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UTI Prevention

UTI Prevention. Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals (504) 219-4563 *** 800-256-2748 www.infectiousdisease.dhh.louisiana.gov Your taxes at work. Source of Infection. Normal Bladder. Bladder content sterile

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UTI Prevention

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  1. UTI Prevention Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals (504) 219-4563 *** 800-256-2748 www.infectiousdisease.dhh.louisiana.gov Your taxes at work

  2. Source of Infection

  3. Normal Bladder • Bladder content sterile • Micturition empties bladder completely • Exfoliation of urethral cells pushes microbes out • Any interference will increase risk of infection

  4. Urinary Catheter Risks • Catheter • Breaches barrier • Balloon prevents complete emtying • Distends bladder • Pool of urine • Condom catheter • Warm moist conditions inside  high inoculum • Travel upwards • Closed systems • Never completely closed • Bag may have high counts • Travel upwards

  5. Source of bacteria Extra-luminal • Endogenous: meatal, rectal or vaginal colonization • Exogenous: • Contaminated hands of HCP • Contaminated equipment • Use of closed sterile urinary drainage system led to marked reduction in bacteriuria risk  implying importance of intraluminal route • BUT even with closed system UTI do occur  extra-luminal route cannot be eliminated Intra-luminal

  6. Microbe Migration • Microbes migrate • Up lumen: even non-motile bacteria • Up external surface of catheter • Biofilm= matrix of polysacharides • with encased bacteria, up to 4 spcies (usually 1 in urine) • Microcolonies • Water channels • Bacteria in biofilms express different genes • Increase production of extracell polymeric substance (EPS) • 50-90% of biofilm mass • Biofilms • Poor antibiotic diffusion • Slow bacterial multiplication • Less effectiveness of antibiotics

  7. Asymptomatic Bacteriuria • Clinical significance of ASB in catetherized patients undetermined • 75-90% of ASB in catetherized patients never develop SUTI • Monitoring and treatment of ASB does not reduce SUTI incidence • Most SUTI are not preceded by bacteriuria

  8. Personal Risk Factors • Female • Advanced age • Duration • Diabetes • Renal insufficiency (Creatinine > 2mg/dL)

  9. Incidence • Most common in • Acute and long term care • Pediatric and geriatric populations • Urinary instrument: catheter • Incidence function of duration • 1-5% per day • Almost 100% after 30 days • Prevalence in LTCF 5% at any time

  10. Urinary Catheter Use • Used in about • Wards: 10% pf patients days • ICU: 50% pf patients days • Over-utilization in some hospitals • 50% insertions without proper indication • 50% continuation without proper indication • 30% of physicians unaware of patient status re: Ucath • Hospital wide protocols • For insertion, continuation • Computerized charting • Allow nurse to remove

  11. Patient fecal flora in OP: Ecoli 80% Hospitalization: Shift to hospital flora Klebsiella, Pseudomonas, Proteus, Enterobacter, Candida More resistant strains Shift with duration of Catheter Hospitalization NNIS E.coli 25% Enterococci 16% Pse.aeruginosa 11% Candida 5% Klebs.pneumo 7% Enterobacter 5% Proteus 5% StaphCoagNeg 4% Staph.au 2% UTI Agents

  12. Prevention

  13. Appropriate Urinary Catether Use • Insert ONLY for appropriate indications • Minimize use and duration particularly in high risk patients: • Women • Elderly • Immuno-compromissed • Post operative: • Urologic surgery • Long duration surgery (remove as soon as possible) • Monitoring of urinary output

  14. Inappropriate Urinary Catether Use • MANAGING INCONTINENCE Periodic /night time may be OK • Obtaining urine for culture

  15. Proper Technique for Insertion • Hand hygiene, standard precaution before and after insertion • Proper training of person performing insertion • Aseptic technique and sterile equipment in acute care • Clean technique in LTCF for intermittent cath • Properly secure cath after insertion • Use smallest bore effective to minimize bladder neck and urethral trauma • Prevent bladder distension with intermittent cath, Use ultra-sound to assess urine volume in intermittent cath

  16. Proper Technique for Insertion • Replace cath and collecting system if break in aseptic technique, disconnection or leakage • Maintained unobstructed urinary flow: • Avoid kinking • Collecting bag below bladder level • Empty collecting bag regularly, prevent contact of drainage spigot with collecting container • Change cath on clinical indications, not routinely

  17. Proper Technique for Insertion • Do not use systematic antibiotic prophylaxis • Do not clean peri-urethral areawith antiseptics while cath in place • No bladder irrigation (except after bleeding after prostatic or bladder surgery • No antiseptic or antimicrobial solutions in urinary drainage bag

  18. Catether Material • Hydrophilic caths in patients requiring intermittent catetherization • Silicone to reduce risk of encrustation in long term cathy users with frequent obstruction

  19. Specimen Collection • Aspirate urine from needleless portwith a sterile syringe after cleansing the port with a disinfectant • Obtain large volumes aseptically from drainage bag – Not for culture

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