Interventions to prevent urinary catheter–associated infections in children and neonates: a systematic review

Silva, André Ricardo Araújo da; Marques, Amanda; Biase, C Biscaia di; Zingg, Walter; Dramowski, Angela

doi:10.1016/j.jpurol.2018.07.011

Cited by 10 publications

(2 citation statements)

References 26 publications

(51 reference statements)

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“…[5,7] Risk management strategies include minimizing the time a patient spends catheterized and avoiding IUC in the absence of a clear indication. [8,9] During medical and surgical procedures that require general anesthesia and IUC, patients often have the urinary catheter removed immediately after the procedure is completed. This has successfully reduced the rates of UTI associated with these procedures.…”

Section: Introductionmentioning

confidence: 99%

Avoiding Urinary Catheterization in Patients Undergoing Atrial Fibrillation Catheter Ablation

Lehman

Ahmed

Patel

2019

Journal of Atrial Fibrillation

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Indwelling urinary catheters are commonly inserted when administering general anesthesia. However, there are significant risks to routine IUC insertion. We compared urinary and other outcomes in a population of patients undergoing atrial fibrillation (AF) ablation with or without IUC. Methods: This was a single center, retrospective review of patients undergoing AF ablation. Patients were identified by procedure codes and patient health characteristics and outcome data were manually extracted from electronic health records. The primary composite endpoint was 7-day periprocedural urinary outcomes including cystitis, dysuria, hematuria, urethral damage, or urinary retention. Results: 404 patients were included in the study, 297 with IUC and 107 without IUC. Uncatheterized patients were less likely to have congestive heart failure (CHF) (31.8% vs 43.4%; P = 0.039) and had a shorter procedure length (4.2 vs 4.9 hours; P < 0.001) with less fluid administered (1485 vs 2040 mL; P < 0.001). No urinary complications occurred in the uncatheterized group versus 14 in the catheterized group (P = 0.026). 3 patients in the uncatheterized group developed serious infections versus none in the catheterized group (P = 0.018). There was no incidence of death and no statistically significant difference in readmission in the 30 days after procedure. Conclusions: There were no urinary complications in 107 patients who received no IUC during AF ablation. Avoiding bladder catheters during AF ablation procedures may lower incidence of adverse urinary complications without adding substantial risk of urinary retention.

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Section: Introductionmentioning

confidence: 99%

Avoiding Urinary Catheterization in Patients Undergoing Atrial Fibrillation Catheter Ablation

Lehman

Ahmed

Patel

2019

Journal of Atrial Fibrillation

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“…2 CAUTI prevention guidelines have been developed; however, their applicability to pediatric populations are unclear because supporting data and validation studies come primarily from adult populations. [3][4][5][6][7] In general, the prevention of CAUTIs in adult populations focuses on judicious catheter use as well as proper aseptic practices for catheter insertion and maintenance. [8][9][10] To reduce CAUTIs, adult hospitals have adopted strategies to limit urinary catheter use and to promote early catheter removal and Dr Foster contributed to the study design, participated in the catheter-associated urinary tract infection (CAUTI) engagement efforts and interpretation of data, drafted the initial manuscript, and reviewed and revised the manuscript; Ms Ackerman and Ms Wenthe contributed to the study design, participated in the CAUTI engagement efforts and interpretation of data, helped draft the initial manuscript, and reviewed and revised the manuscript; Drs Hupertz and Sanders contributed to the study design, participated in the CAUTI engagement efforts, and reviewed and revised the manuscript; Ms Mustin and Ms Sisson helped design the study, coordinated CAUTI engagement efforts, maintained the database, performed statistical analyses, and contributed to and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.…”

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confidence: 99%

Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network

et al. 2020

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BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals.METHODS: Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS:After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively.CONCLUSIONS: IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.

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Monitoring of micturition and bladder volumes can replace routine indwelling urinary catheters in children receiving intravenous opioids: a prospective cohort study

et al. 2020

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In this prospective observational study, the incidence, risk factors and the time to event of urinary retention in children receiving intravenous opioids were evaluated. Urinary retention was confirmed by ultrasound following the inability to void for 8 h or earlier in patients experiencing discomfort. In total, 207 opioid episodes were evaluated, of which 199 (96.1%) concerned morphine, in 187 children admitted to the pediatric ward or pediatric intensive care unit. The median age was 7.6 years (IQR 0.9–13.8), and 123 (59.4%) were male. The incidence of urinary retention was 31/207 (15.0%) opioid episodes, in which 14/32 (43.8%) patients received continuous sedation for mechanical ventilation and 17/175 (9.7%) received no sedation. Multivariable logistic regression analysis showed a significant association with continuous sedation (OR 6.8, 95% CI 2.7–17.4, p 0.001) and highest daily fluid intake (OR 0.8 per 10% deviation of normal intake, 95% CI 0.7–0.9, p 0.01). Opioid dosage, age and gender were not significantly associated. Most events (28/31, 90.3%) occurred within 24 h.Conclusion: The incidence of urinary retention in children receiving intravenous opioids is low, indicating that placement of urinary catheters is not routinely necessary in these patients. However, micturition and bladder volumes must be monitored, especially in sedated children and during the first 24 h of opioid administration. What is Known:• Great variation exists in the routine placement of urinary catheters in children receiving IV opioids. What is New:•Confirmed by ultrasound, the incidence of urinary retention in children receiving intravenous opioids in this study was 15%, indicating that placement of urinary catheters is not routinely necessary in these patients.•Children receiving continuous sedation for invasive mechanical ventilation showed a sevenfold greater risk of developing urinary retention than non-sedated patients.

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Interventions to prevent urinary catheter–associated infections in children and neonates: a systematic review

Abstract: Evidence exists to support the use of a multimodal strategy for CAUTI reduction in hospitalized children and neonates.

Cited by 10 publications

References 26 publications

Avoiding Urinary Catheterization in Patients Undergoing Atrial Fibrillation Catheter Ablation

Avoiding Urinary Catheterization in Patients Undergoing Atrial Fibrillation Catheter Ablation

Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network

Monitoring of micturition and bladder volumes can replace routine indwelling urinary catheters in children receiving intravenous opioids: a prospective cohort study

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