients with indwelling urinary catheter is one of the most important factors in preventing problems associated with indwelling urinary catheters. Caregiver education about caring of indwelling urinary catheters is important the same as patient education to prevent urinary catheters problems. Methods: A pre test post test control group design was used with nursing students of Zarqa University College. Data were collected through self-administered questionnaire. Results: Experimental group did not do better in the posttest than the control group after they joined an educational session about caring for patients with indwelling urinary catheter. Level of student (first year vs. second year) has been identified as a covariate that may have distorted the results. Conclusion: One educational session is insufficient to change level of knowledge regarding caring for patients with indwelling urinary catheter, in addition to considering the level of nursing student when conducting the educational session.
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Woodward S. Selecting and fitting a penile sheath. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:290-292. [PMID: 25757584 DOI: 10.12968/bjon.2015.24.5.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Sue Woodward
- Lecturer, Florence Nightingale Faculty of Nursing and Midwifery, King's College London
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Saint S, Kowalski CP, Forman J, Damschroder L, Hofer TP, Kaufman SR, Creswell JW, Krein SL. A Multicenter Qualitative Study on Preventing Hospital-Acquired Urinary Tract Infection in US Hospitals. Infect Control Hosp Epidemiol 2015; 29:333-41. [DOI: 10.1086/529589] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.Although urinary tract infection (UTI) is the most common hospital-acquired infection, there is little information about why hospitals use or do not use a range of available preventive practices. We thus conducted a multicenter study to understand better how US hospitals approach the prevention of hospital-acquired UTI.Methods.This research is part of a larger study employing both quantitative and qualitative methods. The qualitative phase consisted of 38 semistructured phone interviews with key personnel at 14 purposefully sampled US hospitals and 39 in-person interviews at 5 of those 14 hospitals, to identify recurrent and unifying themes that characterize how hospitals have addressed hospital-acquired UTI.Results.Four recurrent themes emerged from our study data. First, although preventing hospital-acquired UTI was a low priority for most hospitals, there was substantial recognition of the value of early removal of a urinary catheter for patients. Second, those hospitals that made UTI prevention a high priority also focused on noninfectious complications and had committed advocates, or “champions,” who facilitated prevention activities. Third, hospital-specific pilot studies were important in deciding whether or not to use devices such as antimicrobial-impregnated catheters. Finally, external forces, such as public reporting, influenced UTI surveillance and infection prevention activities.Conclusions.Clinicians and policy makers can use our findings to develop initiatives that, for example, use a champion to promote the removal of unnecessary urinary catheters or exploit external forces, such public reporting, to enhance patient safety.
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Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkangvan D, Yuekyen C, Warachan B, Warren DK, Fraser VJ. Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand. Infect Control Hosp Epidemiol 2015; 28:791-8. [PMID: 17564980 DOI: 10.1086/518453] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/01/2006] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.Methods.A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.Results.A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).Conclusions.This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.
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Affiliation(s)
- Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand.
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Lo E, Nicolle L, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Marschall J, Mermel LA, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals. Infect Control Hosp Epidemiol 2015; 29 Suppl 1:S41-50. [DOI: 10.1086/591066] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Burden of CAUTIsa. Urinary tract infection is the most common hospital-acquired infection; 80% of these infections are attributable to an indwelling urethral catheter.b. Twelve to sixteen percent of hospital inpatients will have a urinary catheter at some time during their hospital stay.c. The daily risk of acquisition of urinary infection varies from 3% to 7% when an indwelling urethral catheter remains in situ.2. Outcomes associated with CAUTIa. Urinary tract infection is the most important adverse outcome of urinary catheter use. Bacteremia and sepsis may occur in a small proportion of infected patients.b. Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means that the cumulative burden of CAUTI is substantial.c. Catheter use is also associated with negative outcomes other than infection, including nonbacterial urethral inflammation, urethral strictures, and mechanical trauma.
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Abstract
It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. To limit the incidence of ICU-acquired infections, aggressive infection control measures must be implemented and enforced. Researchers and national committees have developed and continue to develop evidence-based guidelines to control ICU infections. A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research.
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Affiliation(s)
- Mohamed F Osman
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA
| | - Reza Askari
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA.
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