Instructions
Take Another Course
|
•
Risk factors for CAUTI may be patient-related, or intrinsic or extrinsic risk factors influenced by healthcare provider behaviors. The most significant risk factor for CAUTI development is how long the catheter has been in place. The daily risk of bacteriuria when a catheter is in place is 3-10%. In one week, the risk is 25%, and by day 30, the risk is up to 100%![6] Anyone with a catheter will have bacteria in their urine and most will not have any signs or symptoms of infection. Other risk factors for developing CAUTI are seen listed below, and include gender (female), advanced age and related or unrelated decline in immunity, diabetes, dehydration, debilitation, renal insufficiency, fecal incontinence with inadequate hygiene, problems with insertion, and lack of adequate catheter maintenance.
Types of CAUTIs
The National Healthcare Safety Network, which is the surveillance division of the CDC, outlines diagnostic criteria for symptomatic urinary tract infection, asymptomatic bacteremic urinary tract infection, and other urinary tract infection, and is used primarily in the hospital setting for reporting. The SUTI criteria are presented in a decision tree format. The clinician selects whether the patient currently has a catheter in place or if the patient had a catheter removed within 48 hours. The decision tree then provides signs and symptoms prompts such as fever> 38 degrees C, suprapubic tenderness, costovertebral angle or “CVA” tenderness or pain, urinary symptoms, and urine culture findings.
Only 4-8% of the frail elderly demonstrate fever and/or urinary tract signs and symptoms when they have a UTI. More often there are signs of functional and cognitive decline and onset of new or worsening urinary incontinence.[7] Asymptomatic bacteremic urinary tract infections or “ABUTI” indicates that the bacteria present in the urine has spread to the bloodstream and the patient has none of the symptoms previously described and the patient may or may not have the urinary catheter in place when this situation occurs. Other urinary tract infections or “OUTIs” are infections of the kidneys, ureters or other tissues or structures that surround the urinary tract. Ascending infections increase the risk for kidney damage. If you are interested you can find these decision trees on the cdc.gov website. CAUTI criteria introduced by McGeer et al. for long term care includes: a currently catheterized patient with at least 2 of the following need to be present: fever>38 C or chills, flank, suprapubic pain or tenderness, change in the character of the urine (new hematuria, foul odor, increased sediment) or worsening functional or mental status.
Asymptomatic Bacteriuria (ASB)
If you care for older adults, asymptomatic bacteriuria (ASB) is a condition that you may frequently encounter. ASB is common in people over 65. The prevalence of bacteriuria in people residing in long term care without a catheter are 18-57% for women and 19-38% for men![8] A midstream urine specimen (2 consecutive specimens in women) with a single bacteria presence of more than 100,000 colony-forming units per milliliter can be diagnostic for ASB. Often this problem is misdiagnosed as UTI or CAUTI and the patient is subjected to unnecessary treatment, additional costs and the development of multi-drug resistant organisms. It is considered unnecessary to monitor and treat this condition since the intervention does not prevent future SUTI and is generally not associated with renal damage.[9] Care should be taken with appropriate clinical assessment skills to obtain accurate information and to substantiate a correct diagnosis. According to authors from the National Institutes of Health, “it is imperative to distinguish symptomatic UTI from asymptomatic bacteriuria,” and that treatment of ASB, “increases the rate of adverse drug effects from the use of antimicrobial medicines; increases the rate of recurrent infections with multi-drug resistant (MDR) bacteria; and doesn’t change survival, chronic genitourinary symptoms, or the rate of SUTI.” The Infectious Diseases Society of America (IDSA) recommends against treatment of ABS.
6. Citation: Pennsylvania Department of Health Services: Criteria for symptomatic urinary tract infection (SUTI). Available at: http://www.dsf.health.state.pa.us/health/lib/health/haip/hospital/nhsn_suti_criteria_update_2009-01.pdf 7. Citation: CDC. Surveillance for urinary tract infection. Document links. Available at: http://www.cdc.gov/nhsn/inpatient-rehab/cauti/index.html 8. Citation: Genao L, Buhr GT. Urinary tract infections in older adults residing in long-term care facilities. Ann Longterm Care. 2012;20(4):33-38. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573848/ 9. Citation: Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin N Am. 2003;17:367-394. Available at: http://medicina.iztacala.unam.mx/medicina/Asymptomatic%20bacteriuria.pdf Rick Fields-Gardner |
.h2.jpg)
