[Prevention of Catheter-Associated Urinary Tract Infections]

Abstract

With a share of 22.4%, nosocomial urinary tract infections (nUTIs) are among the most frequent infections acquired in hospitals, along with surgical site infections (24.7%), pneumonia (21.5%), clostridium difficile infections (6.6%) and primary sepsis (6%) 1. 80% of all nUTIs are associated with indwelling urinary catheters, with 12-16% of all hospitalised patients and up to 81.8% of all intensive care patients receiving an indwelling urinary catheter during their hospital stay 2 3. Therefore, profound knowledge about the basics of catheter-associated nUTIs and the correct management of urinary catheters are of utmost individual and socio-economic importance 4 5. It is estimated that up to 70% of all nUTIs occurring in Germany may be avoided by using appropriate preventative measures 6 7.In 2012, the authors Conway and Larson compared 8 recommendations in English language for the prevention of UTIs and noticed that they have been largely consistent over a period of 30 years 8. Special issues have rarely been addressed in valid studies, and study results are rather heterogeneous. For example, the 2008 SHEA (Society of Hospital Epidemiologists of America) guideline contains only 3 recommendations and 4 prohibitions which are based on more than one randomised controlled clinical study 9 10 11.The confirmed recommendations on the prevention of UTIs are consistent in the following aspects 12 13 14 15 16 17: · Every insertion of a urinary catheter must be based on a well-founded medical indication.. · Well-founded medical indications include acute urinary retention, interventions lasting several hours with a high fluid turnover, surgery involving the urinary tract, the necessity to record fluid turnover especially in critically ill patients, comfort for the dying, facilitating wound healing in the external genitals in the presence of urinary incontinence. Examples of unnecessary use of urinary catheters include prescriptions based on urinary incontinence alone and prolongation of use, e. g. after surgical procedures or after intensive care monitoring/recording has been completed.. · The insertion technique as well as catheter care and the detection of catheter-associated complications must be trained continuously.. · Catheterisation must be performed under sterile precautions.. · Only sterile and closed urinary drainage systems may be used.. · Catheters must be removed as early as possible..