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PubMedDate not supplied

Why catheterize?: audit findings on the use of urinary catheters.

Urinary catheters can be associated with complications such as urinary tract infection, pain and discomfort. This article reports on an audit of 51 patients who had a urinary catheter inserted during their hospital stay. Urinary incontinence meant catheterization in 37.5% (n = 27) of cases, with 64.7% (n = 33) being catheterized by nurses. The study highlighted the need for accurate documentation and care planning; 15 patients did not have a plan of care for their catheter and only eight patients had a plan for the removal of the catheter. Catheterization is the most common cause of hospital-acquired infection, and therefore the use of catheters needs careful examination to reduce this type of infection. The question is raised whether catheterization is used as a convenience for nursing staff or as an essential aspect of care.

Attitude of Health Personnel↗
PubMed2002

Use of silver-hydrogel urinary catheters on the incidence of catheter-associated urinary tract infections in hospitalized patients.

BACKGROUND: Urinary tract infections (UTIs) account for 40% of all nosocomial infections, and about 80% of these are associated with the use of urinary catheters. They not only contribute to excess morbidity and mortality, but they also significantly add to the cost of hospitalization. Clinical trials with silver-coated urinary catheters have shown conflicting results. However, recent trials with silver-hydrogel urinary catheters have shown a reduction in nosocomial UTIs, and these catheters appear to offer cost savings. METHOD: The University of Massachusetts Medical Center is a teaching, tertiary hospital with 18% of its beds in intensive care units. The silver-hydrogel urinary catheters were introduced in October 1997. The rate of catheter-associated UTIs with silver-hydrogel urinary catheter use was compared with a historical baseline UTI rate that was established for January 1996 and January 1997 with the standard, noncoated catheters. The cost of a nosocomial catheter-associated UTI was estimated by calculating the hospital charges resulting from all urinary catheter-associated UTIs in 1 month. A cost-analysis of silver-hydrogel urinary catheter use was performed. RESULTS: The rate of catheter-associated UTIs for noncoated catheters was 4.9/1000 patient-days compared with 2.7/1000 patient-days for the silver-hydrogel catheters, a reduction of 45% (P =.1). The average cost (calculated with hospital charges) of a catheter-associated UTI at our institution was estimated to be $1214.42 US dollars, with a median of $613.72 US dollars. The estimated cost-saving ranged from $12,563.52 US dollars to $142,314.72 US dollars. CONCLUSIONS: The use of silver-hydrogel urinary catheters resulted in a nonsignificant reduction in catheter-associated UTIs and a modest cost-saving.

Adult↗
PubMed2006

Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients.

BACKGROUND: The efficacy of antimicrobial urinary catheters in hospitalized patients is poorly defined. PURPOSE: To assess currently marketed antimicrobial urinary catheters for preventing catheter-associated urinary tract infection (UTI). DATA SOURCES: Electronic databases, conference proceedings, bibliographies, trialists, and catheter manufacturers (search dates, 1966 to June 2005). STUDY SELECTION: Randomized and quasi-randomized trials of nitrofurazone-coated or silver alloy-coated antimicrobial urinary catheter use for less than 30 days; no language restriction. DATA EXTRACTION: Study design, study sample, inclusion and exclusion criteria, allocation, blinding, UTI definition, ascertainment methods, and proportion developing symptomatic UTI (primary end point) or bacteriuria (secondary end point) were extracted by using a structured data collection instrument. DATA SYNTHESIS: Twelve qualifying trials (13,392 total participants or catheters) were identified. They compared nitrofurazone-coated silicone (n = 3) or silver-coated latex (n = 9) catheters with silicone or latex catheters. No study addressed symptomatic UTI. All trials suggested protection against bacteriuria with test catheter use. However, effect size varied considerably and postrandomization exclusions were very common. Effect size was greatest in trials of nitrofurazone-coated catheters (all post-1995) and in pre-1995 silver alloy-coated catheter trials and was smallest in post-1995 silver alloy-coated catheter trials. Control group bacteriuria rate, control catheter type (latex vs. silicone), and patient sample (urology vs. other) also predicted effect size. Few studies addressed secondary bloodstream infection, mortality, costs, or microbial resistance. Short-term adverse effects were minimal. LIMITATIONS: The study was limited by the number, size, and quality of studies and by lack of the following: intention-to-treat analyses, data on clinical end points, and trials comparing nitrofurazone-coated with silver alloy-coated catheters. CONCLUSIONS: According to fair-quality evidence, antimicrobial urinary catheters can prevent bacteriuria in hospitalized patients during short-term catheterization, depending on antimicrobial coating and several other variables. Older data probably lack current relevance. Cost implications and effect on infectious complications remain undefined.

Anti-Infective Agents, Urinary↗
PubMed1999

Activities of a nitrofurazone-containing urinary catheter and a silver hydrogel catheter against multidrug-resistant bacteria characteristic of catheter-associated urinary tract infection.

The in vitro inhibitory activity of a nitrofurazone-coated urinary catheter (NFC) against 86 recently obtained susceptible and multidrug-resistant (MDR) clinical isolates of Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecium, which are species implicated in catheter-associated urinary tract infection and which traditionally have been susceptible to nitrofuran derivatives, was determined using an agar diffusion assay. In a subset of these strains, the activity of the NFC was compared with that of a silver hydrogel urinary catheter (SHC), and the durability of each catheter's inhibitory activity was assessed during serial daily transfers of catheter segments to fresh culture plates. Except for vancomycin-resistant E. faecium, the NFC was active against all isolates tested and showed comparable inhibition zones with susceptible and MDR strains of each species. In contrast, the SHC inhibited only certain staphylococci (P < 0.01 versus the NFC), and among these strains, the SHC produced smaller inhibition zones than did the NFC (P < 0.01). Inhibition was evident for up to 5 days with the NFC, but for only 1 day (if at all) with the SHC (P < 0.01). These data document that, for most genera which traditionally have been susceptible to nitrofuran derivatives, the NFC remains active against contemporary MDR isolates. They also demonstrate that the in vitro antibacterial activity of the NFC is markedly superior to that of the SHC in several respects. Thus, the NFC shows promise for clinical use in the current era of MDR bacteria.

Anti-Infective Agents, Local↗
PubMed2006

Evaluation of catheter-associated urinary tract infections and multi-drug-resistant Escherichia coli isolates from the urine of dogs with indwelling urinary catheters.

OBJECTIVE: To determine the frequency of urinary tract infections (UTIs) in dogs with indwelling urinary catheters in an intensive care unit (ICU) and the frequency of multi-drug-resistant (MDR) Escherichia coli UTIs in those dogs. DESIGN: Prospective study. ANIMALS: All dogs in the ICU with an indwelling urinary catheter from January 2003 through December 2003. PROCEDURES: Urine samples and rectal swab specimens were collected at admission and every 3 days until discharge from the hospital. Escherichia coli isolates from urine samples and rectal swab specimens and those from dogs that were temporally or spatially associated with dogs with MDR E coli UTIs underwent antimicrobial susceptibility testing. Pulsed-field gel electrophoresis was performed on MDR isolates from urine and rectal swab specimens. RESULTS: Urinary catheters were placed in 137 dogs. Twenty-six UTIs were diagnosed, 15 on the day of admission and 11 after 3 or more days of catheterization. Of 12 dogs with E coli UTIs, 6 were infected at admission and 6 acquired the infection in the ICU. Two MDR E coli UTIs were detected, 1 of which was acquired in the ICU. One MDR E coli urinary isolate had an electrophoresis pattern similar to that of rectal isolates from the same dog. Urinary E coli isolates were most frequently resistant to ampicillin and cephalothin. CONCLUSIONS AND CLINICAL RELEVANCE: The ICU-acquired MDR E coli UTI likely originated from the dog's intestinal flora during hospitalization. Dogs that have been referred from a community practice may have MDR E coli UTIs at the time of admission.

Animals↗
PubMedDate not supplied

Infection rislks associated with urinary catheters.

Urinary catheterisation can kill. It is one of the most common healthcare interventions but carries the risk of 'significant danger' to patients from infection (Pratt et al 2001). While essential for some patients, this invasive procedure is sometimes unjustified and even forgotten once in place (Saint et al 2005). Accountability for the safe management of urinary catheters by using evidence-based guidelines is emphasised. New ways of examining practice and planning for improvement (Department of Health 2005), and new technology (Tambyah 2004) will contribute to better outcomes for those patients for whom the procedure is essential.

Humans↗
PubMed2001

An abdominal wall simulator for testing suprapubic urinary catheters.

Urinary catheters (drainage tubes) are in widespread use. The most common type of long-term catheter is the Foley, which is made from natural or synthetic rubber. Foley catheters are passed into the bladder via the urethra or the suprapubic puncture channel (through the abdominal wall). A simulator for the abdominal wall has been developed to simulate aspects of the interaction between it and a suprapubic catheter. The simulator is based on a slab of ultrasoft elastomer with tensionable reinforcing polyamide filaments. The behaviour of the simulator has been compared with data published. A soft membrane (contact pressure) transducer (SMT) was used and novel instrumented 'tongs' for lateral indentation of the puncture track giving indentation stiffness. Slab materials were used with shear moduli of 0.1 and 0.021 MPa. Two filament-tensioning methods were used: by clamping to a winding mechanism and by weights. The combination of the softer slab material and tensioning by weights gave good conformity to physiological data; other combinations did not.

Abdominal Muscles↗
PubMed1990

Prevention of catheter-associated urinary tract infection with a silver oxide-coated urinary catheter: clinical and microbiologic correlates.

In a prospective clinical trial involving 482 acutely hospitalized patients, the overall incidence of catheter-associated urinary tract infection (UTI; 10%) was similar in recipients of a silver oxide-coated urinary catheter (silver catheter) or a control silicone catheter. However, female sex and absence of antimicrobial use were independently associated with an increased risk of UTI. After stratification for these variables, the silver catheter reduced the incidence of UTI among women not receiving antimicrobial agents (19% for control catheter vs. 0 for silver catheter, P = .04; confidence interval for the difference in incidence, 0.4%-38%) but not in the other subgroups. Gram-positive UTI was associated with absence of antimicrobial use, the control catheter, and catheter care violations. Gram-negative and candidal UTIs were more common after 7 days of catheterization, and candidal UTI was associated with being female and antimicrobial use. These findings demonstrate that several clinical variables influenced the incidence and microbiology of catheter-associated UTI and that the silver catheter appeared to prevent UTI among women not receiving antimicrobials.

Adult↗
PubMed2006

Catheter-associated urinary tract infections: new aspects of novel urinary catheters.

Nosocomial urinary tract infection is the most common infection acquired both in hospitals and nursing homes and is usually associated with catheterisation. These catheter-associated urinary tract infections (CAUTIs) have been reported to increase mortality and have a considerable economic impact. To date, the sole effective preventative strategy is the use of a closed drainage system and removal of the catheter as soon as possible. The underlying cause of CAUTI is the formation of a pathogenic biofilm on the surface of the indwelling urinary catheter. Currently, researchers seek to alter the catheter surface in order to inhibit biofilm formation. Many substances are being studied for their potential as biofilm-disrupting catheter coatings. Among these substances, recently developed antibiotic-coated catheters may provide promise for the control of CAUTI. More basic research at the level of pathogenesis and catheter substance is needed to design novel strategies.

Anti-Bacterial Agents↗
PubMed1998

The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis.

PURPOSE: Indwelling urinary catheters are implicated in most cases of nosocomial urinary tract infection. Silver-coating of catheters may reduce the risk of these infections; however, trials have provided mixed results. We performed a meta-analysis to estimate the effectiveness of silver-coated urinary catheters. SUBJECTS AND METHODS: Published or unpublished articles were sought using MEDLINE, reference review, and correspondence with original authors, catheter manufacturers, and experts. Trials using silver-coated urinary catheters in the treatment group and uncoated urinary catheters in the control group were included. Bacteriuria, as evaluated by urine culture, was the outcome variable used to indicate urinary tract infection. Summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using Mantel-Haenszel methods with a fixed-effects model. RESULTS: Of 117 reports retrieved, eight trials with a total of 2,355 patients satisfied inclusion criteria. The summary OR for urinary tract infection was 0.59 (95% CI, 0.42 to 0.84) indicating a significant benefit in the patients receiving silver-coated catheters. A test of heterogeneity, however, indicated that the odds ratios varied significantly among studies. Silver alloy catheters (OR = 0.24; 95% CI, 0.11 to 0.52) were significantly more protective against bacteriuria than silver oxide catheters (OR = 0.79; 95% CI, 0.56 to 1.10). CONCLUSIONS: This meta-analysis clarifies discrepant results among trials of silver-coated urinary catheters by revealing that silver alloy catheters are significantly more effective in preventing urinary tract infections than are silver oxide catheters. Though silver alloy urinary catheters cost about $6 more than standard urinary catheters, they may be worth the extra cost since catheter-related infection is a common cause of nosocomial infection and bacteremia.

Alloys↗
PubMed2000

The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection.

BACKGROUND: Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30. OBJECTIVE: To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients. METHODS: The decision model, performed from the health care payer's perspective, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring short-term urethral catheterization (2-10 days). We compared 2 catheterization strategies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direct medical costs. RESULTS: In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 cases per 1000 patients (number needed to treat = 74) and a 44% relative decrease in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients (number needed to treat = 500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient compared with standard catheter use ($20.87 vs $16.78). In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases. CONCLUSIONS: Using silver alloy catheters in hospitalized patients requiring short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia, and is likely to produce cost savings compared with standard catheters.

Alloys↗
PubMed1999

Hydrogel/silver ion-coated urinary catheter reduces nosocomial urinary tract infection rates in intensive care unit patients: a multicenter study.

OBJECTIVES: Indwelling urinary catheters are the leading source of nosocomial urinary tract infections (NUTIs). The Bardex I.C. catheter is a hydrogel latex Foley catheter with a monolayer of silver metal applied to the inner and outer surfaces of the catheter. We investigated the Bardex I.C. catheter for its ability to decrease the NUTI rate in critical care units. METHODS: Five hospitals participated in a blind prospective study, exchanging the standard latex Foley catheter for the Bardex I.C. Foley catheter. The device use rate and NUTI rate were monitored. Data were collected and analyzed using Wilcoxon rank sum test and four-way analysis of variance. A cost analysis was also performed. RESULTS: The baseline period, intervention period, and number of device days was similar for both periods. The unadjusted catheter-associated infection rate during the baseline and intervention periods was 7.1 and 4.5 infections per 1000 catheter days, respectively (P <0.01). The adjusted catheter-associated infection rate during the baseline and intervention periods was 8.1 and 4.9 infections per 1000 catheter days, respectively. This was not statistically significant (P = 0. 13). CONCLUSIONS: A trend toward a reduction in NUTIs with the use of the hydrogel/silver-coated catheter was noted in all intensive care units at each institution as shown by the unadjusted and adjusted catheter-associated infection rates. One hospital demonstrated a statistically significant reduction in NUTIs. However, statistical significance was not met when the results were adjusted. The cost analysis at one institution demonstrated cost savings with the use of the silver-coated catheter. Future analysis may require a double-blind, prospective-controlled study of longer duration to reach statistical significance.

Cross Infection↗
PubMed1994

Myths surrounding the use of urinary catheters: a summary of key beliefs that inhibit acute care nurses from altering their use of urinary catheters.

Nurses frequently base their use and care of indwelling urinary catheters on long held beliefs that contemporary research is disproving. As an excellent place of attachment, the catheter permits rapid migration of organisms into the bladder, independent of the position of the catheter bag. For treatment of bladder distension, intermittent catheterization is preferable to leaving an indwelling catheter in place. Regardless of the amount of urine obtained, intermittent catheters are usually not intended to remain in the bladder. Irrigation of a bypassing urinary catheter forces organisms into the upper urinary tract. The process of irrigating blocked catheters (except for urology patients) is no longer the preferred intervention. Instead, catheters obstructed from prolonged use must be replaced with new ones or, whenever possible, left out. As a foreign device, urinary catheters in acute care must be recognized as a potential health threat. Indwelling urinary catheter must not be used for nursing convenience to ease heavy workloads, nor left in place as a result of patient coercion.

Acute Disease↗
PubMed1993

Blockage of indwelling urinary catheters: the roles of urinary composition, the catheter, medication and diet.

The aim of this work was to study factors related to the blockage of indwelling urinary catheters. There were 40 patients with indwelling catheters, 20 of whom had catheters that blocked frequently. The other 20 were trouble free at the time of our study. The type and gauge of catheter and frequency of events were recorded. Urine samples for biochemical analysis comprised 24-hour collections, morning specimens on up to 10 different days and 5-8 samples at different times during the same day. Chemical analysis of debris removed from blocked catheters showed it to consist of mixed phosphates of calcium and magnesium, thus being similar to urinary stones that may be seen in spinal cord injury patients. Patients with frequent catheter blockage had significantly elevated urinary pH and ammonium and calcium concentrations. Discriminant analysis gave 78-94% separation of catheter blocking patients from nonblockers depending on the type of sample. We conclude that bacterial urease activity and urinary calcium concentration are the most important factors in catheter blockage. Elevation of urinary pH following ingestion of effervescent preparations, drug- or diet-induced increases in urinary calcium or magnesium excretion and inadequate or erratic fluid intake may be avoidable contributing factors.

Adolescent↗
PubMed1993

The evolution and development of the urinary catheter.

The urinary catheter is one of the most frequently used medical devices and has a long and intriguing history of development. This paper describes the catheter from its simple beginnings through the subtle but important changes it has undergone paralleling the advances in plastics technology witnessed this century. The changes have not been without controversy and the recent association of catheters with tissue toxicity, which has forced the implementation of strict guidelines for their manufacture and use, is described.

Catheters, Indwelling↗
PubMed2005

Colicins prevent colonization of urinary catheters.

OBJECTIVES: Natural microbial defence systems, such as bacteriocins, may be a novel means to prevent catheter-associated urinary tract infection. We investigated in vitro whether a colicin-expressing strain of Escherichia coli could prevent urinary catheter colonization by a colicin-susceptible, uropathgenic strain of E. coli. METHODS: Segments of urinary catheter were inoculated with colicin-producing E. coli K-12 and then exposed to either colicin-susceptible E. coli (a uropathogenic clinical isolate) or colicin-resistant E. coli (derived from the susceptible clinical isolate). Catheters were then incubated overnight, rinsed and sonicated. RESULTS: The presence of colicin-producing E. coli K-12 on the catheter surface completely prevented catheter colonization by colicin-susceptible E. coli but not by resistant E. coli. The colicin-susceptible strain but not the colicin-resistant strain also disappeared from broth cultures in the presence of colicin-producing E. coli K-12. CONCLUSIONS: The observed inhibition of catheter colonization by the uropathogenic clinical isolate of E. coli can be attributed to the presence of a colicin-producing strain of E. coli on the catheter surface. Bacteriocin production by a non-pathogenic organism may have clinical applicability as a means to prevent catheter-associated urinary tract infection.

Catheters, Indwelling↗
PubMed2006

Catheter valves for indwelling urinary catheters: a systematic review.

This mini-review aimed to systematically review the evidence on the effect of catheter valves compared to free drainage into a bag for patients with indwelling urinary catheters. Data sources used were Medline, British Nursing Index, CINAHL, Ahmed, EMBASE, EBM Reviews, the Cochrane Library and reference lists of relevant papers. Papers considered were controlled trials comparing the use of a catheter valve with the catheter bag that were published as a full report, or detailed abstract (containing sufficient information to critique) in Dutch, German or English. Two studies with a total of 122 subjects were identified. The main outcome measures considered were reduction of incidence of bladder spasm and urinary tract infection (UTI) and patient preference. No statistically difference in the incidence of bladder spasm or UTI was demonstrated but patients showed a clear preference for the valve. Further research into catheter valves is needed, with larger study groups, which include housebound male and female patients, and longer follow-up period.

Catheters, Indwelling↗