Enhancing the Safety of Critically Ill Patients by Reducing Urinary and Central Venous Catheter-related Infections

Abstract

Indwelling urinary and central venous catheters are commonly used in the care of critically ill patients. Though both types of devices provide important clinical benefits, they are also the leading causes of nosocomial infection in the intensive care unit (ICU). Enhancing the safety of critically ill patients requires that critical care specialists be aware of the proven methods for preventing urinary catheter-related and central venous catheter-associated infection. To this end, we provide a concise evidence-based overview of preventive methods for both urinary and central venous catheter-related infection. The objective of this update is to consider the evidence supporting specific preventive methods, devoting more attention to recently evaluated interventions and to interventions that many consider controversial (e.g., silver alloy urinary catheters, antimicrobial central venous catheters). Several recent evidence-based reviews provide additional details about the risk factors, microbiology, and pathophysiology of each infection, and provide a more comprehensive review of all the potential preventive methods (1-3). This review is derived from the evidence report produced by the Evidence-Based Practice Center at the University of California at San Francisco-Stanford University, under contract with the Agency for Healthcare Research and Quality (4, 5). URINARY CATHETER-RELATED INFECTIONSCatheter-related urinary tract infection (UTI) is the most common nosocomial infection seen in medical ICUs in the U.S., accounting for 31% of nosocomial infections (6). The daily incidence of bacteriuria in catheterized patients is approximately 3-10% (7). Among patients with bacteriuria, up to 25% will develop symptoms of local UTI, and about 3% will develop bacteremia (7). Each episode of hospital-acquired symptomatic catheter-related UTI costs an additional US $676, and each episode of catheter-related nosocomial bacteremia costs a minimum of US $2,836 (7).The best strategy to prevent nosocomial UTI is to avoid catheterization. Unfortunately, unjustified and excessively prolonged catheter use is common, even in the critically ill (8). Jain and coworkers found that initial catheter insertion was unjustified in 13% of 135 catheterized patients in a medical ICU; continued catheter use was deemed inappropriate for 41% of catheterized patient-days (8). The most common reason for inappropriate catheter use among these medical ICU patients was for close monitoring of urine output; however, the investigators found that often there was no longer a clinically appropriate indication for close urine output monitoring or that an indwelling catheter was not required for this purpose (8). Closed Drainage Systems and Use of Aseptic Insertion TechniquesThe use of proper insertion and maintenance techniques is paramount. The most important infection control advance in urinary catheter-related infection prevention was the introduction approximately four decades ago of the closed catheter drainage system. Maintenance of a closed system includes ...

Letter to the Editor: Shaving

“…The incidence of HAI in ICU patients has been estimated to be as high as 30 percent, 10 and 25 percent of all HAIs are estimated to occur in ICU patients. 11 Surgical site infections (SSI) and three other types of infections commonly seen in ICU patients-central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP)-account for more than 80 percent of all HAIs. 10 Data on the incidence of HAIs in U.S. hospitals primarily comes from the CDC's National Nosocomial Infection Surveillance System (NNIS).…”

“…It is estimated that one of the two types of infection above (exit-site infection or CLABSI) occur in 3-7 percent of catheters, 21 resulting in approximately 80,000 episodes of CLABSI in the U.S. every year. 11 Most of these infections occur in patients with temporary central venous catheters, often placed in ICU patients. CLABSI are estimated to result in an absolute increase in mortality of 10-30 percent for ICU patients, 10,22,23 and the total yearly costs to the U.S. health care system are between $300 million and $2 billion.…”

Evaluation of an Infection Control Measures Protocol Application by Nurses on Patients' Safety at Burn Units

“…Healthcare-Associated Infection (HAI) has become a major component of the national and international movement to enhance patient safety [3,4]. Moreover, the Institute of Medicine report recommended immediate and strong mandatory reporting of other adverse health events, suggesting that public monitoring may hold healthcare facilities more accountable to improve the quality of medical care and to reduce the incidence of infections [5].…”

“…Hence, nurses should receive additional infection control training and periodic evaluations of aseptic care as a planned patient safety activity [14]. This is of particular importance in burn units [4].…”

Generating Evidence Based Interpretation of Hematology Screens via Anomaly Characterization

“…The risk of serious complications due to HAIs is particularly high for patients requiring intensive care [3,4]. Preventing HAIs is one of 20 Priority Areas for National Action [5], and resulted in preventive measures tied to financial reimbursement.…”