Office of Public Health Louisiana Dept of Health amp Hospitals 504 2194563 8002562748 wwwinfectiousdiseasedhhlouisianagov Your taxes at work Source of Infection Normal Bladder Bladder content sterile ID: 707428
Download Presentation The PPT/PDF document "UTI Prevention Infectious Disease Epide..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
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
Your taxes at workSlide2
Source of InfectionSlide3
Normal BladderBladder content sterileMicturition empties bladder completelyExfoliation of urethral cells pushes microbes outAny interference will increase risk of infectionSlide4
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 upwardsSlide5
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
-luminalSlide6
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 antibioticsSlide7
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 bacteriuriaSlide8
Personal Risk FactorsFemaleAdvanced ageDurationDiabetesRenal insufficiency (Creatinine > 2mg/dL)Slide9
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 timeSlide10
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 removeSlide11
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%Slide12
PreventionSlide13
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 outputSlide14
Inappropriate Urinary Catether UseMANAGING INCONTINENCEPeriodic /night time may be OKObtaining urine for cultureSlide15
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 cathSlide16
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 routinelySlide17
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 bagSlide18
Catether MaterialHydrophilic caths in patients requiring intermittent catetherizationSilicone to reduce risk of encrustation in long term cathy users with frequent obstructionSlide19
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