Biofilms

Now let’s explore some of the most difficult types of infections: those that are associated with biofilms. Earlier we discussed Proteus and Pseudomonas species, which are the bacteria most commonly associated with biofilms.

Biofilms consist of a protective coating which forms around bacteria, allowing protected growth. Biofilms are composed of host cells and cellular by-products and forms a coating around the bacteria and can be found on the inside and outside surfaces of the catheter. Biofilms seem to really like latex catheters.  Biofilms are also encountered in the management of chronic wounds.

They tend to attach to all catheter and drainage system equipment within hours of catheter insertion.

And they are resistant to antimicrobials and the host’s own defenses due to the protection of the biofilms, making them difficult to eradicate.

In addition, biofilms can cause encrustations which can result in catheter obstruction.

In order to eliminate biofilms the catheter must be removed.

Implementing best practice guidelines have been shown to prevent and reduce the risk of CAUTIs. This can include reviewing and preventing insertions for inappropriate indications and reducing the number of indwelling catheter days. We will outline the best practices that apply to all practice settings.

Keep in mind that we will used best practices as the basis for a “bundle” of interventions based on the idea that optimizing the use of urinary catheters can be accomplished through continual assessment and removal, as soon as feasible, based on evidence-based guidelines.

In a retrospective study of hospitalized patients with indwelling urinary catheters, 21% lacked documentation for an appropriate reason for catheter use, and 41-58% had catheters in place longer than necessary. All urinary catheter orders should be reviewed prior to insertion against a standardized list of appropriate indications. Nurses need to discuss with the prescriber what alternatives to catheterization exist when the appropriate indications for use are not met. All health care settings need to provide their patients with effective alternatives to indwelling urinary catheters and have them readily available. Catheters should remain in place only for as long as they are needed.

The main points then...

Rick Fields-Gardner