Reducing catheter-associated urinary tract infections in the ICU

This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting | Current Opinion in Critical Care

Purpose of review: Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures.

Recent findings: The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states.

Summary: CAUTI reduction is possible in the ICU through a combination of reduced catheter usage, improved catheter care and stewardship of urine cultures.

Full reference: Sampathkumar, P. (2017) Reducing catheter-associated urinary tract infections in the ICU. Current Opinion in Critical Care: Published online: 28 July 2017

Prevention of central venous line associated bloodstream infections in adult intensive care units

Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters | Intensive and Critical Care Nursing

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Aim: Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.

Methods: A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion.

Results: Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the ‘On the CUSP: Stop Blood Stream Infections’ national programme.

Conclusions: Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.

Full reference: Velasquez Reyes, D.C. et al. (2017) Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive and Critical Care Nursing. Published online: 26 June 2017

Risk of Central Line-Associated Bloodstream Infection in Neonates

Umbilical venous catheters (UVC) or peripherally inserted central catheters (PICC), commonly used in high risk neonates, may have a threshold dwell time for subsequent increased risk of central line associated blood stream infection (CLABSI) | The Journal of Hospital Infection

Aim: To evaluate the CLABSI risks in neonates having either UVC, PICC or those having both sequentially.

Methods: Study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional Neonatal Intensive Care Units: 1392 having UVC only (Group 1), 1317 PICC only (Group 2) and 1276 both UVC and PICC (Group 3).

Results: There were 403 CLABSI among 6000 venous catheters inserted, totalling 43302 catheter days. CLABSI rates were higher in Group 3 infants who were of lowest gestation (16.9/1000 UVC days and 12.5/1000 PICC days; median 28 weeks) when compared with Group 1 (3.3/1000 UVC days; 37 weeks) and Group 2 (4.8/1000 PICC days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed UVC CLABSI rate increased stepwise to 42/1000 UVC days by day 10, with the highest rate in Group 3 (85/1000 UVC days). PICC CLABSI rates remained relatively stable at 12-20/1000 PICC days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among Group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk, than late replacement.

Conclusions: There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 could be considered.

Full reference: Sanderson, E. et al. (2017) Dwell Time and Risk of Central Line-Associated Bloodstream Infection in Neonates. The Journal of Hospital Infection. Published online: 24 June 2017

Reducing Catheter Associated Urinary Tract Infections

Reducing Catheter Associated Urinary Tract Infections (CAUTI’s) at a District General Hospital. Can change be sustained? | Commissioning for Quality and Innovation (CQINN) project. 

This shared-learning tool describes how Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.

Full document: Six Step strategy for reducing cather associated urinary tract_infections

The value of direct observation to reduce catheter-associated urinary tract infection

Afonso, E. & Blot, S. Intensive and Critical Care Nursing | Published online: 26 April 2017

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Urinary tract catheterization and monitoring of the urinary output is indispensable in critically ill patients as might indicate intravascular circulating volume, organ perfusion, and pending shock (Paratz et al., 2014; Eastwood et al., 2015). The presence of a urinary catheter however involves the risk of infection.

We read with interest the article by Galiczewski and Shurpin (2017) about the efficiency of direct observation to reduce bladder catheter utilization and catheter-associated urinary tract infections in the ICU.

Read the comment article here

Read the original research article here

Improving the catheter associated UTI rate in an intensive care unit

Galiczewski, J.M. & Shurpin, K.M. Intensive and Critical Care Nursing. Published online: 22 February 2017

Background: Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality.

Aim: The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates.

Conclusion: The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes.

Read the full abstract here

Prevention of Catheter-Associated Bloodstream Infections in a Pediatric ICU

Düzkaya, D.S. et al. (2016) Critical Care Nurse. 36(6) pp. e1-e7

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Background: Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs.

Conclusions: Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings.

Read the full abstract here