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Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B. Incidence of Urinary Tract Infection Among Patients: Systematic Review and Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231168746. [PMID: 37096884 PMCID: PMC10134187 DOI: 10.1177/00469580231168746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Healthcare-associated infection is one of the most common and severe threats to patients' health and remains a significant challenge for healthcare providers. Among healthcare-associated infections, urinary tract infection (UTI) is one of the most common infections. This study aimed to determine the global incidence of UTI among patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used to perform this systematic review and meta-analysis. The articles were searched from April 4 to August 5, 2022, from electronic databases (Scopus, PubMed, Web of Science, Google Scholar, DOAJ, and MedNar) using Boolean logic operators, MeSH terms, and keywords. The quality of the study was assessed using the JBI Critical Assessment tool. One thousand nine ninety three articles were retrieved from the electronic databases, of which 38 articles conducted on 981 221 patients were included in the current study. The study found the global pooled incidence of UTI accounted for 1.6%. Based on the subgroup analysis by survey period and WHO region, the highest incidence of UTI was reported in the African Region [3.6%] and among studies conducted between 1996 and 2001 [3.7%]. This study revealed the overall pooled incidence of UTI was 1.6%. The highest incidence of UTI (3.6%) was reported in the African region. This indicates that there is a need to implement safety measures.
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Affiliation(s)
| | - Addisu Alemu
- Haramaya University College of Health and Medical Science, Harar, Ethiopia
| | | | | | - Fila Ahmed
- Haramaya University College of Health and Medical Science, Harar, Ethiopia
| | - Baredin Mohammed
- Haramaya University College of Health and Medical Science, Harar, Ethiopia
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Ndomba ALM, Laisser RM, Silago V, Kidenya BR, Mwanga J, Seni J, Mshana SE. Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania. Microorganisms 2022; 10:microorganisms10020473. [PMID: 35208927 PMCID: PMC8879566 DOI: 10.3390/microorganisms10020473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient's well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1-1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1-3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1-5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2-3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2-0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2-0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
- Correspondence:
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Joseph Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
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Gale CB, Yan ZB, Fefer M, Goward GR, Brook MA. Synthesis of Siliconized Photosensitizers for Use in 1O 2-Generating Silicone Elastomers: An Electron Paramagnetic Resonance Study. Macromolecules 2021. [DOI: 10.1021/acs.macromol.1c00460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Cody B. Gale
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - Z. Blossom Yan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - Michael Fefer
- Suncor AgroScience, 2489 North Sheridan Way, Mississauga, Ontario L5K 1A8, Canada
| | - Gillian R. Goward
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - Michael A. Brook
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario L8S 4M1, Canada
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Kuy S, Gupta R, Roy C, Awad S. Incidence of Catheter-Associated Urinary Tract Infections With Compliance With Preventive Guidelines. JAMA Surg 2020; 155:661-662. [PMID: 32320018 PMCID: PMC7177634 DOI: 10.1001/jamasurg.2020.0428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/04/2020] [Indexed: 11/14/2022]
Affiliation(s)
- SreyRam Kuy
- Baylor College of Medicine, Surgery, Houston, Texas
- Michael E. DeBakey, Veterans Affairs Medical Center, Surgery, Houston, Texas
| | - Rohit Gupta
- Baylor College of Medicine, Surgery, Houston, Texas
| | - Cayla Roy
- Baylor College of Medicine, Surgery, Houston, Texas
| | - Samir Awad
- Baylor College of Medicine, Surgery, Houston, Texas
- Michael E. DeBakey, Veterans Affairs Medical Center, Surgery, Houston, Texas
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Mohan T, Čas A, Bračič M, Plohl O, Vesel A, Rupnik M, Zemljič LF, Rebol J. Highly Protein Repellent and Antiadhesive Polysaccharide Biomaterial Coating for Urinary Catheter Applications. ACS Biomater Sci Eng 2019; 5:5825-5832. [DOI: 10.1021/acsbiomaterials.9b01288] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Tamilselvan Mohan
- Laboratory for Characterization and Processing of Polymers (LCPP), Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, Maribor 2000, Slovenia
| | - Alja Čas
- Laboratory for Characterization and Processing of Polymers (LCPP), Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, Maribor 2000, Slovenia
| | - Matej Bračič
- Laboratory for Characterization and Processing of Polymers (LCPP), Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, Maribor 2000, Slovenia
| | - Olivija Plohl
- Laboratory for Characterization and Processing of Polymers (LCPP), Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, Maribor 2000, Slovenia
| | - Alenka Vesel
- Department of Surface Engineering and Optoelectronics, Jožef Stefan Institute, Teslova 30, Ljubljana SI-1000, Slovenia
| | - Maja Rupnik
- Faculty of Medicine, University of Maribor, Taborska ulica 8, Maribor 2000, Slovenia
- National Laboratory for Health, Environment and Food, Prvomajska ulica 1, Maribor 2000, Slovenia
| | - Lidija Fras Zemljič
- Laboratory for Characterization and Processing of Polymers (LCPP), Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, Maribor 2000, Slovenia
| | - Janez Rebol
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, Maribor 2000, Slovenia
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Sun X, Li Q, Guo Z, Wang K, Gui T, Gao C. Study on the Core-Shell Reversion of PSBMA- b-PLMA Nanoparticles for the Fabrication of Antifouling Coatings. ACS APPLIED MATERIALS & INTERFACES 2019; 11:21323-21333. [PMID: 31134794 DOI: 10.1021/acsami.9b02258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper, two series of poly(sulfobetaine methacrylate)- b-poly(lauryl methacrylate) (PSBMA- b-PLMA) diblock copolymers were prepared to investigate the core-shell reversion of amphiphilic copolymers. Experimental results proved that the PSBMA- b-PLMA copolymers can be self-assembled as core-shell nanoparticles in chloroform. Moreover, 1H NMR spectra and contact angle measurements revealed that there is a transitional PSBMA/PLMA block ratio of 0.6, above which the nanoparticles are capable of switching their core and shell in aqueous solution. Consequently, nanoparticles with PSBMA/PLMA block ratios above 0.6 showed superior antifouling and antibacterial abilities to those with block ratios below 0.4. Moreover, it was also found that the block chain length plays an important role in core-shell reversion as evidenced by 1H NMR spectra, water contact angle, and antifouling tests. As a result, coatings fabricated with the PLMA100 series of nanoparticles showed better antifouling abilities than those of the PLMA150 series at the same block ratio probably because of the thinner shell of PLMA100 copolymers. PSBMA100- b-PLMA100 was proved to be the best candidate for the fabrication of antifouling coatings as it exhibited the highest efficacy in antibacterial adhesion and antiprotein adsorption. This study provided a facile method to fabricate antifouling coatings by developing amphiphilic diblock copolymers with tuned hydrophobic/hydrophilic block ratio, block chain length, etc.
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Affiliation(s)
- Xiuhua Sun
- School of Marine Science and Technology , Harbin Institute of Technology at Weihai , Weihai 264209 , China
| | - Qi Li
- School of Marine Science and Technology , Harbin Institute of Technology at Weihai , Weihai 264209 , China
| | - Zhiren Guo
- School of Marine Science and Technology , Harbin Institute of Technology at Weihai , Weihai 264209 , China
| | - Ke Wang
- State Key Laboratory of Marine Coatings , Marine Chemical Research Institute Co., Ltd. , Qingdao 266071 , China
| | - Taijiang Gui
- State Key Laboratory of Marine Coatings , Marine Chemical Research Institute Co., Ltd. , Qingdao 266071 , China
| | - Changlu Gao
- School of Marine Science and Technology , Harbin Institute of Technology at Weihai , Weihai 264209 , China
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Belfield K, Kalith S, Aimar K, Parkinson R, Bayston R. Micro-organisms attached to the lumens and balloons of indwelling urinary catheters and correlation with symptoms, antibiotic use and catheter specimen of urine results. J Med Microbiol 2019; 68:549-554. [PMID: 30806614 DOI: 10.1099/jmm.0.000946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
To determine micro-organisms attached to removed urethral catheters and relate this to patient-specific information. Indwelling urethral catheters were collected from patients at a UK teaching hospital. The balloon and lumen were sonicated, and micro-organisms were enumerated. Catheter specimen urine results were retrospectively reviewed. Escherichia coli and Enterococcus faecalis were the most common isolates from 61 catheters. 19.7% of patients received antibiotics and 25 % of those had a multi-drug-resistant (MDR) organism in the lumen. Only 2.04% of catheters from patients not receiving antibiotics had a MDR organism. All lumens were colonized irrespective of antibiotic use. Symptom presentation did not correlate with numbers of colonizing organisms or species. Despite heavy colonization, only 8/61 patients were symptomatic. Indwelling urinary catheters in place for ≥10 days were universally colonized and there was no correlation with symptom presentation. Symptom presentation remains the most important factor for defining catheter-associated urinary tract infection.
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Affiliation(s)
- Katherine Belfield
- Biomaterials-Related Infection Group, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sajitha Kalith
- Biomaterials-Related Infection Group, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kelsey Aimar
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard Parkinson
- Urology Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Roger Bayston
- Biomaterials-Related Infection Group, School of Medicine, University of Nottingham, Nottingham, UK
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Li M, Yao L, Han C, Li H, Xun Y, Yan P, Wang M, He W, Lu C, Yang K. The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 2018; 30:523-535. [DOI: 10.1007/s00192-018-3791-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
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Fasugba O, Mitchell BG, Beckingham W, Bennett N, Gardner A. Point prevalence surveys of healthcare-associated urinary tract infections: Development, pilot testing and evaluation of face-to-face and online educational packages. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dawson CH, Gallo M, Prevc K. TWOC around the clock: a multimodal approach to improving catheter care. J Infect Prev 2017; 18:57-64. [PMID: 28989506 DOI: 10.1177/1757177416668584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/06/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are the second-largest group of healthcare-associated infections (HCAI). The Saving Lives Urinary Catheter Care Bundle was introduced to reduce catheter-associated urinary tract infections (CAUTI). In response, we implemented a catheter care group to examine ways to improve catheter care in an acute hospital NHS Trust. METHODS We adopted a multimodal approach, revolving around four components: (1) Catheter Care Pathway; (2) HOUDINI checklist; (3) catheter magnets; and (4) use of bladder ultrasound scanners. RESULTS The yearly CAUTI prevalence survey showed an annual reduction in CAUTI from 2012-2013 to 2014-2015 (3.5% to 2.4%). Evaluations of the multimodal approach have highlighted limitations, leading to priorities being established around provision of tools, education, and use of measurement and feedback. CONCLUSIONS Our multimodal approach demonstrates CAUTI rate improvements are achievable, directly benefiting patients. However, long-term maintenance of multimodal components is required to ensure sustained benefit. Engagement and accountability have emerged as significant challenges to the effectiveness and longevity of the catheter care group. We suggest greater emphasis on such challenges if long-term national or international improvement is to be achieved.
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Affiliation(s)
- Carolyn H Dawson
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Melanie Gallo
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kate Prevc
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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11
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Bračič M, Fras-Zemljič L, Pérez L, Kogej K, Stana-Kleinschek K, Kargl R, Mohan T. Protein-repellent and antimicrobial nanoparticle coatings from hyaluronic acid and a lysine-derived biocompatible surfactant. J Mater Chem B 2017; 5:3888-3897. [PMID: 32264250 DOI: 10.1039/c7tb00311k] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Biofilm formation triggered by uncontrolled protein adsorption, on medical devices is the leading cause of catheter-associated urinary tract infections (CAUTI) during implantation. Herein, we report a water-based, green and one-step strategy to functionalize surfaces of silicone catheters, poly(dimethylsiloxane) (PDMS), with antifouling and antimicrobial substances to avoid uncontrolled protein adsorption and microbial attachment. A novel synergetic formulation consisting of an anionic glycosaminoglycan (hyaluronic acid, HA) and a lysine-derived biocompatible cationic surfactant (Nε-myristoyl-lysine methyl ester, MKM) was prepared, resulting in the formation of nanoparticles (NPs, ca. 100-250 nm). Besides their high stability and long-lasting hydrophilicity in ambient and aqueous environments for 60 days, the nanometric layers (48 ± 3 nm) of HA-MKM NPs on PDMS showed no adsorption of BSA and lysozyme and substantially lower adsorption of fibrinogen as revealed by a quartz crystal microbalance with dissipation (QCM-D). In vitro antimicrobial test with S. aureus, E. coli, P. aeruginosa, P. mirabilis, C. albicans microbes under dynamic conditions revealed that the microbial growth was hampered by 85% compared with unmodified PDMS. Given the multiple functionalities, charges and diverse physiochemical properties of polysaccharide-lysine-based surfactant mixtures, this approach can be easily extended to the development of novel coatings on other silicone-based materials, thereby broadening potential applicability of PDMS-based biomaterials/devices in microfluidics, diagnostic biosensors and others.
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Affiliation(s)
- M Bračič
- Laboratory for Characterization and Processing of Polymers, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia
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Fasugba O, Koerner J, Mitchell B, Gardner A. Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. J Hosp Infect 2017; 95:233-242. [DOI: 10.1016/j.jhin.2016.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
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Bardsley A. Intermittent catheterisation: an option for managing bladder dysfunction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S16-8. [PMID: 27172502 DOI: 10.12968/bjon.2016.25.9.s16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Bardsley
- Senior Lecturer, Course Director for Non-Medical Prescribing, Coventry University discusses the role of intermittent catheterisation and considerations for health professionals and the individual concerned
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board, Lansdowne Hospital
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15
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A point prevalence study of healthcare associated urinary tract infections in Australian acute and aged care facilities. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Safdar N, Codispoti N, Purvis S, Knobloch MJ. Patient perspectives on indwelling urinary catheter use in the hospital. Am J Infect Control 2016; 44:e23-4. [PMID: 26698670 PMCID: PMC5262492 DOI: 10.1016/j.ajic.2015.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 11/20/2022]
Abstract
Urinary tract infections are one of the most common hospital-acquired infections, with 70%-80% resulting from catheter-associated urinary tract infections (CAUTIs). We undertook a qualitative study to assess patient perspectives of indwelling urinary catheters using a semistructured interview. We found that patient awareness and patient engagement regarding indwelling urinary catheters and their consequences could be improved in the hospital setting. Implementing educational programs incorporating patient preferences for both health care workers and patients is likely to increase the involvement of patients in decision-making regarding urinary catheters and may lead to a decline in CAUTIs.
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Affiliation(s)
- Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | | | - Suzanne Purvis
- Geriatrics, University of Wisconsin Hospital and Clinics, Madison, WI
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Kidd EA, Stewart F, Kassis NC, Hom E, Omar MI. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015; 2015:CD004203. [PMID: 26661940 PMCID: PMC8612698 DOI: 10.1002/14651858.cd004203.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Indwelling urethral catheters are often used for bladder drainage in hospital. Urinary tract infection is the most common hospital-acquired infection, and a common complication of urinary catheterisation. Pain, ease of use and quality of life are important to consider, as well as formal economic analysis. Suprapubic catheterisation can also result in bowel perforation and death. OBJECTIVES To determine the advantages and disadvantages of alternative routes of short-term bladder catheterisation in adults in terms of infection, adverse events, replacement, duration of use, participant satisfaction and cost effectiveness. For the purpose of this review, we define 'short-term' as intended duration of catheterisation for 14 days or less. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 26 February 2015), CINAHL (searched 27 January 2015) and the reference lists of relevant articles. SELECTION CRITERIA We included all randomised and quasi-randomised trials comparing different routes of catheterisation for short-term use in hospitalised adults. DATA COLLECTION AND ANALYSIS At least two review authors extracted data and performed 'Risk of bias' assessment of the included trials. We sought clarification from the trialists if further information was required. MAIN RESULTS In this systematic review, we included 42 trials.Twenty-five trials compared indwelling urethral and suprapubic catheterisation. There was insufficient evidence for symptomatic urinary tract infection (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.61 to 1.69; 5 trials, 575 participants; very low-quality evidence). Participants with indwelling catheters had more cases of asymptomatic bacteriuria (RR 2.25, 95% CI 1.63 to 3.10; 19 trials, 1894 participants; very low quality evidence) and more participants reported pain (RR 5.62, 95% CI 3.31 to 9.55; 4 trials, 535 participants; low-quality evidence). Duration of catheterisation was shorter in the indwelling urethral catheter group (MD -1.73, 95% CI -2.42 to -1.05; 2 trials, 274 participants).Fourteen trials compared indwelling urethral catheterisation with intermittent catheterisation. Two trials had data for symptomatic UTI which were suitable for meta-analysis. Due to evidence of significant clinical and statistical heterogeneity, we did not pool the results, which were inconclusive and the quality of evidence was very low. The main source of heterogeneity was the reason for hospitalisation as Hakvoort and colleagues recruited participants undergoing urogenital surgery; whereas in the trial conducted by Tang and colleagues elderly women in geriatric rehabilitation ward were recruited. The evidence was also inconclusive for asymptomatic bacteriuria (RR 1.04; 95% CI 0.85 to 1.28; 13 trials, 1333 participants; very low quality evidence). Almost three times as many people developed acute urinary retention with the intermittent catheter (16% with urethral versus 45% with intermittent); RR 0.45, 95% CI 0.22 to 0.91; 4 trials, 384 participants.Three trials compared intermittent catheterisation with suprapubic catheterisation, with only female participants. The evidence was inconclusive for symptomatic urinary tract infection, asymptomatic bacteriuria, pain or cost.None of the trials reported the following critical outcomes: quality of life; ease of use, and cost utility analysis. AUTHORS' CONCLUSIONS Suprapubic catheters reduced the number of participants with asymptomatic bacteriuria, recatheterisation and pain compared with indwelling urethral. The evidence for symptomatic urinary tract infection was inconclusive.For indwelling versus intermittent urethral catheterisation, the evidence was inconclusive for symptomatic urinary tract infection and asymptomatic bacteriuria. No trials reported pain.The evidence was inconclusive for suprapubic versus intermittent urethral catheterisation. Trials should use a standardised definition for symptomatic urinary tract infection. Further adequately-powered trials comparing all catheters are required, particularly suprapubic and intermittent urethral catheterisation.
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Affiliation(s)
- Emily A Kidd
- University of AberdeenCochrane Incontinence GroupHealth Sciences Building (second floor)AberdeenUKAB25 2ZD
| | - Fiona Stewart
- University of AberdeenAcademic Urology UnitForesterhillAberdeenScotlandUKAB25 2ZD
| | - Nadine C Kassis
- Toledo Clinic Urogynecology3425 Executive ParkwaySuite 108ToledoUSAOH 43606
| | - Emily Hom
- Baylor Scott and White Health2401 South 31st StreetMS‐01‐E316ATempleTXUSA76508
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitForesterhillAberdeenScotlandUKAB25 2ZD
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Affiliation(s)
- Alison Bardsley
- Senior Lecturer and Course Director for Non-Medical Prescribing and BSc in Professional Practice, Coventry University
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Affiliation(s)
- Alison Bardsley
- Senior Lecturer and Course Director for Non-Medical Prescribing and BSc in Professional Practice, Coventry University
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Abstract
Intermittent self-catheterisation (ISC) is the insertion and removal of a catheter to drain the bladder and is a safe and effective way to preserve renal function. It can be used as a one-off intervention to drain urine post-operatively or to measure residual urine volumes if a bladder scanner is unavailable. ISC can also be used as a long-term option to manage bladder dysfunction, and for some provides an excellent option to maintain independence and improve quality of life. Urinary tract infections are a common complication for women undertaking ISC. This article explores the prevention of urinary tract infections in women undertaking long-term ISC for the management of bladder dysfunction.
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Affiliation(s)
- Alison Bardsley
- Course Director and Senior Lecturer, Faculty of Health and Life Sciences, Coventry University
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Gardner A, Mitchell B, Beckingham W, Fasugba O. A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals. BMJ Open 2014; 4:e005099. [PMID: 25079929 PMCID: PMC4120374 DOI: 10.1136/bmjopen-2014-005099] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. SETTING Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. PARTICIPANTS A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. OUTCOME MEASURES The primary outcome measures were the HAUTI and CAUTI point prevalence. RESULTS Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. CONCLUSIONS These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.
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Affiliation(s)
- Anne Gardner
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
| | - Brett Mitchell
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
- Faculty of Nursing and Health, Avondale College, Wahroonga, New South Wales, Australia
| | - Wendy Beckingham
- Department of Infection Prevention and Control, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
| | - Oyebola Fasugba
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
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Mitchell B, Gardner A, Beckingham W, Fasugba O. Healthcare associated urinary tract infections: a protocol for a national point prevalence study. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi13037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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