A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring
Abstract
:1. Introduction
2. Methods
2.1. Design and Patient Population
2.2. Catheter and Monitoring System
2.3. Setting
2.4. Ethical Considerations
2.5. Definition and Protocols
- Fever without evidence of another source;
- Pain or burning while urinating;
- Urgency;
- Hematuria;
- Costovertebral angle tenderness;
- (a)
- IAP measurement set-up [10,11] using the gravity urinary catheter (protocol discarded when automatic IAP measurements with the Accuryn SmartFoley® were introduced).Before performing IAP monitoring, the registered nurse (RN) is to ensure the following:
- The bedside monitor has been set up to perform IAP monitoring properly;
- The pressure bag attached to the tubing and transducer set-up for IAP monitoring is inflated to above 300 mm Hg;
- The tubing and transducer set-up has been properly primed with normal saline. Additionally, ensure that the tubing remains sterile by keeping the end covers intact;
- The following sterile supplies are at the bedside: 30 mL of sterile normal saline to instill into the bladder, a sterile 60 mL syringe, sterile gloves, sterile towels and amp, chlorhexidine, or alcohol preps for three separate cleaning steps. Nonsterile supplies needed at the bedside include clamps and amp, absorbent pads;
- The patient has an inserted Urinary Catheter with an access hub in place, and the catheter is draining urine appropriately.
- (b)
- Performing IAP monitoring in the burn ICU (adopted and slightly modified from the WSACS recommendations [10,11]:
- Ensure the patient has been placed supine;
- Clean the access hub with chlorhexidine or alcohol. Rub the hub vigorously for at least 15 s (First clean);
- Clamp the Foley Catheter below the access hub;
- Don sterile gloves and establish a sterile field with sterile towels around the access hub using sterile technique;
- Prepare a sterile syringe with 30 mL of sterile normal saline;
- Clean access hub with chlorhexidine or alcohol using sterile technique. Rub the hub vigorously for at least 15 s. Allow the hub to dry for 30 s (Second clean);
- Instill 30 mL of sterile normal saline in the bladder;
- Clean access hub with chlorhexidine or alcohol using sterile technique. Rub the hub vigorously for at least 15 s. Allow the hub to dry for 30 s (Third clean);
- Attach monitoring tubing to access the hub. The system is now considered closed;
- Zero the IAP monitoring system on the bedside monitor;
- Obtain IAP;
- Unclamp Foley Catheter. Close off IAP monitoring tubing;
- Properly position the patient. Do not leave supine.
- (c)
- Standard Operating Procedures (SOP) in the BICU concerning IAP monitoring:
- IAP monitoring is routinely performed every 4 h. Monitoring times can be increased or decreased based on the condition/or situation of the individual patient;
- It is the responsibility of the RN to promptly report IAPs of 20 mm Hg or greater to the provider;
- IAP monitoring tubing and normal saline used in the pressure bag are to be changed every 72 h;
- IAP monitoring tubing can be left attached to the Foley access hub but must be in the closed position when not in use;
- Sterile technique and proper cleaning are used when adding 30 mL of sterile saline for each IAP monitoring session.
- (d)
- Automated IAP measurement: The patient is in the supine position, and active abdominal muscle contractions are absent. IAP is measured via button press. IAP monitoring is routinely performed every 4 h. Monitoring times can be increased or decreased based on the condition/or situation of the individual patient.
2.6. Statistical Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Category | Period 1, Median [Q25, Q75] or No. (%) | Period 2, Median [Q25, Q75] or No. (%) |
---|---|---|---|
Total patients (n) | 2243 | 1317, 40 CAUTIs | 926, 2 CAUTIs |
Age (years) | 49.0 [33.0, 61.5] | 43.5 [34.2, 52.8] | |
BMI (kg/m2) | 26.3 [23.4, 29.7] | 24.1 [24.0, 24.2] | |
Gender | Male | 52.5% (21) | 100.0% (2) |
Female | 47.5% (19) | 0.0% (0) | |
Race | Caucasian | 57.5% (23) | 50.0% (1) |
African American | 32.5% (13) | 50.0% (1) | |
Unknown | 7.5% (3) | 0.0% (0) | |
Hispanic | 2.5% (1) | 0.0% (0) | |
Catheter day of CAUTI | 4.5 [2.0, 6.2] | 6.0 [5.5, 6.5] | |
Type of injury | Burn | 85.0% (34) | 100.0% (2) |
TBSA% | 24.2 [12.2, 70.0] | 19.8 [18.4, 21.1] | |
Smoke inhalation | 5.0% (2) | 0.0% (0) | |
Electrical injury | 2.5% (1) | 0.0% (0) | |
Frostbite | 2.5% (1) | 0.0% (0) | |
Unknown | 2.5% (1) | 0.0% (0) | |
Comorbidities | Hypertension | 13.4% (11) | 16.7% (1) |
Smoker | 11.0% (9) | 0 | |
IDDM | 8.5% (7) | 0 | |
Anxiety | 7.3% (6) | 0 | |
Depression | 6.1% (5) | 0 | |
Cerebrovascular accident | 4.9% (4) | 0 | |
Hyperlipidemia | 4.9% (4) | 0 | |
Polysubstance abuse | 3.7% (3) | 16.7% (1) | |
Hepatitis | 3.7% (3) | 0 | |
Coronary artery disease | 3.7% (3) | 0 | |
COPD | 3.7% (3) | 0 | |
Dementia | 2.4% (2) | 16.7% (1) | |
Hypothyroidism | 2.4% (2) | 0 | |
Myocardial infarction | 2.4% (2) | 0 | |
Arthritis | 2.4% (2) | 0 | |
Seizures | 2.4% (2) | 0 | |
Asthma | 2.4% (2) | 0 | |
Post-traumatic stress disorder | 1.2% (1) | 0 | |
Alcohol abuse | 1.2% (1) | 16.7% (1) | |
Degenerative disc disease | 1.2% (1) | 0 | |
Back pain | 1.2% (1) | 0 | |
GERD | 1.2% (1) | 0 | |
Anemia | 1.2% (1) | 0 | |
Congestive heart failure | 1.2% (1) | 0 | |
HIV | 1.2% (1) | 0 | |
Hyperthyroidism | 1.2% (1) | 0 | |
Autism | 1.2% (1) | 0 | |
Bipolar disorder | 1.2% (1) | 0 | |
Renal insufficiency | 1.2% (1) | 0 | |
Pancytopenia | 0 | 16.7% (1) | |
Cholelithiasis | 0 | 16.7% (1) |
Organism | Period 1, % (N) | Period 2, % (N) |
---|---|---|
Pseudomonas aeruginosa | 45.2% (19) | 0 |
Escherichia coli | 19.0% (8) | 50.0% (1) |
VRE | 4.8% (2) | 0 |
Klebsiella pneumoniae | 4.8% (2) | 0 |
Enterococcus species | 4.8% (2) | 0 |
Achromobacter xylosoxidans | 4.8% (2) | 0 |
Acinetobacter Baumannii | 4.8% (2) | 0 |
Staphylococcus | 2.4% (1) | 0 |
Lactobacillus | 2.4% (1) | 0 |
Klebsiella oxytoca | 2.4% (1) | 0 |
Proteus vulgaris | 2.4% (1) | 0 |
Enterobacter cloacae | 2.4% (1) | 0 |
Enterococcus faecalis | 0 | 50.0% (1) |
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Brockway, P.; Hill, D.M.; Moll, V.; Stanton, K.; Malbrain, M.L.N.G.; Velamuri, S.R. A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring. Life 2022, 12, 1950. https://doi.org/10.3390/life12121950
Brockway P, Hill DM, Moll V, Stanton K, Malbrain MLNG, Velamuri SR. A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring. Life. 2022; 12(12):1950. https://doi.org/10.3390/life12121950
Chicago/Turabian StyleBrockway, Patrick, David M. Hill, Vanessa Moll, Kelly Stanton, Manu L. N. G. Malbrain, and Sai R. Velamuri. 2022. "A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring" Life 12, no. 12: 1950. https://doi.org/10.3390/life12121950