UTI AND URINARY CATHETERS

Background and Aim : The most frequent hospital associated infection (HAI) is urinary tractinfection (UTI). Hospital associated UTI is linked with a urinary catheter in ۷۰-۸۰% of the cases.Therefore, strategies to reduce catheter associated UTI (CAUTI) are of most importance.Methods : The following questions should be answered on every patient with urinary catheter: thereal need for catheter insertion, duration, appropriate type and size of catheter. The followingconsiderations should also be followed: a proper technique of insertion, and proper maintenance.Results : The most important determining factor for the development of CAUTI is the duration ofcatheter maintenance. The risk of CAUTI is ۳-۷% daily and around ۱۰۰% after ۳۰ days. Internalcatheters should not be used to control incontinence in the elderly. Intermittent catheterization is abetter alternative for patients with bladder emptying problems. Using a sterile technique ofinsertion is an important key, however, the need for antiseptic cleaning of the meatus is notestablished. Using catheters and reservoirs with a closed system helps in reducing CAUTI and anybreak in the closed system necessitates the change of catheter with its reservoir. The benefit of bagirrigation and using antiseptics for the disinfection of reservoirs is not established. Using shorttime intervals for change of catheters is not recommended and is associated with increasedinfection rates in some studies. Indications for change of catheters include: obstruction, infection,and disrupted closed system. Antibiotics are not recommended routinely when inserting orchanging catheters. The use of complex drainage systems with antibiotics/valves is notrecommended and does not reduce symptomatic UTI. The use of silicone catheters is notassociated with less UTI but is associated with less encrustation and is used in cases of frequentobstruction.Conclusion : Key elements for the prevention of CAUTI are establishing a real need forcatheterization in candidates and using alternatives to internal catheters in selective patients,minimal duration of catheterization in case needed, using sterile technique of insertion andmaintainance of closed system. The use of expensive coated catheters or reservoir systems havenot been associated with reduced CAUTI in most studies.

کلیدواژه ها:

Urinary tract infection