Catheter-associated urinary tract infections are commonly reported health care-associated infections. It was demonstrated that the urinary catheter alleviation navigator protocol (UCANP) pilot ...resulted in a reduction of catheter utilization and catheter days.
Quality improvement initiative that was implemented at a single urban, tertiary health care center, focusing on early discontinuation of indwelling urinary catheters (IUCs) and avoidance of reinsertion. The protocol was expanded hospital-wide from September 2020 to April 2022. We compared IUC utilization, IUC standardized utilization ratio (SUR), and catheter-associated urinary tract infection standardized infection ratio in the preintervention period (March 2020 to August 2020) to the postintervention period (May 2022 to October 2022).
Preimplementation, 2 patients with IUC removal were placed on UCANP. Postimplementation, 835 (45%) patients with IUC removal participated in the protocol. The number of patients requiring IUC reinsertion did not differ among the 2 groups. IUC utilization was significantly decreased from 0.28 to 0.24 with a 14% reduction (P = .025). SUR decreased by 11% from 0.778 to 0.693 (P = .007) and standardized infection ratio by 84% from 0.311 to 0.049 (P = .009).
Our protocol significantly reduced IUC utilization and SUR after hospital-wide implementation. UCANP is a safe and effective strategy that can potentially decrease unnecessary IUCs in patients with transient urinary retention.
•UCANP significantly reduced IUC utilization after hospital-wide implementation.•CAUTI rate was decreased when combining UCANP with other interventions.•UCANP is a safe and effective approach to managing transient urinary retention.
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•Pal/Zn(OH)2 nanocomposites were prepared for antibacterial coating of urinary catheter.•Catheter coated with Pal/Zn(OH)2 exhibited excellent antibacterial properties.•Catheter coated ...antibacterial materials presented the good biocompatibility.•It provides a simple strategy to resolve catheter-related urinary tract infections.
Catheter-associated urinary tract infections are the most common health care-associated infection in worldwide hospitals, which exacerbates the antibacterial resistance and the morbidity. The antibacterial materials composed of Zn(OH)2 and palygorskite were prepared by co-precipitation method for antibacterial coating of catheter in this study. The changes of surface morphology of catheter before and after coating confirmed that the antibacterial materials have been successfully coated on the catheter surface. This coating presented excellent antibacterial properties and a significant inhibitory effect on Escherichia coli and Staphylococcus aureus for at least seven days. Furthermore, it also exhibited a stronger ability to resist the formation of biofilm than the untreated catheters, and the biocompatibility to human bladder epithelial immortalized cells and the toxicity to human erythrocytes also were within acceptable limits. Therefore, this study is expected to provide a feasible and facile strategy to improve the antibacterial performance and biocompatibility of the untreated catheter preventing from bacterial resistance and catheter-associated urinary tract infections.
Urinary tract infections due to the presence of a urinary catheter represent a real problem for patients who have to carry such an invasive device for a long time.Our aim was to identify the ...susceptibility of extended spectrum beta lactamases (ESBL) versus non-ESBL bacteria to antibiotics in urinary tract infections in patients who are chronic carriers of urinary catheters.The retrospective study included a period of 5 years, a total of 405 patients who are chronic carriers of urinary catheters, admitted to rehabilitation and palliative care units.Escherichia coli (E coli) was isolated in 41.2% of patients, Klebsiella pneumoniae (K pneumoniae) in 24.7%, and Proteus mirabilis (P mirabilis) in 15.3%. E coli microbial resistance rates ranged from a minimum of 7.5% (nitrofurantoin) to a maximum of 77.1% (ampicillin). In the case of K pneumoniae, microbial resistance ranged from 34.2% (netilmicin) to 73.2% (ceftriaxone). Resistance rates of P mirabilis ranged from 11.1% (cefepim) to 89.5% (ampicillin). Positivity of ESBL bacteria was identified in 47.4% of patients. Resistance rates of ESBL-positive E coli ranged from 50.0% (ceftriaxone) to 88.1% (cefepime), and ESBL-negative E coli rates ranged from 3.4% (cefepime) to 64.4% (amikacin). Resistance rates of ESBL-positive K pneumoniae ranged between 39.1% (netilmicin) and 85.1% (ceftriaxone), and ESBL-negative K pneumoniae between 7.1% (cefepime) and 53.3% (amikacin). In cases of ESBL-positive P mirabilis, rates ranged from 13.3% (cefepime) to 90.3% (ceftriaxone), whereas in cases of ESBL-negative P mirabilis, rates ranged between 8.3% (cefepime) and 80.0% (trimetroprim).Bacteriuria and asymptomatic catheter infection in chronic carriers is an important public health concern due to the frequent presence of multidrug-resistant bacteria. Our study highlights the need to develop control programs of catheter infections to minimize the risk of infections associated with these medical devices, and also the need for treatment of the infection rather than catheter colonization or contamination.
During laparoscopic inguinal hernia repair (LIH) repair, it is common practice to insert a urinary catheter (UC) to mitigate the risk of bladder injury or acute postoperative urinary retention. ...However, this procedure often leads to potential complications or infections. This study aims to evaluate the implications of the UC placement during LIH repair.
This retrospective, monocentric study included patients who underwent LIH repair between 01/01/2018 to 31/12/2022. Patients were divided into two groups: UC and no-UC.
212 patients were included: 119 (56 %) in the no-UC group and 93 (44 %) in the UC group. The UC group presented a higher prevalence of bilateral hernias (38.7 % vs. 52.7 %), (p=0.01) and a greater frequency of intraperitoneal approach (TAPP) (83.9 % vs. 100 %), (p=0.01). No intraoperative complications were attributable to the absence of the UC. Four patients in the UC group had postoperative acute urinary retention necessitating intermittent catheterization, allowing discharge (p = 0.13). Rates of readmission and reoperation rates were comparable between groups. One month post-surgery, 7.5 % of UC group patients (vs. 0.8 %) developed urinary tract infection (p=0.01). Subgroup analysis confirmed a higher incidence of urinary tract infections in unilateral hernia and in TAPP procedure.
Routine UC insertion during LIH repair seems unnecessary; rather, it increases the risk of postoperative urinary tract infections and should thus be avoided.
•Lack of knowledge among intensive care nurses about how to secure a urinary catheter may pose certain risks to patients.•Specific and detailed training in how to secure a urinary catheter is needed ...to ensure safe and standardised procedures.•Clinical practice guidelines must provide clear instructions on how to secure urinary catheters in intensive care.
To explore the knowledge and beliefs of intensive care nurses about urinary catheter securement.
A self-report survey tool comprising 19 questions (15 closed, 4 open-ended) was developed through consultation with a panel of experts and then disseminated electronically to nurse members of two societies for critical care medicine and nursing in Spain. Responses were analysed by calculating descriptive statistics and through qualitative analysis.
Nurses' self-reported knowledge and beliefs about urinary catheter securement in the intensive care patient.
Responses of 333 nurses were analysed. Most respondents considered that urinary catheter securement was beneficial for patients (n = 261, 78.4 %) and that it reduced the risk of both meatal pressure injury (n = 266, 79.9 %) and accidental tugging (n = 304, 91.3 %). Regarding the securement procedure, less than a quarter of nurses mentioned the use of barrier film to protect the skin at the securement site (n = 62, 18.6 %) or the need to leave slack in the tube to avoid tugging (n = 45, 13.5 %). Qualitative analysis of responses to open-ended questions revealed that some nurses believed that catheter securement was contraindicated due to the risk of skin injury, or that it interfered with some aspects of basic care, thus increasing their workload.
There appears to be a lack of knowledge among Spanish intensive care nurses about recommended procedures for securing a urinary catheter. Clear and concise guidelines for the intensive care setting are required to ensure safe and standardised practice without creating additional burden for nurses.
Lack of knowledge among intensive care nurses about how to secure urinary catheters may pose certain risks to patients, therefore specific training in how to secure a urinary catheter is needed.
Urinary catheters have been used for more than 3000 years, although materials have changed from wood to silver to rubber. Research continues to try and find the optimal catheter materials, which ...improve safety and quality of life. Advantages when comparing newer catheter materials are not always obvious but catheters coated with a hydrophilic layer may reduce urethral trauma and the incidence of urinary tract infections. However, extrapolation of the data is limited by lack of end-point standardization and heterogenous populations.
Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking.
To decrease urinary catheterization and, consequently, ...catheter-associated urinary tract infections (CAUTIs) and non-infectious complications.
Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation).
In total, 25,880 patients were included in this study 13,171 at baseline (August–October 2016) and 12,709 post intervention (August–October 2017). Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001).
A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.
The bacterium Escherichia coli is one of the main causes of urinary tract infections. The formation of bacterial biofilms, especially associated with the use of urinary catheters, contributes to the ...establishment of recurrent infections and the development of resistance to treatment. Strains of E. coli that produce extended-spectrum beta-lactamases (ESBL) have a greater ability to form biofilms. In addition, there is a lack of drugs available in the market with antibiofilm activity. Promethazine (PMZ) is an antihistamine known to have antimicrobial activity against different pathogens, including in the form of biofilms, but there are still few studies of its activity against ESBL E. coli biofilms. The aim of this study was to evaluate the antimicrobial activity of PMZ against ESBL E. coli biofilms, as well as to assess the application of this drug as a biofilm prevention agent in urinary catheters. To this end, the minimum inhibitory concentration and minimum bactericidal concentration of PMZ in ESBL E. coli strains were determined using the broth microdilution assay and tolerance level measurement. The activity of PMZ against the cell viability of the in vitro biofilm formation of ESBL E. coli was analyzed by the MTT colorimetric assay and its ability to prevent biofilm formation when impregnated in a urinary catheter was investigated by counting colony-forming units (CFU) and confirmed by scanning electron microscopy (SEM). PMZ showed bactericidal activity and significantly reduced (p < 0.05) the viability of the biofilm being formed by ESBL E. coli at concentrations of 256 and 512 μg/ml, as well as preventing the formation of biofilm on urinary catheters at concentrations starting at 512 μg/ml by reducing the number of CFUs, as also observed by SEM. Thus, PMZ is a promising candidate to prevent the formation of ESBL E. coli biofilms on abiotic surfaces.
•Promethazine has bactericidal activity against ESBL E. coli strains.•Promethazine in vitro reduces ESBL E. coli biofilm formation.•Promethazine prevents ESBL E. coli biofilm formation in urinary catheters.
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases ...Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
•Urinary catheterization is vital for individuals who cannot empty their bladder.•During the Coronavirus disease 2019 (COVID-19) pandemic process, YouTube videos are one of the important resources ...for nursing students.•Application errors in YouTube videos can cause irreversible misapplications in students.
Psychomotor skill competence is an important factor in nursing practices. YouTube videos connect theory and practice, thereby consolidating learning. This article describes the findings of a study to evaluate the quality of videos on urinary catheter insertion and removal on the video sharing site YouTube(www.youtube.com). Videos were evaluated with the “Urinary Catheterization Checklist,” “Remove Urinary Catheter Check List” and “Evaluation of Video Media Guidelines.” This study initially evaluated 653 YouTube videos, and following the implementation of exclusion criteria, analyses were made of a total of 242 videos, as 146 videos about urinary catheter insertion and 96 videos about urinary catheter removal. Although there are high quality videos on YouTube about urinary catheter insertion and removal, the number of low quality videos is high. Therefore, universities and hospitals should be encouraged to produce high-quality videos to provide accurate and unbiased information. In addition, students should be given a critical perspective so that they can evaluate the quality of the videos they watch.
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