Catheter-associated urinary tract infections in the 'intensive care unit': Why we still should care

The bactericidal efficacy of two antiseptics against common pathogens associated with catheter-associated urinary tract infection in the elderly under divergent conditions: A laboratory-based study

BACKGROUND

Cleaning the external urethral orifice in patients with indwelling catheters can effectively reduce the number of local microorganisms. Employing appropriate disinfection strategies can prevent between 17% and 69% of catheter-associated urinary tract infection (CAUTI) cases. However, the optimal antiseptics and their conditions of use (temperature, concentration, and exposure time) remain unclear.

METHODS

The suspension quantitative bactericidal test method was employed to evaluate the bactericidal efficacy of two skin and mucous membrane antiseptics, BAC and AEOW, against common pathogens associated with CAUTI in the elderly under various conditions.

RESULTS

Within the observation period, except for the standard strains of E. faecium, other pathogens achieved bactericidal efficacy after being exposed to BAC for 1 min. When the antiseptic is heated to 40 °C, the standard strains of E. faecium can also achieve bactericidal efficacy after being exposed to it for 5 min. Furthermore, upon the addition of 30 g/L bovine serum albumin (BSA) to AEOW, all pathogens except for the clinical strain of E. faecium exhibited bactericidal efficacy within 1 min. When the antiseptic is heated to 40 °C, the clinical strain of E. faecium showed bactericidal efficacy for 3 min. When 3 g/L BSA interference substance was incorporated into AEOW, all pathogens achieved bactericidal efficacy for 30 s.

CONCLUSION

BAC and AEOW exhibit effective bactericidal activity against common pathogens associated with CAUTI in elderly patients. When used for perineal irrigation, these antiseptics can be heated for improved patient comfort, as temperatures within the range of 40 °C do not affect their disinfection efficacy.

Kotter's 8-step change model to improve hand hygiene compliance in intensive care unit: A 41-month prospective longitudinal quality improvement study

BACKGROUND

Despite numerous studies assessing bundled interventions to enhance hand hygiene compliance (HHC), compliance rates persist at suboptimal levels. Our objective was to employ Kotter's Change Model (KCM) to enhance HHC and conduct a comprehensive process evaluation among medical staff within the intensive care unit (ICU).

METHODS

KCM was implemented at the ICU of Zhongnan Hospital of Wuhan University from March 2018 to August 2021, with a 41-month longitudinal monitoring of HHC. The primary outcome focused on the absolute monthly change in HHC. Secondary outcomes encompassed the HHC characteristics across different phases, varying trends in HHC concerning different hand hygiene opportunities and occupations, quarterly incidences of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).

RESULTS

This study included 20,222 hand hygiene actions and 24,195 opportunities. The overall HHC was 83.58 % (95 %CI, 83.11 %-84.04 %). Following the KCM implementation, HHC surged from 35.71 % (95 % CI, 22.99 %-50.83 %) to 87.75 % (95 % CI, 85.53 %-89.67 %), reflecting a notable increase of 145.73 %. The most rapid growth in HHC occurred post-patient contact, elevating from 35.29 % to 89.8 %. Despite escalating patient numbers and treatment complexities annually, the quarterly rates of CLABSI (0 ‰-3.53 ‰) and CAUTI (0.96 ‰-4.26 ‰) remained consistently low.

CONCLUSION

Utilizing KCM systematically alters healthcare providers' perception of hand hygiene, fostering an environment that advocates for and sustains improved HHC among ICU personnel.

IMPLICATIONS FOR CLINICAL PRACTICE

The Kotter's change model can be an effective framework for healthcare organizations to systematically improve and maintain hand hygiene compliance among healthcare providers, which can in turn help reduce healthcare-associated infections.

Incidence, characteristics and influencing factors of medical adhesive-related skin injury in the indwelling urinary catheter attachment region in critically ill patients: A longitudinal study

BACKGROUND

Medical adhesives are potentially harmful to the skin, depending on the patient's condition, the adhesive agent and the adhesive application and removal technique.

AIM

The objective of the study was to determine the incidence, characteristics and influencing factors of medical adhesive-related skin injury from the indwelling urinary catheter attachment in critically ill patients.

STUDY DESIGN

This is a longitudinal study. Data were collected in an adult intensive care unit of a university hospital, a sample size of 132. The socio-demographic and clinical data were obtained from the medical records. Skin exposed to indwelling urinary catheter adhesive tapes was examined daily by trained field researchers. The association between independent variables and medical adhesive-related skin injury was investigated by bivariate statistical analysis and multiple logistic regression.

RESULTS

The medical adhesive-related skin injury incidence was 28%. The association between independent variables and medical adhesive-related skin injury was mechanical (91.8%): skin peeling (56.7%), skin breakdown (18.9%) and tension injury or blister (16.2%); followed by irritant contact dermatitis (21.6%), with no statistical difference between the groups. More than one type of medical adhesive-related skin injury was concomitantly located in 16% of patients, with skin peeling present in all of these cases. The length of stay in the intensive care unit was an independent risk factor for medical adhesive-related skin injury (odds ratio [OR]: 1.072; 95% confidence interval [2.1-12.5]) and the Braden Scale score was a predictive factor (OR: 0.711; 95% CI: 0.3-49.3), with higher scores indicating lower risk.

CONCLUSIONS

Medical adhesive-related skin injury at the indwelling urinary catheter fixation site is a relevant problem, its mechanical aetiology is predominant and most of the risk factors are modifiable.

RELEVANCE TO CLINICAL PRACTICE

This evidence contributes to the epidemiological and clinical knowledge of medical adhesive-related skin injury at the indwelling urinary catheter attachment site, as well as to recognizing the problem as relevant and implementing preventive care.

Effectiveness and safety of a simple catheter securement device aimed at preventing catheter-associated urinary tract infection in intensive care unit patients: A randomized controlled trial

BACKGROUND

Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness.

AIM

To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive-related skin injury (MARSI) associated with the securement device.

STUDY DESIGN

Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in-house device piloted as part of this trial. Controls (n = 181) received standard care, including non-securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log-rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups.

RESULTS

Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%.

CONCLUSION

Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in-house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement.

RELEVANCE TO CLINICAL PRACTICE

Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in-house devices is safe and effective.

Healthcare Professionals' Knowledge, Attitude and Practice of Infection Prevention in Southwest Ethiopia

Introduction

Infection prevention (IP) is a practical and scientifically supported technique to prevent avoidable infections. The effectiveness of IP techniques applied will depend on the knowledge, attitudes, and behaviors of healthcare professionals.

Objective

This study aimed to assess the knowledge, attitude, and practice (KAP) of IP and its associated factors among healthcare professionals at Mizan-Tepi University Teaching Hospital (MTUTH) in southwest Ethiopia.

Methods

A cross-sectional survey was conducted from September 1 and 15, 2021 among 196 healthcare professionals at MTUTH in south-west Ethiopia. The knowledge, attitude and practice outcome variables were measured using 13, 13, and 12 questions respectively. A logistic regression analysis was used. The level of significance was declared at a P < .05.

Results

The level of good knowledge, favorable attitude, and good practice of IP were 71.9%, 63.8%, and 53.6% respectively. Being a GP/specialist [adjusted odds ratio (aOR) = 10.6, 95% CI (2.13-52.9)] and the presence of an IP manual at work [aOR = 3.43, 95% CI (1.33-8.82)] were factors connected with good IP knowledge. The presence of sufficient PPE in the work area [aOR = 2.73, 95% CI (1.36-5.50)] and IP training [aOR = 3.05, 95% CI (1.28-7.29)] were factors associated with a favorable attitude toward IP. Good IP practice was linked to having enough personal protective equipment (PPE) in the workplace [aOR = 3.63, 95% CI (1.71-7.72)] and having good IP knowledge [aOR = 3.08, 95% CI (1.39-6.86)].

Conclusion

The level of KAP of IP among study participants was poor. The provision of adequate PPE, IP manuals and in-service training will help to improve the KAP of healthcare professionals toward IP. Therefore, the hospital management authority and other concerned stakeholders like local NGOs and regional health bureau should provide consistent support to the health professionals in terms of training, resources, and infrastructure to improve and integrate universal precaution in everyday services.