Indwelling Urinary Catheters: A Pathway to Health Care–Associated Infections

Orthostatic Intolerance Following Posterior Lumbar Interbody Fusion: Incidence, Risk Factors, and Impact on Postoperative Recovery - A Prospective Cohort Study

BACKGROUND CONTEXT

Despite the well-established consensus about the importance of early ambulation, the causes of orthostatic intolerance and its impact on patient recovery after posterior lumbar interbody fusion (PLIF) remain poorly understood.

PURPOSE

To determine the incidence of orthostatic intolerance and relevant risk factors after PLIF in an enhanced recovery after surgery (ERAS) program.

STUDY DESIGN

A prospective observational cohort study.

PATIENT SAMPLE

This study investigated perioperative data collected from 378 patients who underwent PLIF at one center between September 2023 and July 2024.

OUTCOME MEASURE

Patients' postoperative orthostatic intolerance symptoms were recorded and graded by a standardized evaluation scale. The occurrence of any symptom that resulted in termination of ambulation (dizziness, nausea, vomiting, a feeling of heat, visual disturbances, hypotension, and syncope) was classified as orthostatic intolerance.

METHODS

Possible risk factors were identified through univariate and multivariate analysis. The length of postoperative hospitalization, catheterization, and ambulation delay in orthostatic intolerance patients versus orthostatic tolerant patients was compared.

RESULTS

For orthostatic intolerance patients, the median time to first attempted ambulation was 26.0 (IQR: 20.8-31.2) hours after surgery. Overall, the observed incidence of orthostatic intolerance was 15.3%. Univariate analysis showed that a higher incidence of orthostatic intolerance was associated with history of orthostatic intolerance (6 vs 13, P=0.044), low hemoglobin on postoperative day 1 (103.8±14.8g/L vs 110.7±13.3g/L, P<0.001), and high postoperative back pain visual analog scale (VAS) scores while supine [4.0 (2.0) (4.0±1.8) vs 3.0 (1.0) (3.4±1.8), P=0.015]. Multivariate analysis through logistic regression controlling for covariates established the same three variables as independent risk factors: history of orthostatic intolerance (OR=3.029, 95% CI 1.021-8.988, P=0.046), low hemoglobin on postoperative day 1 (OR=2.890, 95% CI 1.566-5.334, P<0.001), and high postoperative back pain VAS scores while supine (OR=1.218, 95% CI 1.030-1.441, P=0.021). Overall, orthostatic intolerance patients had a longer postoperative hospital stay [6.0 (2.0) (6.3±1.8) vs 6.0 (2.0) (5.8±1.8), P=0.013], catheterization period [24.1 (5.2) (26.0±8.9) vs 22.6 (4.7) (22.8±4.0), P=0.042], and ambulation delay [48.2 (6.3) (48.7±7.8) vs 25.0 (4.5) (25.0±3.9), P<0.001] than orthostatic tolerance patients. However, there were no clinically meaningful differences regarding postoperative hospital stay or catheterization period found between the two groups in this study.

CONCLUSIONS

Orthostatic intolerance is a common complication that prevents early ambulation in ERAS programs after PLIF. Careful monitoring of postoperative hemoglobin levels and administration of postoperative analgesia may reduce the incidence of orthostatic intolerance and promote early ambulation.

Urinary Catheterization Management in Older Adults with Hip Fracture: A Systematic Review

OBJECTIVES

Urinary catheterization is a common procedure in the perioperative management of patients with hip fracture. However, decisions on its insertion or removal are often variable. This systematic review aimed to synthesize current evidence on urinary catheterization management in older patients with hip fracture by thoroughly reviewing the implementation of structured programs.

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

Older adults hospitalized for hip fracture.

METHODS

Studies published until April 1, 2023, were retrieved from MEDLINE (PubMed interface), SCOPUS (Elsevier interface), and Cochrane Central Register of Controlled Trials (EBSCO interface). Observational and interventional studies investigating the use of urinary catheterization in older adults with hip fracture were included and corresponding data on structured programs and associated results were extracted. The quality assessment of the studies was performed using the Critical Appraisal Skills Programme tool.

RESULTS

Of the 674 articles identified through the literature search, 16 studies were included. The mean ages in the 16 studies ranged from 67 to 86 years. Studies on the implementation of structured programs were few and heterogeneous. These studies identified 24 to 48 hours as the appropriate duration of postoperative catheterization; intermittent catheterization was associated with a lower incidence of complications.

CONCLUSIONS AND IMPLICATIONS

Our review revealed a lack of standardized perioperative urinary catheterization management in older patients with hip fracture and uncovered the need for a tailored approach, which is crucial to improving the quality of care and outcomes in these patients.

Safety and Clinical Efficacy of Prostatic Artery Embolization in Patients with Indwelling Urinary Catheter for Benign Hyperplasia-A Multicenter Study

Background/Objectives: This multicentric study aimed to evaluate the efficacy and safety of prostatic artery embolization (PAE) to remove indwelling urinary catheter (IUC) in patients with symptomatic benign prostatic hyperplasia (BPH). Secondary objectives were to identify features associated with post-PAE catheter-free survival (PCFS). Methods: All consecutive patients who underwent PAE for IUC related to BPH with a follow-up of at least 2 years (except for early death) in 6 French University Hospitals were retrospectively included. Clinical efficacy was defined as the removal of the IUC after PAE (through a trial without catheter [TWOC]) and evaluated at regular intervals. Chi-square tests, Wilcoxon tests and multivariable binary logistic regressions were utilized to investigate predictors of TWOC success. Univariable and multivariable Cox regressions were utilized to investigate predictors of PCFS in patients with TWOC success. Results: 140 men with IUC (median age: 82.5 years, interquartile range [IQR] = 73-88.2 years, range: 46-100) who underwent PAE between January 2017 and March 2021 were included. Initial successful catheter removal (TWOC success) following PAE occurred in 113/140 (80.7%) patients, and 3/140 (2.1%) patients encountered major complications. In patients with TWOC success, PCFS at 6 months, 1 year and 2 years were 87.5% (95%CI: 81.4-94.1), 84.4% (95%CI: 77.7-91.7) and 79% (71.3-87.4), respectively. No independent predictive factors for TWOC success and PCFS were identified. Conclusions: PAE should be considered as a safe option with good clinical efficacy in the short and long term for elderly and inoperable patients with IUC due to symptomatic BPH.

Novel surface biochemical modifications of urinary catheters to prevent catheter-associated urinary tract infections

More than 70% of hospital-acquired urinary tract infections are related to urinary catheters, which are commonly used for the treatment of about 20% of hospitalized patients. Urinary catheters are used to drain the bladder if there is an obstruction in the tube that carries urine out of the bladder (urethra). During catheter-associated urinary tract infections, microorganisms rise up in the urinary tract and reach the bladder, and cause infections. Various materials are used to fabricate urinary catheters such as silicone, polyurethane, and latex. These materials allow bacteria and fungi to develop colonies on their inner and outer surfaces, leading to bacteriuria or other infections. Urinary catheters could be modified to exert antibacterial and antifungal effects. Although so many research have been conducted over the past years on the fabrication of antibacterial and antifouling catheters, an ideal catheter needs to be developed for long-term catheterization of more than a month. In this review, we are going to introduce the recent advances in fabricating antibacterial materials to prevent catheter-associated urinary tract infections, such as nanoparticles, antibiotics, chemical compounds, antimicrobial peptides, bacteriophages, and plant extracts.

An overlooked complication of the clean intermittent catheters: prostate calculi

OBJECTIVE

Although the clinical importance of prostate calculi has been understood over time, it is a urinary system disease that can cause different symptoms and can be ignored by urologists sometime. Clean intermittent catheter (CIC) is the gold standard method for bladder rehabilitation and urinary drainage in patients with neurogenic bladder. The aim of this study was to compare the incidence of prostate calculi and related pathologies between patients using CIC and not using CIC.

MATERIAL-METHOD

A total of 314 neurogenic bladder patients who were followed up and treated in our urology clinic were included in this study. The patients were divided into two groups as patients non-using CIC (Group-1, n:154) and patients using CIC (Group-2, n:160).Presence of prostate calculi, the number of CIC used per/day, plasma uric acid levels, urine parameters, mean-stone-density (MSD) and calculi sizes were retrospectively scanned from patient records.

RESULTS

In this study, no significant difference was observed between the parameters such as age, uric acid level, MSD, urine parameters, and other electrolyte levels (Table 1) While the incidence of prostate calculi in Group 1 was 23.4%; The incidence of prostate calculi in group 2 was 37.5(p = 0.007) (Fig. 2). CONCLUSıON: In this study, it was tried to show the relationship between the use of CIC and prostate calculi that cause LUTS and dysuria, which are generally ignored in clinical evaluation but do not pass in patients. As a result of this study, it was determined that the incidence of prostate calculi increased in patients using CIC.

Omitting Foley Catheter Use in Mastectomy Patients With or Without Immediate Reconstruction

BACKGROUND

Foley catheter placement is often advised in surgeries anticipated to exceed 3 hours; however, this time cutoff does not take into account the type of surgery. Complications from Foley catheter placement include urinary tract infections and genitourinary trauma that may be costly to healthcare systems. Our objective was to determine whether mastectomy with or without reconstruction can be done without Foley use, without an increase in urinary retention risk.

METHODS

One hundred eighty-seven patients who underwent unilateral or bilateral mastectomies with or without reconstruction in 2020 and 2021 were reviewed. Chart review included intraoperative fluids given, estimated blood loss, lymph node dissection, and duration of procedure.

RESULTS

After excluding patients with case duration under 180 minutes, 145 remained. Ninety-four patients did not have a Foley and 51 patients had an intraoperative Foley. None of the patients without a Foley experienced postoperative urinary retention, including 3 patients who also underwent lymphatic microsurgical preventive healing approach. Eighty-six percent of patients were discharged on the day of surgery. Patients with or without a Foley did not differ significantly in terms of race, rate of axillary lymph node dissection, body mass index, rate of same-day discharge, presence of hypertension or diabetes, estimated blood loss, or age.

CONCLUSIONS

Patients undergoing unilateral and bilateral mastectomies with or without reconstruction or lymphatic microsurgical preventive healing approach may avoid Foley catheter placement without increased risk of urinary retention, even if the case is anticipated to exceed 3 hours. Advantages include elimination of catheter-associated urinary tract infections and their associated hospital costs, as well as avoiding genitourinary trauma.

State of the Art of Non-Invasive Technologies for Bladder Monitoring: A Scoping Review

Bladder monitoring, including urinary incontinence management and bladder urinary volume monitoring, is a vital part of urological care. Urinary incontinence is a common medical condition affecting the quality of life of more than 420 million people worldwide, and bladder urinary volume is an important indicator to evaluate the function and health of the bladder. Previous studies on non-invasive techniques for urinary incontinence management technology, bladder activity and bladder urine volume monitoring have been conducted. This scoping review outlines the prevalence of bladder monitoring with a focus on recent developments in smart incontinence care wearable devices and the latest technologies for non-invasive bladder urine volume monitoring using ultrasound, optical and electrical bioimpedance techniques. The results found are promising and their application will improve the well-being of the population suffering from neurogenic dysfunction of the bladder and the management of urinary incontinence. The latest research advances in bladder urinary volume monitoring and urinary incontinence management have significantly improved existing market products and solutions and will enable the development of more effective future solutions.

Catheter-associated urinary tract infection: an overview

CAUTIs (catheter-associated urinary tract infections) continue to be one of the most common health-care-related illnesses in the entire globe. CAUTIs are the cause of 40% of all hospital-acquired infections and 80% of all nosocomial urinary tract infections (UTIs). A urine catheter is implanted into a high percentage of inpatients at some point during their hospitalization, and indwelling urinary catheter adoption likely to be on the rise. Urinary catheters, made of plastic materials, inhibit the urinary tract's natural defence mechanisms and enhance the bacterial colonization or biofilm formation on the catheter surface, which may cause CAUTIs. It is associated with increased burden of disease, mortality, hospital bills and length of hospital stay. Therefore, to prevent these infections, technological innovations in catheter materials that limit biofilm formation will be required. Unfortunately, many health-care practitioners are unclear of the precise indications for bladder catheterization and accurate CAUTI criteria, which can lead to unnecessary catheterization, antibiotic overuse for asymptomatic bacteriuria and the spread of resistant organisms. As a result, we discuss CAUTIs in general, including definitions, pathophysiology, causation, indications for catheterization and a variety of effective CAUTI-fighting strategies.

Ureteral Obstruction Due to Inadvertent Placement of the Suprapubic Catheter and Bladder Indwelling Catheter: Presentation of Two Clinical Cases and Review of the Literature

Introduction: Suprapubic catheter (SPC) and bladder indwelling catheter (BIC) placement are among the most common urological procedures. Inadvertent misplacement of the catheter tip into the ureteral orifice is an infrequent event with potentially critical complications. Case Presentation: We describe two cases of inadvertent intraureteral misplacement of an SPC and a BIC. A 66-year-old man with chronic kidney disease (CKD) stage G3b, urethral stenosis, long-term SPC who attended the emergency room (ER) 6 hours after the last catheter replacement due to low back pain, fever, deterioration of the general condition, anuria, acute kidney injury (AKI); CT-scan revealed a left uretero-hydronephrosis secondary to obstruction of the catheter balloon misplaced inside the distal ureter. A 59-year-old woman with CKD stage G3b, post-radiotherapy cystitis, and small capacity bladder, long-term BIC who attended the ER a few hours after the last BIC replacement due to abdominal pain, anuria, AKI; CT-scan revealed left hydronephrosis secondary to catheter obstruction within the distal ureter. In both patients, management was conservative, consisting of removing the catheter and repositioning it inside the bladder, in addition to hydration and antibiotherapy. Conclusions: These cases illustrate that awareness of this rare complication can be prevented by confirming the correct positioning of SPC or BIC after its replacement. Early detection and management of this complication can prevent a serious clinical setting.

Knowledge, Practice and Associated Factors of Health Care Workers on Prevention of Catheter-Associated Urinary Tract Infections in South Wollo Zone Public Hospitals, Northeast Ethiopia

Introduction

Health care providers are responsible for inserting and maintaining urinary catheters. Hence, it is very important that health care professionals need to be skillful and knowledgeable to prevent urinary tract infection for those patients undergoing indwelling catheter. Thus, this study aimed to assess knowledge, practice and associated factors of health care workers on prevention of catheter-associated urinary tract infections in South Wollo zone public hospitals, Northeast Ethiopia.

Methods

An institution-based cross-sectional study design was employed by using a simple random sampling technique among 413 health care workers. Data were entered into Epi-Data version 4.6 and were exported to SPSS version 26 for analysis. Bivariable logistic regression analyses were performed, and variables with P-value less than 0.25 were fitted to multivariable logistic regression. In multivariable regression analysis, variables having p-value <0.05 were declared as significant factors for outcome variable.

Results

Out of the total 413 health care workers, 298 (72.2%) had adequate knowledge and 233 (56.4%) had adequate level of practice towards catheter-associated urinary tract infection prevention. Received training [AOR = 2.33, 95% CI: 1.404–3.889] and being bachelor degree holder [AOR = 1.90, 95% CI: 1.084–3.359] were significantly associated with adequate knowledge. On the other hand, being master and doctor [AOR = 4.71, 95% CI: 1.768–12.56], adequate level of knowledge [AOR = 2.90, 95% CI: 1.785–4.723], received training [AOR = 2.09, 95% CI: 1.315–3.338] and work experience ≥20 years [AOR = 5.82, 95% CI: 1.497–22.69] were significantly associated with adequate level of practice.

Conclusion

A substantial proportion of health care workers had inadequate knowledge and practice towards catheter-associated urinary tract infection prevention. Therefore, health care workers should strictly follow infection prevention guidelines and should update their knowledge and practice by taking short and long term training.

Improving Nurses’ Knowledge about Prevention of Catheter Acquired Urinary Tract Infections in Intensive Care Units

BACKGROUND: Lack of knowledge about causes and strategies to prevent catheter-acquired urinary tract infections (CAUTIs) requires an intervention that focuses on providing all evidence-based information to decrease the incidence of CAUTIs in admitted intensive care units (ICU) patients. Improving the nurses’ knowledge will eventually help in the reduction of CAUTIs. AIM: We aimed to investigate the improving nurses’ knowledge about prevention of catheter acquired urinary tract infections in intensive care units. METHODS: The present study is a h ealth system-operational research, pre-test–post-test design with a control arm study. The study was conducted in two ICU units in one of the University hospitals, Cairo, Egypt, involving a total sample of 42 nurses. Self-administered questionnaires were used to assess nurses’ knowledge about CAUTIs. The intervention was implemented through on job educational training sessions to nursing staff. Cochran Q was used to test the effect of the intervention on a satisfactory level of knowledge. RESULTS: Knowledge score improved from 61.4 ± 14.1 in pre-test to 90.5 in the early post-test (EP) test done after 1 week to 91.3 in late post-test ( LP) done after 1 month among nurses of the intervention ICU (p < 0.001). The percentage of nurses reporting a satisfactory level of knowledge significantly increased from 13.3% in the pre-test to 90% and 93.3% in follow-up (EP and LP, respectively) in the intervention ICU (p < 0.05) CONCLUSION: The implemented training and education strategy used were effectively improved ICU nurses’ knowledge concerning CAUTI.

Effect of Cluster Nursing Based on Risk Management Strategy on Urinary Tract Infection in Patients With Severe Craniocerebral Injury

Objective

To observe the effect of cluster nursing based on risk management strategy in the management of urinary tract infection in patients with severe craniocerebral injury.

Methods

A total of 116 patients with severe craniocerebral injury who were admitted to our hospital from March 2019 to March 2021 were included. They were divided into the control group (58 patients) and the observation group (58 patients). The control group received routine nursing care and the observation group received cluster nursing based on risk management strategy. The incidence of catheter-associated urinary tract infection (CAUTI), the results of bacterial culture on the surface of the urinary catheter, the incidence of nursing risk events, the duration of placing the urinary catheter, the length of hospital stay, and hospital costs as well as the patient satisfaction score were compared between the two groups. The knowledge, attitude, and practice scale for prevention of catheter infection and the competence evaluation scale of nurses were used to evaluate the sense-control ability and core competence of the interveners.

Results

The total incidence of CAUTI in the observation group was (6.90%) lower than that in the control group (20.69%) (p < 0.05). The bacterial culture results on the catheter surface of patients in the observation group before and after 6 and 12 h of catheter cleaning were better than those of patients in the control group (p < 0.05). The duration of indwelling urinary catheter, hospitalization time, and hospitalization expenses of patients in the observation group were lower than those of patients in the control group (p < 0.05). The incidence rate of nursing risk events in the observation group was (1.72%) lower than that in the control group (11.86%) (p < 0.05). The overall satisfaction score of patients and the control and core ability scores of nursing staff in the observation group were higher than those in the control group (p < 0.05).

Conclusion

Cluster nursing based on risk management strategy can effectively reduce the incidence of nursing risk events and the probability of UTI in patients with severe craniocerebral injury, shorten the duration of indwelling urinary catheter and hospitalization.

Managing complications associated with the use of indwelling urinary catheters

The insertion of an indwelling urethral urinary catheter is an invasive procedure that is commonly undertaken in healthcare settings. However, there are several risks and potential complications associated with these devices, so their use should be avoided where possible. It is important that nurses are equipped with the necessary knowledge and skills not only to assess if a patient requires a catheter, but also to minimise the risk of associated complications and to understand how these can be managed. This article discusses some of the common complications that can occur with the use of indwelling urinary catheters, including: catheter-associated urinary tract infections; catheter blockages; encrustation; negative pressure; bladder spasm and trauma; and, in men, paraphimosis. It also explains the steps that nurses can take to reduce the risk of these complications and how to manage them effectively.

Short-term urinary catheters and their risks: an integrated systematic review

This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital. This integrated review examined the risks associated with short-term urinary catheters. The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients. Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates. Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.

Short-term urinary catheters and their risks: an integrated systematic review

Background:

This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital.

Aims:

This integrated review examined the risks associated with short-term urinary catheters.

Methods:

The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients.

Findings:

Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates.

Conclusion:

Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.

Catheter-associated urinary tract infection: why do not we control this adverse event?

OBJECTIVE

To identify factors related to the occurrence of urinary tract infection associated with urinary catheter use.

METHOD

A longitudinal, retrospective cohort study carried out by analyzing the electronic medical records of patients admitted to an intensive care unit of a high-complexity hospital from July 2016 to June 2017. Demographic and clinical data were analyzed by descriptive and analytical analysis.

RESULTS

The incidence density of urinary tract infection related to urinary catheter use was 4.8 per 1000 catheters/day, the majority (80.6%) with no indication for catheter use, and there was no prescription for insertion and/or maintenance in 86.7%. The mean time between catheter insertion and infection diagnosis was 11.3 ± 6.3 days (6 to 28 days). Statistically significant factors (p < 0.001) related to urinary infection linked to catheter use were hospitalization time in the unit (16.7 ± 9 days), catheter permanence time (12.7 ± 6.9 days), and the use of antimicrobials in the intensive care unit (8.6 ± 6.3 days).

CONCLUSION

The association of indication absence and the record of the need for maintenance possibly potentiated the occurrence of urinary tract infection associated to catheter use.

Does periurethral cleaning with water prior to indwelling urinary catheterization increase the risk of urinary tract infections? A systematic review and meta-analysis

OBJECTIVE

To determine whether periurethral cleaning with water before indwelling urinary catheterization increases the risk of urinary tract infections (UTIs) compared with studies using anti-infective agents.

METHODS

A literature search via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through October 2017 and a manual search of references for additional relevant studies. Trials studying clean intermittent catheterization were excluded. Data were extracted independently by 2 reviewers. Disagreements were resolved through discussion. Results of randomized controlled trials were pooled using random effects models. Both individual and pooled risk estimates were reported using risk ratios (RRs) and 95% confidence intervals (CIs).

RESULTS

From 121 identified articles, 5 studies involving 824 patients were included in the review (822 patients included in meta-analysis). No statistical significance in the incidence of UTIs existed between the water group and antiseptics group (RR, 1.07; 95% CI, 0.77-1.49; P = .89; I² = 0%). Available data comparing water with povidone-iodine or chlorhexidine gluconate demonstrated no significant difference between the incidence of UTIs (RR, 1.10; 95% CI, 0.66-1.83; P = .79; I² = 0%; and RR, 1.05; 95% CI, 0.68-1.62; P = .72; I² = 0%; respectively).

CONCLUSIONS

Based on current data, water is as safe as other topical antiseptics for periurethral cleansing before indwelling urinary catheter insertion.