2009 CAUTI guidelines - Centers for Disease Control and Prevention

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2D.5. Maintain unobstructed urine flow. (Category IB)2D.6. Further research is needed on the benefit of spatial separation of patients with urinarycatheters to prevent transmission of pathogens colonizing urinary drainage systems. (Norecommendation/unresolved issue)2D.7. When performing surveillance for CAUTI, consider providing regular (e.g., quarterly)feedback of unit-specific CAUTI rates to nursing staff and other appropriate clinical care staff.(Category II)Q3: What are the best practices for preventing UTI associated withobstructed urinary catheters?The available data examined the following practices:1. Methods to prevent/reduce encrustations or blockage2. Catheter materials preventing blockageFor this question, available relevant outcomes included blockage/encrustation. We did not finddata on the outcomes of CAUTI. The evidence for this question consists of 1 systematicreview, 277 2 RCTs, 278,279 and 2 observational studies. 280,281 The findings of the evidence reviewand the grades for all important outcomes are shown in Evidence Review Table 3.Q3.1. Methods to prevent/reduce encrustations or blockageLow-quality evidence suggested a benefit of acidifying solutions or oral acetohydroxamic acid inpreventing or reducing catheter encrustations and blockage in long-term catheterizedpatients. 277,278,280,281 No differences were seen with daily catheter irrigation with normal saline.Q3.2. Catheter materials preventing blockageLow-quality evidence suggested a benefit of silicone over latex or Teflon-coated catheters inprevention or reducing catheter encrustations in long-term catheterized patients who were proneto blockage. No differences were seen with different materials in patients considered “nonblockers.”279Evidence Review Table 3. What are the best practices for preventing UTI associated withobstructed urinary catheters?3.1.a. Further research is needed on the benefit of irrigating the catheter with acidifyingsolutions or use of oral urease inhibitors in long-term catheterized patients who have frequentcatheter obstruction. (No recommendation/unresolved issue)3.2.a. Silicone might be preferable to other materials to reduce the risk of encrustation in longtermcatheterized patients who have frequent obstruction. (Category II)48
References1. Wong ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control. 1983;11(1):28-36.2. Lo E, Nicolle L, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol.2008;29:S41-S50.3. Stephan F, Sax H, Wachsmuth M, Hoffmeyer P, Clergue F, Pittet D. Reduction of urinary tract infection and antibiotic use after surgery: A controlled,prospective, before-after intervention study. Clin Infect Dis. 2006;42(11):1544-1551.4. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: Nausea, vomiting, sedation, pruritis, and urinary retention. evidence frompublished data. Br J Anaesth. 2005;95(5):584-591.5. Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: Antimicrobial-resistant pathogens associated with healthcare-associated infections: Annualsummary of data reported to the national healthcare safety network at the centers for disease control and prevention, 2006-2007. Infect Control Hosp Epidemiol.2008;29(11):996-1011.6. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28(1):68-75.7. Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med. 1982;307(11):637-642.8. Givens CD, Wenzel RP. Catheter-associated urinary tract infections in surgical patients: A controlled study on the excess morbidity and costs. J Urol.1980;124(5):646-648.9. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control HospEpidemiol. 2002;23(1):27-31.10. Schaberg DR, Weinstein RA, Stamm WE. Epidemics of nosocomial urinary tract infection caused by multiply resistant gram-negative bacilli: Epidemiology andcontrol. J Infect Dis. 1976;133(3):363-366.11. Yoon HJ, Choi JY, Park YS, et al. Outbreaks of serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: Aclinical, epidemiologic, and laboratory perspective. Am J Infect Control. 2005;33(10):595-601.12. Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents. 2001;17(4):299-303.13. Weinstein JW, Mazon D, Pantelick E, Reagan-Cirincione P, Dembry LM, Hierholzer WJ,Jr. A decade of prevalence surveys in a tertiary-care center: Trends innosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epidemiol. 1999;20(8):543-548.14. Munasinghe RL, Yazdani H, Siddique M, Hafeez W. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. InfectControl Hosp Epidemiol. 2001;22(10):647-649.49
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 20 and 21: IV. Recommendations for Further Res
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 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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