Associated Urinary Tract Infection

Ensure use of skin antisepsis at insertion and proper aseptic technique for maintenance of catheter and drainage bag, and the use of closed urinary drainage system. Ensure removal of urinary catheter when no longer essential for care. 

Hospitals and providers must work to reduce the burden of these infections. Four specific infections account for more than 80% of all hospital-related infections. Their list includes surgical site infections (SSls), catheter-associated urinary tract infection (CAUTIs), central venous catheter (CVC)-related bloodstream infections (CRBSls), and ventilator-associated pneumonia (VAP). Preventing the transmission of antibiotic-resistant bacteria such as MRSA has become increasingly important. Effective measures exist to prevent the most common healthcare-associated infections (H Als). 

Central Venous Catheter-Related Bloodstream Infections 

Employ maximal sterile barrier precautions. Use aseptic technique including the use of a cap, mask, sterile gown, sterile gloves, and a large sterile sheet for the insertion of all CVCs. Use 2% chlorhexidine gluconate solution for skin sterilization at the CVC insertion site. Avoid femoral site for nonemergency CVC insertion and ensure prompt removal of unnecessary catheters. 

Ensure administration of appropriate prophylactic antibiotic, generally begun within 1 h before skin incision and discontinued within 24 h. Avoid shaving of the operative site and use clippers or other methods for hair removal in the area of skin incision(s). Ensure maintenance of blood glucose less than 150 mg/dL during postoperative period. Use tighter controls needed in specific patient populations. 

Ensure elevation of the head of the bed to more than 30° for all mechanically ventilated patients. Minimize the duration of mechanical ventilation by minimizing sedative administration (including daily sedation holidays) and/or using protocol-based weaning. 

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Tambyah PA, Mala DG. Catiieter-associated urinary tract infection is rarely syn tomatic. Arch Intern Med 2000 160 678-682. 

Stamm WE. Catheter-associated urinary tract infection Epidemiology, pathogenesis, and prevention. AmJMed 1991 91(suppl 3) 65s-71s. 

Kadurugamuwa, J. L., Modi, K., Yu, J., Francis, K. P., Purchio, T and Contag, P. R. (2005) Noninvasive biophotonic imaging for monitoring of catheter-associated urinary tract infections and therapy in mice. Infect. Immun. 73, 3878-3887. 

Warren, J. W. (2001) Catheter-associated urinary tract infections. Int. J. Antimicrob. Agents 17, 299-303. 

Kurosaka, Y., Ishida, Y., Yamamura, E Takase, H Otani, T., and Kumon, H. (2001) A non-surgical rat model of foreign body-associated urinary tract infection with Pseudomonas aeruginosa. Microbiol. Immunol. 45, 9-15. 

Catheter-associated urinary tract infections. Note ICD-9 code does not distinguish between catheter-associated infection and inflammation. 

Gentry H and Cope S, Using silver to reduce catheter-associated urinary tract infections , Nursing standard (Royal College of Nursing (Great Britain) 1987), 19 (50), 2005, pp 51-54. 

Kunin CM. Catheter-associated urinary tract infections a syllogism compounded by a questionable dichotomy. Clin Infect Dis 2009 48 1189-90. 

Reddy ST, Chung KK, McDaniel CJ, Daroniche RO, Landman J, Brennan AB. Micro-patterned surfaces for reducing the risk of catheter-associated urinary tract infection an in vitro study on the effect of sharklet micropattemed surfaces to inhibit bacterial colonization and migration of mop Ahog nc Escherichia coli. J Endourol 2011 25 1547-52. http //dx.doi.Org/10.1089/end.2010.0611. 

Ha, U., Cho, Y.-H., 2006. Catheter-associated urinary tract infections new aspects of novel urinary catheters. International Journal of Antimicrobial Agents 28,485-490. 

Johnson, J.R., Kuskowski, M.A., Wilt, T.J., 2006. Systematic review antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Annals of Internal Medicine 144, 116-126. 

Parker, D., Callan, L., Harwood, J., Thompson, D.L., WUde, M., Gray, M., 2009. Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Part 1 catheter selection. Journal of Wound Ostomy Continence Nursing 36, 23-34. 

Evaluation of nonneurogenic bladder-sphincter dysfunction ( voiding dysfunction ) begins with a careful history and a physical examination followed by urine analysis. Radiologic investigation starts with renal and bladder ultrasound. A VCU is performed in persistent and severe cases of nonneurogenic bladder-sphincter dysfunction and in children with associated urinary tract infection and breakthrough infections. 

Morck DW, Lam K, Mckay SG, Olson I4E, Prosser B, Ellis BD, Cledand R, Costerton JW (1994) Comparative e uation of flero dn, ampidllin, trimethoprim-sulfamethoxazole, and gentamicin as treatments of catheter-associated urinary tract infection in a rabbit model. Int J Antimicrob Agents... 

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