The definition of catheter-associated urinary tract infections (CAUTI) according to the CDC is a UTI where an indwelling urinary catheter was in place for more than two calendar days on the date of event (day 1 being the day of device placement).
2. Burden of disease.
Catheter-associated urinary tract infections (CAUTI) are the most prevalent health-care associated infections (HAIs) accounting for one third (27%) of HAIs in developed countries according to the ECDCs annual report from 2008. The attributable mortality of CAUTI is low but the high frequency of catheter use in health care settings resulting in CAUTI, means that the burden of CAUTI is substantial with regard to prolonged hospital stays and increased antibiotic use. According to European studies, 15-25% of hospitalised patients and 5% of patients in elderly homes have a urinary catheter. More studies estimate that 41-58% of catheters in place are probably unnecessary. The risk for CAUTI increases by 5% for each day with a catheter. The annual costs for CAUTI accounts for £ 99 million every year (£ 1968 per episode) in the United Kingdom. A strong leadership and a systematic approach engaging all healthcare staff are crucial in order to achieve maximum effect.
3. How to prevent-specific requirements.
In addition to standard measures for the prevention of health-care associated infections (HAIs) described elsewhere up to 70% of CAUTI can be prevented by following evidence-based guidelines focusing on the catheter use . A bundling strategy using selected evidence based activities undertaken simultaneously, can reduce significantly the incidence of CAUTI as well as the use of urinary tract catheter-days. Such bundled actions should focus on five clearly defined activities [2-4]:
3.1 Avoid unnecessary urinary catheterisation.
Minimize urinary catheter use and consider alternatives, for example suprapubic catheters, intermittent catheterisation, external condom catheters for males and diapers. Avoid bladder distension. Use portable bedside ultrasound device to assess urine volume. Make the indication for the urinary catheters clear among doctors and nurses. Urinary catheterisation is indicated in the following cases:
Clearly document the clinical indication for the urinary catheter, the time and date of insertion, the expected duration, the type of catheter and drainage system. Also note the planned date of removal of the catheter and the reasons for keeping the catheter.
3.2 Selection of catheter-material and size.
Use as small a catheter as possible ensuring proper drainage, to minimize trauma and risk of infection.
3.3 Aseptic insertion techniques.
3.4 Aseptic maintenance routines.
3.5 Daily review of urinary-catheter.
Originally contributed by Birgitta Lytsy (Department of clinical microbiology and infection control, Uppsala University Hospital, Sweden)