Urinary catheterization in medical wards

A comprehensive status update on modification of foley catheter to combat catheter-associated urinary tract infections and microbial biofilms

Present-day healthcare employs several types of invasive devices, including urinary catheters, to improve medical wellness, the clinical outcome of disease, and the quality of patient life. Among urinary catheters, the Foley catheter is most commonly used in patients for bladder drainage and collection of urine. Although such devices are very useful for patients who cannot empty their bladder for various reasons, they also expose patients to catheter-associated urinary tract infections (CAUTIs). Catheter provides an ideal surface for bacterial colonization and biofilm formation, resulting in persistent bacterial infection and severe complications. Hence, rigorous efforts have been made to develop catheters that harbour antimicrobial and anti-fouling properties to resist colonization by bacterial pathogens. In this regard, catheter modification by surface functionalization, impregnation, blending, or coating with antibiotics, bioactive compounds, and nanoformulations have proved to be effective in controlling biofilm formation. This review attempts to illustrate the complications associated with indwelling Foley catheters, primarily focussing on challenges in fighting CAUTI, catheter colonization, and biofilm formation. In this review, we also collate scientific literature on catheter modification using antibiotics, plant bioactive components, bacteriophages, nanoparticles, and studies demonstrating their efficacy through in vitro and in vivo testing.

Deposition of Daldinia starbaeckii (ELF) functionalized silver nanoparticles on urinary catheter tube using chitosan polymer to prevent microbial biofilms formation during UTI infection

Catheter-associated urinary tract infections (CAUTI) are the most common healthcare problem in hospitals. In this study, we isolated the Daldinia starbaeckii (An endolichenic fungus from Roccella montagnie) and its biomass extract were used to simultaneously synthesize and deposit DSFAgNPs on the inner and outer surfaces of the catheter tube using chitosan biopolymer via In-situ deposition method. Perfectly designed D. starbaeckii extract functionalized DSFAgNPs were characterized by UV spectroscopy, FTIR, SEM, EDS, TEM, and XRD. The microbial efficacy of DSFAgNPs & DSFAgNPs coated catheter (CTH3) was evaluated against eight human pathogenic gram (+ / -) ive strains and Candida albicans. Results indicated DSFAgNPs showed significant biological activity against both gram (+ / -) ive bacteria with an average MIC90 of 4 µl/ml. The most promising activity was observed against Helicobacter pylori. When bacteria strains allow to grow with CTH3 we reported significant reduction in colony formation unit (CFU/ml) in broth culture assay with an average 70% inhibition. Further, antibiofilm activity of CTH3 against P. aeruginosa showed strong inhibition of biofilm formation (85%). The study explored an alternate approach for significantly prevent CAUTI among hospital patients. We isolated an endolichenic fungus from lichen Roccella montagnei. The molecular characterization of fungus identified as Daldinia starbaeckii (DSF). The DSF was cultured and its fungal biomass exudes were used to simultaneously construct DSF-AgNPs and its deposition on the catheter surface using biopolymer chitosan via In-situ deposition method. Further, antimicrobial and antibiofilm efficacy of DSF-AgNPs was checked against urinary catheter contaminating and human pathogenic bacterial strains. Based on our research, we determined that DSF-AgNPs coating on a urinary catheter through this method is a cost-effective, eco-friendly approach to prevent catheter contamination.

Catheter-Associated Urinary Tract Infection: Incidence, Associated Factors and Drug Resistance Patterns of Bacterial Isolates in Southern Ethiopia

Introduction

Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity. The aim of this study was to determine the prevalence, associated factors and antibiogram of the bacterial isolates among CAUTIs patients.

Methods

A facility-based, cross-sectional study was conducted from March to December 2019 at Arba Minch General Hospital, Southern Ethiopia. Clinical and socio-demographic data were obtained using a questionnaire. Clean catch midstream urine samples were collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated in an aerobic atmosphere at 37°C for 24 h. After overnight incubation, the bacterial growth on the respective media was inspected visually and graded for the presence of significant bacteriuria. A significant bacteriuria was considered, if pure culture at a concentration of ≥10⁵ colony forming unit (CFU)/mL. All isolates were further identified using colony morphology and biochemical tests. Antimicrobial sensitivity was determined by modified Kirby–Bauer disc diffusion method. Data were analyzed using SPSS version 25. P-value less than 0.05 was used as statistical significance.

Results

The overall incidence of symptomatic CAUTIs was 39/231 (16.8%). Independent predictors of CAUTIs were prolonged (≥7 days) catheterization (AOR = 3.6, 95% CI = 1.0–12.2), diabetes mellitus (AOR = 5.3, 95% CI = 1.4–19.6) and insertion of catheter in surgical ward (AOR = 3.6, 95% CI = 1.08–12.28). The most common bacterial isolates were E. coli 17/42 (40.5%), Klebsiella species 9/42 (21.4%) and Enterococcus species 5/42 (11.9%). High (>80%) drug resistance was observed against cotrimoxazole, cefoxitin and tetracycline. Ciprofloxacin and nitrofurantoin were the most active drugs. The overall prevalence of MDR among isolates was 37/42 (88.1%). Most bacterial isolates 30/42 (71.4%) were biofilm producers.

Conclusion

High levels of drug resistance were observed to commonly used antibiotics. In our study, biofilm-producing bacterial isolates were the predominant cause of CAUTIs. Therefore, continuous surveillance of antimicrobial resistance patterns is necessary to help physicians in treatment and management of CAUTIs.

Bladder Care in Palliative Care Inpatients: A Prospective Dual Site Cohort Study

Background: Urinary catheterization is often undertaken to relieve distressing bladder symptoms in palliative care.

Objective: The primary aim of this study was to determine the incidence of, and clinical indications that predispose patients admitted to palliative care units to, urinary catheterization. The secondary aims were to determine causal factors, including the type of malignancy, antecedent medications, and duration of admission in these patients.

Methods: This was a prospective observational dual site cohort study in palliative care inpatients. Univariate categorical chi-square analysis was performed to compare patients with and without urinary catheterization, and to identify risk factors associated with urinary catheter use.

Results: The incidence of catheterization in this cohort was 41% (43/104) and urinary retention (63%) was the most common cause. Agitation (47%) and urinary incontinence (70%) were common symptoms in those catheterized. Medications that were significantly associated with the need for urinary catheterization were benzodiazepines (p < 0.01) and antipsychotics (p = 0.01). All measures that define poor functional status were found to be significant (p < 0.01). Patients with prolonged hospitalization of greater than three weeks were catheterized more frequently (p = 0.017). The majority of patients catheterized (79%) were admitted for terminal care.

Conclusions: The high incidence of urinary catheterization highlights the need for good bladder care for all patients in the palliative care setting. Patients with risk factors include the use of antipsychotics and benzodiazepines, declining functional status and prolonged hospital admission are more likely to be catheterized.

Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections

Urinary catheters are common medical devices, whose main function is to drain the bladder. Although they improve patients’ quality of life, catheter placement predisposes the patient to develop a catheter-associated urinary tract infection (CAUTI). The catheter is used by pathogens as a platform for colonization and biofilm formation, leading to bacteriuria and increasing the risk of developing secondary bloodstream infections. In an effort to prevent microbial colonization, several catheter modifications have been made ranging from introduction of antimicrobial compounds to antifouling coatings. In this review, we discuss the effectiveness of different coatings in preventing catheter colonization in vitro and in vivo, the challenges in fighting CAUTIs, and novel approaches targeting host–catheter–microbe interactions.

Magnitude of Biofilm Formation and Antimicrobial Resistance Pattern of Bacteria Isolated from Urinary Catheterized Inpatients of Jimma University Medical Center, Southwest Ethiopia

Biofilm formation is one of the features of most bacteria. Catheterization in medicine is a source of highly resistant bacterial infections, and those bacteria respond poorly to antimicrobial therapy. Bacterial biofilm features were not described from catheterized inpatients in Ethiopia as its formation is known to afford antimicrobial resistance and challenge patient management. The aim of this study was to isolate catheter-associated urinary bacterial pathogens, their biofilm formation, and antimicrobial susceptibility pattern among inpatients of Jimma University Medical Center (JUMC) in Southwest Ethiopia. A prospective cross-sectional study was conducted among urinary catheterized inpatients of JUMC from February to August 2016. A total of 143 study participants were enrolled consecutively in this study. Urine samples were collected from catheterized patients and processed using a standard bacteriological protocol for isolation and identification. Evaluation of in vitro biofilm formation and antimicrobial susceptibility pattern of uropathogenic bacteria was done using microtiter plates and disk diffusion method, respectively. Data were cleaned, coded, and entered into SPSS version 20 for analysis. All statistical test values of p < 0.05 were considered statistically significant. From all study participants, mean age was 44 years. Sixty bacterial strains were recovered from 57 urinary catheterized inpatients among which 54 of them were monomicrobial (94.7%). The remaining six bacterial strains were recovered from three study participants each with two bacterial isolates. The predominant bacterial isolates were Gram-negative bacteria with E. coli turning out first. About 80% of bacterial isolates were biofilm formers. The majority of the bacteria were resistant to commonly prescribed antimicrobial agents. In conclusion, the majority of bacterial uropathogen isolates were Gram-negative, biofilm formers, and resistant to commonly prescribed antimicrobial agents. Relatively ciprofloxacin, nitrofurantoin, and amikacin were highly effective against most isolated bacteria.

The level of safety standards in implementing therapeutic and caring procedures by emergency department personnel

AIM

The present study aimed to determine the level of applying safety standards in treatment and therapy processes.

DESIGN

In the present descriptive study, 120 cases of nasogastric intubation, bladder catheterization and intramuscular and intravenous injections done by emergency staff were randomly selected.

METHODS

The data were collected by a two-section checklist including demographic features and four sheets of observation. Then, the data were analysed based on descriptive statistics.

RESULT

The results indicated that the level of compliance with safety standards was 63.3% in intramuscular injection, 86.7% for intravenous injection, 90% for bladder catheterization and 80% for nasogastric intubation. In addition, no statistically significant difference was observed between these processes and the variables such as ages, education and experience and work shift.

Is Bladder Training by Clamping Before Removal Necessary for Short-Term Indwelling Urinary Catheter Inpatient? A Systematic Review and Meta-analysis

PURPOSE

Urinary catheterization is a common technique in clinical practice. There is, however, no consensus on management prior to removal of the indwelling catheter for short-term patients. This systematic review examined the necessity of clamping before removal of an indwelling urinary catheter in short-term patients.

METHODS

A systematic literature review was conducted using eight databases and predetermined keywords-guided searches. Some 2,515 studies were evaluated. Ten studies that met the inclusion criteria were selected.

RESULTS

The quality of the studies was assessed using the Jadad scoring system. Only 40.0% of studies were rated as high quality. This review found that catheter clamping prior to removal was not necessary for the short-term patient. When made a comparison with the unclamping group, there was no significant difference in recatheterization risk, risk of urine retention, patients' subjective perceptions and rate of urinary tract infection.

CONCLUSIONS

This review indicated that bladder training by clamping prior to removal of urinary catheters is not necessary in short-term catheter patients. In addition, clamping carries the risk of complications such as prolonging urinary catheter retention and urinary tract injury. Further investigation requires higher quality methodologies and more diverse study designs.

Infection prevention in the emergency department

Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to health care personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, health care personnel vaccination, and environmental controls to strategies for preventing health care-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care.

Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital

INTRODUCTION

The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards.

METHODS

A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey.

RESULTS

Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility.

CONCLUSIONS

Further educational efforts should be focused on improving catheterization prescribing practices by physicians.

Intermittent self-catheterisation: past, present and future

In the past, the only way to drain a bladder was to use intermittent catheterisation. For four millennia, intermittent self-catheterisation (ISC) was used to treat bladder dysfunction. That changed in the 20th century when Foley redesigned and improved on 19th century designs for an indwelling urethral catheter. While some patients benefit from indwelling catheters, long- and short-term indwelling catheters can increase infection risks and contribute to bladder dysfunction. NICE guidance on infection control recommends that intermittent catheterisation should be used in preference to an indwelling catheter if it is a clinically appropriate and practical option for the patient. NICE also recommends that patients should be offered a choice of either single-use hydrophilic or gel reservoir catheters for intermittent self-catheterisation. Voiding problems increase the risks of infection, bladder and renal dysfunction, and can impair quality of life. Individuals who have reasonable bladder capacity and sufficient dexterity and motivation can regain bladder control using ISC, which can make a huge difference to their health and wellbeing.

Wide range of point prevalences of healthcare-associated infections in Western Greece

The purpose of this study was to estimate the prevalence of healthcare-associated infections (HAIs) in the region of Western Greece and its relationship with possible predisposing factors. Two 1-day prevalence studies were performed in all hospitals of the region. The average HAI prevalence was 2·9% (range 0–6·8%) in the hospitals and 0–22·7% between different medical wards. Overall, 90% of HAI patients had predisposing factors. The most frequently isolated microorganism was Escherichia coli (14·3%). The study revealed a relatively low overall point prevalence of HAI, but remarkable discrepancies between the hospitals and wards. This may be due to the presence of confounding medical conditions and/or underreporting of HAIs from certain hospital wards. Local point-prevalence surveys may increase the awareness of HAIs in hospital staff and contribute to the establishment of effective infection control.