CAUTI – Woes of Catheters

A health condition or a surgical procedure necessitates the use of a catheter but unfortunately, while it works to improve the functioning of the urinary bladder, it may also work to bring on some health woes. And primarily among them is UTI, or urinary tract infection.

What is Urinary Tract Infection (UTI)?

A urinary tract infection is an infection in any part of the urinary system - could be the kidneys, ureters, bladder or the urethra. A recent survey indicated that UTI is the fourth most common type of infection accounting for 12.9% of healthcare infections. Infection can be found in the lower urinary tract and this type, called cystitis, is usually caused by Escherichia coli or a type of bacteria which is found in the gastrointestinal tract. If an infection is found in the upper tract, it means infection in the kidney which is referred to as pyelonephritis.

Causes of UTI

Urinary tract infection could occur due to a number of reasons primary of which are sexual activity and use of a catheter. Other than these causes, UTI could arise due to hereditary bladder infections, diabetes, enlarged prostate and spinal cord injury, among others.

Symptoms of UTI

Symptoms of UTI include pain and a burning sensation while urinating, a strong urge to urinate and passing urine in small amounts frequently. The urine will have a strong odor, be cloudy in appearance and could contain blood. The infection is accompanied by pain – pelvic in women and rectal pain in men. If the kidney is affected then the person will experience nausea, vomiting, get pain in the upper back and side, high fever and chills. If there is an infection in the urinary bladder, then there is likely to be lower abdomen pain, painful urination, and blood in the urine.

Women are more likely to suffer from UTI than men because their urethra is shorter and closer to the anus.

What is Catheter-Associated Urinary Tract Infection (CAUTI)?

CAUTI, or catheter-associated urinary tract infection, is a very common type of UTI and is as a result of widespread use of urinary catheters. It occurs in a person with symptoms or signs attributable to the urinary tract and no alternate source. Infection may enter a person whose urinary tract is currently catheterized or has been catheterized within the previous 48 hours.

Catheter acquired urinary tract infection is common in patients with an indwelling urethral, indwelling suprapubic or intermittent catheterization and is said to be the most frequent healthcare-associated infection worldwide, accounting for up to 40% of hospital-acquired infections in US hospitals each year while in home care settings, there is 8% prevalence chance of CAUTI. It is, reportedly, the most common cause of secondary bloodstream infection in acute care facilities.

Causes of Catheter Associated UTI

UTI occurs when bacteria enter the urinary tract through the urine and goes into the urethra and begins to multiply in the bladder. With CAUTI, urethral catheters transport bacteria into the bladder and allow colonization by providing a surface for bacterial adhesion and causing mucosal irritation.

• The use of a urinary catheter increases the risk of contracting the infection through bacteriuria, which means bacteria in the urine. The presence of a catheter is the biggest risk for development of bacteriuria and users face the risk of getting infected by bacteriuria between 3 to 10% a day.
• Long-term indwelling catheterization is the biggest risk for developing CAUTI. As per a study, between 10 and 30% of short-term catheterization can lead to the development of bacteriuria while in long-term catheterization, there is between 90-100% chance of an infection.
• Other causes of CAUTI are colonization of the drainage bag, improper catheter care, diarrhea, diabetes, an absence of antibiotics, female gender and renal problems.

Symptoms of CAUTI

Urinary catheter infection symptoms include beginning or aggravation of fever, rigors, altered mental status, malaise or lethargy, flank pain, acute hematuria, pelvic discomfort, urgent or frequent urination (after the catheter has been removed) or suprapubic pain and tenderness.

Complications of CAUTI

CAUTI causes discomfort to the patient, leads to a prolonged hospital stay and increased cost and mortality. Treating the infection can lead to further stress on the person’s immune system weakening it further. It has been estimated that each year, more than 13,000 deaths are associated with UTIs.

Urinary catheter associated infection can lead to such complications as cystitis, pyelonephritis, gram-negative bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis, endophthalmitis, and meningitis. Particularly in males, CAUTI can cause prostatitis, epididymitis, and orchitis.

Prevention of CAUTI

Urinary catheter related infection can be prevented by following the below-given measures:

• The most effective way of reducing instances of CAUTI is to restrict the use of the urinary catheter in patients with symptoms as well as by prompt removal of the catheter as soon as its requirement is over. Catheter use should be minimum and appropriate while indwelling urinary catheter should not be used in the instance of urinary incontinence unless all other methods to control it have failed. Healthcare staff should be well trained to notice the symptoms and be alert as to when to remove the catheter.
• Catheter use and its duration should be minimized in all patients but especially in those who are at a higher risk for CAUTI, e.g. women, elderly persons and patients with weakened immunity. Those who need to be catheterized during surgery should have the tube removed immediately post surgery.
• Indwelling urethral catheters should be inserted using aseptic technique and sterile equipment. A closed catheter drainage system with ports in the distal catheter for needle aspiration of urines should be used to reduce CAUTI in patients with short-term and long-term indwelling urethral or suprapubic catheters.
• Care for the catheter and urine drainage bag is also very vital. The drainage bag and connecting tube should always be kept below the level of the bladder to prevent urine from flowing from the urine bag back into the bladder which could lead to an infection.

CAUTI Treatment

Catheter related urinary tract infection is more difficult to treat than a regular UTI. Follow the below-given points to treat CAUTI.

• Immediate attention is required because if the infection reaches the kidney then it can get serious. Sometimes, the mere removal of the catheter is enough to get rid of the infection.
• In most other cases, antibiotic treatment is prescribed by a doctor. In mild cases, oral antibiotics may be given but if the infection is severe, the doctor may advise intravenous antibiotic.
• Drinking a lot of fluid to flush out the kidney is recommended. However, fluids like caffeinated drinks, citrus juices, and alcohol are to be avoided.