UTI Prevention Infectious Disease Epidemiology Section - PowerPoint Presentation

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UTI Prevention

Infectious Disease Epidemiology Section

Office of Public Health

Louisiana Dept of Health & Hospitals

(504) 219-4563 *** 800-256-2748

www.infectiousdisease.dhh.louisiana.gov

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Source of Infection

Normal BladderBladder content sterileMicturition empties bladder completelyExfoliation of urethral cells pushes microbes outAny interference will increase risk of infection

Urinary Catheter Risks CatheterBreaches barrierBalloon prevents complete emtyingDistends bladderPool of urineCondom catheterWarm moist conditions inside  high inoculumTravel upwardsClosed systemsNever completely closedBag may have high countsTravel upwards

Source of bacteriaEndogenous: meatal, rectal or vaginal colonizationExogenous: Contaminated hands of HCPContaminated equipmentUse of closed sterile urinary drainage system led to marked reduction in bacteriuria risk  implying importance of intraluminal routeBUT even with closed system UTI do occur  extra-luminal route cannot be eliminated

Extra-luminal

Intra

-luminal

Microbe MigrationMicrobes migrateUp lumen: even non-motile bacteriaUp external surface of catheterBiofilm = matrix of polysacharides with encased bacteria, up to 4 spcies (usually 1 in urine)MicrocoloniesWater channelsBacteria in biofilms express different genesIncrease production of extracell polymeric substance (EPS)50-90% of biofilm massBiofilmsPoor antibiotic diffusionSlow bacterial multiplication Less effectiveness of antibiotics

Asymptomatic BacteriuriaClinical significance of ASB in catetherized patients undetermined75-90% of ASB in catetherized patients never develop SUTIMonitoring and treatment of ASB does not reduce SUTI incidenceMost SUTI are not preceded by bacteriuria

Personal Risk FactorsFemaleAdvanced ageDurationDiabetesRenal insufficiency (Creatinine > 2mg/dL)

Incidence Most common inAcute and long term carePediatric and geriatric populationsUrinary instrument: catheterIncidence function of duration1-5% per dayAlmost 100% after 30 daysPrevalence in LTCF 5% at any time

Urinary Catheter UseUsed in about Wards: 10% pf patients daysICU: 50% pf patients daysOver-utilization in some hospitals50% insertions without proper indication50% continuation without proper indication30% of physicians unaware of patient status re: UcathHospital wide protocolsFor insertion, continuationComputerized chartingAllow nurse to remove

UTI AgentsPatient fecal flora in OP: Ecoli 80%Hospitalization: Shift to hospital floraKlebsiella, Pseudomonas, Proteus, Enterobacter, CandidaMore resistant strainsShift with duration ofCatheterHospitalizationNNIS E.coli

25%

Enterococci

16%

Pse.aeruginosa

11%

Candida 5%

Klebs.pneumo

7%

Enterobacter

5%Proteus 5%StaphCoagNeg 4%Staph.au 2%

Prevention

Appropriate Urinary Catether UseInsert ONLY for appropriate indicationsMinimize use and duration particularly in high risk patients:WomenElderlyImmuno-compromissedPost operative: Urologic surgeryLong duration surgery (remove as soon as possible)Monitoring of urinary output

Inappropriate Urinary Catether UseMANAGING INCONTINENCEPeriodic /night time may be OKObtaining urine for culture

Proper Technique for InsertionHand hygiene, standard precaution before and after insertionProper training of person performing insertion Aseptic technique and sterile equipment in acute careClean technique in LTCF for intermittent cathProperly secure cath after insertionUse smallest bore effective to minimize bladder neck and urethral traumaPrevent bladder distension with intermittent cath, Use ultra-sound to assess urine volume in intermittent cath

Proper Technique for InsertionReplace cath and collecting system if break in aseptic technique, disconnection or leakageMaintained unobstructed urinary flow:Avoid kinkingCollecting bag below bladder levelEmpty collecting bag regularly, prevent contact of drainage spigot with collecting containerChange cath on clinical indications, not routinely

Proper Technique for InsertionDo not use systematic antibiotic prophylaxisDo not clean peri-urethral areawith antiseptics while cath in placeNo bladder irrigation (except after bleeding after prostatic or bladder surgeryNo antiseptic or antimicrobial solutions in urinary drainage bag

Catether MaterialHydrophilic caths in patients requiring intermittent catetherizationSilicone to reduce risk of encrustation in long term cathy users with frequent obstruction

Specimen CollectionAspirate urine from needleless portwith a sterile syringe after cleansing the port with a disinfectantObtain large volumes aseptically from drainage bag – Not for culture