Prevention of catheter associated urinary tract infections Dr. Suzan Sanavi, Nephrologist, M.D University of Social Welfare and Rehabilitation Akhavan Physical Spine Center
INTRODUCTION Urinary bladder catheters are used for urine drainage or as a means to collect urine for measurement. Many clinical situations are appropriate for the placement of indwelling urethral catheters, but too frequently they are used without proper indication or continued longer than needed. Daily evaluation of the ongoing need for the indwelling catheters with removal when not longer indicated is essential to reduce complications.
GENERAL COMPLICATIONS *Bacteriuria and urinary tract infection The presence of bacteria in the urine is almost universal in patients with catheters in place for over one week. Rates vary depending upon the type of catheter and duration of use. Recurrent urinary tract infections as a result of chronic catheter use can lead to acute or chronic pyelonephritis, or bladder cancer.
*Epididymitis Urethral instrumentation can cause epididymitis which may rarely disseminate to the testes as orchitis. *Bladder fistula The presence of air or feces in the urine may indicate the formation of a fistula. Fistulas can occur between the bladder and intestine,or vagina. They more likely occur in prolonged catheterization with risk factors including malignancy. *Bladder perforation *Bladder stone formation
COMPLICATIONS SPECIFIC TO TYPE OF CATHETER *Condom catheters Most complications related to condom catheter usage are due to improper or prolonged application, and inadequate monitoring of the device when in place. Most complications are minor and self limited; however, significant penile injury resulting in scarring and deformity can occur. Pressure effects can lead to skin depigmentation can occur particularly in patients with underlying dermatologic conditions.
*Urethral catheters Traumatic urethral catheter placement can lead to urethral injury. Inflammation and infection of the periurethral soft tissues may create an abscess. Incontinence can occur due to catheterization and is also related to urethral sphincter dysfunction. *Suprapubic catheters Complications associated with initial placement include cutaneous or bladder bleeding and bowel injury, which is more common if suprapubic catheter placement is attempted when the bladder is not fully distended.
PREVENTION OF COMPLICATIONS Appropriate urinary catheter implementation and management can reduce the incidence of complications. The most effective strategies to reduce infectious complications of urinary catheters are avoidance of unnecessary catheterization, and catheter removal when the catheter is no longer indicated. Adherence to a protocol for indwelling catheter placement, care, and removal can reduce the incidence of urinary tract infection and other complications.
Measures which help prevent complications associated with urinary catheters include: Use of urinary catheters only for appropriate indications. Considering alternatives to indwelling urethral catheters. Provision of adequate training to medical staff, patients, and other caregivers on catheter placement and management. Removal of catheters when no longer indicated. Not routinely replacing urethral catheters.
Specific measures to prevent catheter associated urinary tract infection include: Using a continuously closed drainage system. Not routinely irrigating catheters; catheters are irrigated only under select circumstances.
RECOMMENDATIONS The most effective strategy to reduce complications of urinary bladder catheters is the avoidance of unnecessary catheterization. When urinary bladder catheters are required, adequate training of the patient, hospital personnel, and caregivers is essential to avoid complications related to placement, ensure proper care, and to promptly recognize and treat complications expeditiously when they do occur. The most common complication of urinary bladder catheters is catheterassociated urinary tract infection. In males, urinary infection can lead to epididymitis or orchitis. Other rare complications of indwelling catheters include urinary tract obstruction from retained balloon fragments, bladder fistula, bladder perforation, or bladder stone formation.
The most common complication of urinary bladder catheters is catheter-associated urinary tract infection. In males, urinary infection can lead to epididymitis or orchitis. Other rare complications of indwelling catheters include urinary tract obstruction from retained balloon fragments, bladder fistula, bladder perforation, or bladder stone formation.