Catheter-associated urinary tract infections are the most common type of infection in hospital-acquired infections. Risk factors for catheter-associated urinary tract infections include both patient-side and catheter placement and maintenance aspects. Patient risk factors include: patient age, gender, underlying disease, immunity and other health conditions. Risk factors for catheterization and maintenance include: duration of catheterization, method of catheterization, quality of catheter care, and clinical use of antimicrobial drugs. Catheter-related urinary tract infections are mainly retrograde infections. Medical institutions and medical personnel should strengthen the prevention and control of catheter-associated urinary tract infections by addressing risk factors.
I. Definition of catheter-associated urinary tract infection.
Catheter-associated urinary tract infection mainly refers to urinary tract infections that occur after a catheter is placed in a patient or within 48 hours of catheter removal.
Clinical diagnosis: Patients present with urinary tract irritation symptoms such as urinary frequency, urinary urgency, urinary pain, or lower abdominal tenderness, percussion pain in the kidney area, with or without fever, and urinalysis leukocytes ≥ 5/high magnification field in men and ≥ 10/high magnification field in women, which should be combined with urine culture in the case of catheter insertion.
Pathogenic diagnosis: On the basis of clinical diagnosis, one of the following conditions is met.
(a), clean middle urine or catheterized retained urine (non-retentive catheterization) culture Gram-positive cocci colony count ≥ 104 cfu/ml, Gram-negative bacilli colony count ≥ 105 cfu/ml.
(B), the bacterial colony count of urine retained by cystocentesis on the pubic symphysis ≥ 103 cfu/ml.
(C), fresh urine specimens by centrifugation application of phase contrast microscopy, in every 30 field of view in half of the field of view to see bacteria.
(D), there is evidence of urinary tract infection by surgery, pathology or imaging.
Patients with endoscopy or catheter placement within 1 week and urine culture of Gram-positive cocci colonies ≥ 104 cfu/ml and Gram-negative bacilli colonies ≥ 105 cfu/ml, although asymptomatic, should be diagnosed with asymptomatic bacteriuria.
Second, the main points of catheter-associated urinary tract infection prevention.
(A), management requirements.
1, medical institutions should improve the rules and regulations, develop and implement the prevention and control of catheter-related urinary tract infections and operating procedures, clear responsibilities of relevant departments and personnel.
2, medical personnel should receive training and education on aseptic technique, catheterization, maintenance of indwelling catheters and catheter-related urinary tract infection prevention, and master the relevant operating procedures.
3, medical staff should assess the risk factors for catheter-related urinary tract infections in patients, and implement measures to prevent and control catheter-related urinary tract infections.
4, medical institutions should gradually carry out targeted monitoring of catheter-related urinary tract infections, continuous improvement, and effective reduction of infection rates.
(B), infection prevention points.
1.Before placing the catheter.
(1) Strictly grasp the indications for indwelling catheters and avoid unnecessary indwelling catheterization.
(2) Carefully check the sterile catheterization package, if the package is out of date, the outer package is broken or wet, it should not be used.
(3) Select catheters of appropriate size and material according to the patient’s age, gender, and urethra to minimize urethral injury and urinary tract infection.
(4). For patients with indwelling catheters, closed drainage devices should be used.
(5) Inform the patient of the purpose of the indwelling catheter, the key points of cooperation and the precautions to be taken after the placement of the catheter.
2.When placing the catheter.
(1) Medical staff should strictly follow the Code of Hand Hygiene for Medical Staff, wash their hands carefully and then wear sterile gloves to perform catheterization.
(2) Strictly follow the principles of aseptic technique to place the catheter and move gently to avoid damaging the urethral mucosa.
(3) Properly lay the sterile towel to avoid contamination of the urethral opening and maintain the maximum sterile barrier.
(4).Adequately disinfect the urethral orifice to prevent contamination. To disinfect the urethral orifice and its surrounding skin mucosa using appropriate disinfectant cotton balls, which should not be reused. Men: first wash the foreskin and coronal sulcus, then rotate and disinfect from the urethral orifice and glans outward. Women: first wash the vulva according to the principle of top to bottom and inward to outward, then wash and disinfect the urethral opening, vestibule, both sides of the labia majora and minora, and finally perineum and anus.
(5) The catheter is inserted at an appropriate depth, and after insertion, 10-15 ml of sterile water is injected into the bladder, and the catheter is gently pulled to confirm that it is securely fixed and will not be dislodged.
(6) During the catheter placement, instruct the patient to relax and coordinate to avoid contamination, if the catheter is contaminated it should be replaced again.
3.After placement.
(1), properly fix the urinary catheter, avoid folding and bending, ensure that the height of the urine collection bag is lower than the bladder level, avoid contact with the ground, and prevent retrograde infection.
(2) Keep the urine drainage device airtight, unobstructed and intact, and clip the drainage tube when moving or handling to prevent retrograde flow of urine.
(3) Urine should be emptied from the urine collection bag in a timely manner using a personalized collection container. When emptying the urine in the urine collection bag, follow the principle of aseptic operation and avoid the outlet of the urine collection bag touching the collection container.
(4) When a small amount of urine specimen is retained for microbial pathogenesis testing, the catheter should be disinfected and a sterile syringe should be used to extract the specimen for testing. When retaining a large number of urine specimens (this method cannot be used for general bacterial and fungal tests), they can be collected from the urine collection bag, avoiding opening the interface between the catheter and the urine collection bag.
(5), Bladder irrigation or perfusion with solutions containing antiseptics or antibacterial drugs should not be routinely used to prevent urinary tract infections.
(6) The urethral opening should be kept clean, and patients with fecal incontinence should also be disinfected after cleaning. The urethral orifice should be cleaned or flushed daily during indwelling catheterization.
(7) Patients should pay attention to the protection of the catheter when bathing or wiping themselves, and should not immerse the catheter in water.
(8) Patients with long-term indwelling catheters should not change catheters frequently. If the catheter is obstructed or inadvertently dislodged, and if the sterility and tightness of the indwelling catheter device is damaged, the catheter should be replaced immediately.
(9) Patients with urinary tract infections should have their catheters changed promptly and urine should be retained for microbiologic pathogenic testing.
(10) Assess the need for indwelling catheters on a daily basis, remove catheters as soon as possible when not needed, and shorten the duration of indwelling catheters as much as possible.
(11) For patients with long-term indwelling catheters, bladder function should be trained when the catheter is removed.
(12) Medical and nursing staff should strictly enforce hand hygiene when maintaining the catheter.