2009 CAUTI guidelines - Centers for Disease Control and Prevention

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IV. Recommendations for Further ResearchOur literature review revealed that many of the studies addressing strategies to prevent CAUTIwere not of sufficient quality to allow firm conclusions regarding the benefit of certaininterventions. Future studies of CAUTI prevention should:1) Be primary analytic research (i.e. systematic reviews, meta-analyses,interventional studies, and observational studies [cohort, case-control, analyticcross-sectional studies])2) Evaluate clinically relevant outcomes (e.g., SUTI, bloodstream infectionssecondary to CAUTI)3) Adjust for confounders as needed using multivariable analyses4) Stratify outcomes by patient populations at risk for CAUTI5) Ensure adequate statistical power to detect differencesThe following is a compilation of recommendations for further research:1. Catheter materialsa. Antimicrobial and antiseptic-impregnated cathetersi. Effect of catheters on reducing the risk of SUTI and other clinicallysignificant outcomesii. Patient populations most likely to benefitiii. Incidence of antimicrobial resistance in urinary pathogensiv. Role of bacterial biofilms in the pathogenesis of CAUTIb. Standard cathetersi. Optimal materials for reducing the risk of CAUTI and other urethralcomplications2. Appropriate urinary catheter usea. Incontinent patientsi. Risks and benefits of periodic (e.g., nighttime) use of external cathetersii. Risk of local complications (e.g., skin maceration, phimosis) with the useof external cathetersiii. Appropriate use of urinary catheters to manage sacral or perineal woundsb. Appropriate indications for continued use in postoperative patients andassociated risks3. Antisepticsa. Use of antiseptic vs. sterile solutions for periurethral cleaning prior to catheterinsertionb. Use of antiseptics (e.g., methenamine) to prevent CAUTI4. Alternatives to indwelling urethral catheters and bag drainagea. Risks and benefits of suprapubic catheters as an alternative to chronic indwellingurethral cathetersb. Use of a urethral stent as an alternative to an indwelling catheter in selectedpatients with bladder outlet obstructionc. Use of catheter valves in reducing the risk of CAUTI and other urinarycomplicationsd. Other alternative methods of urinary drainage20
5. Optimal methods for preventing encrustation in long-term catheterized patients whohave frequent obstructiona. Optimal catheter materialsb. Irrigation with acidifying solutions or oral urease inhibitorsc. Use of methenamine6. Other prevention measuresa. Use of portable ultrasound in patients with low-urine output to reduceunnecessary catheter insertions or irrigations (in catheterized patients)b. Use of new prevention strategies such as bacterial interference in patientsrequiring chronic catheterizationc. Optimal cleaning and storage procedures (e.g., wet vs. dry storage) for cathetersused for clean intermittent catheterization7. Prevention of transmissiona. Spatial separation of patients with urinary catheters (in the absence of epidemicspread or frequent cross-infection) to prevent transmission of pathogenscolonizing urinary drainage systems21
Page 4 and 5: AcknowledgementHICPAC thanks the fo
Page 6 and 7: AbbreviationsADLAPACHE IIASAASBBUNC
Page 8 and 9: I. Executive SummaryThis guideline
Page 10 and 11: II. Summary of RecommendationsTable
Page 12 and 13: II. Proper Techniques for Urinary C
Page 14 and 15: 1. If obstruction is anticipated, c
Page 16 and 17: a. Procedure-specific guidelines fo
Page 18 and 19: III. Implementation and AuditPriori
Page 22 and 23: V. BackgroundUrinary tract infectio
Page 24 and 25: acteriuria inevitably occurs over t
Page 26 and 27: VII. MethodsThis guideline was base
Page 28 and 29: Figure 2: Results of the Study Sele
Page 30 and 31: After determining the GRADE of the
Page 32 and 33: Category I recommendations are defi
Page 34 and 35: VIII. Evidence ReviewQ1. Who should
Page 36 and 37: Evidence Review Table 1B. What are
Page 38 and 39: Very low-quality evidence suggested
Page 40 and 41: Q2B.2. Hydrophilic catheters vs. st
Page 42 and 43: For all comparisons, we considered
Page 44 and 45: a. Clamping vs. free drainage prior
Page 46 and 47: studies. 3,25,260-276 The findings
Page 48 and 49: 2D.5. Maintain unobstructed urine f
Page 50 and 51: 15. Jain P, Parada JP, David A, Smi
Page 52 and 53: 44. Chaudhuri P, Vengadasalam D. Ur
Page 54 and 55: 71. Kelleher RE, Meeropol E, Parks
Page 56 and 57: 101. Hirsh DD, Fainstein V, Musher
Page 58 and 59: 132. Van Nagell, JR, Penny RM, Rodd
Page 60 and 61: 163. Lai KK, Fontecchio SA, Lai KK,
Page 62 and 63: 193. Waites KB, Canupp KC, Armstron
Page 64 and 65: 222. Cohen A. A microbiological com
Page 66 and 67: 253. Chavigny KH. The use of polymi

2009 CAUTI guidelines - Centers for Disease Control and Prevention

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