What is catheter-associated urinary tract infection?
Catheter-associated urinary tract infection, also known as “CAUTI”, is an infection involving any part of the urinary system, including the urethra, bladder, ureters and kidneys, that occurs when germs enter the urinary tract and multiply due to the insertion of a urinary catheter (a flexible plastic tube) through the urethra or a small opening made in the lower stomach into the bladder to drain urine when you cannot urinate on your own. It is estimated that about 75% of urinary tract infections are associated with the use of a urinary catheter.
Is CAUTI a healthcare-associated infection?
According to the US Centers for Disease Control and Prevention (CDC), urinary tract infections are the most common type of healthcare-associated infections (HAI), which are infections that patients contract while receiving treatment for other medical conditions in healthcare facilities, and are often caused by the use of a urinary catheter. So yes, CAUTI is a healthcare-associated infection.
What germs cause CAUTI?
Germs capable of causing CAUTI are known as uropathogens and they are often bacteria. The most
common ones are Escherichia coli and Proteus mirabilis. Uropathogens are usually fecal contaminants or
the patient's own native or transient microflora that colonize the periurethral area. Healthcare workers
and other patients may also be the source of these uropathogens.
Why are urinary tract infections common with catheters?
The urinary system is evolved in such a way as to prevent germs from entering the urinary tract through the urethra and beginning to multiply in the bladder. However, the use of a urinary catheter introduces a way for germs to enter the system directly during insertion or post-placement manipulation of the catheter or its drainage system. Moreover, urinary catheters may facilitate the colonization of germs by providing a biofilm surface for bacterial adhesion.
How is CAUTI transmitted?
CAUTI occurs when germs enter and infect the urinary tract through the urinary catheter. This can happen during the insertion of a catheter if proper aseptic techniques are not followed. Infections can also occur if:
- the drainage bag is not emptied often enough;
- urine in the drainage bag flows backward into the bladder;
- feces contaminate the catheter; or
- the catheter is not cleaned regularly.
How is CAUTI diagnosed and treated?
CAUTI can be diagnosed by a urinalysis, urine culture and blood test. It is possible that patients with CAUTI do not have any symptoms. In most cases, CAUTI can be treated with antibiotics and/or the removal or change of the catheter. Healthcare professionals will determine the best treatment for each patient depending on the type of germs causing CAUTI and the conditions and symptoms of the patient.
What measures can be taken to lower the risk of CAUTI?
The prolonged use of a urinary catheter is the main reason for an increased risk of contracting CAUTI. Therefore, the best way to prevent it is to ensure that catheters are used only when necessary, and it should be removed as soon as possible when no longer needed. It is also important to make sure thatmproper aseptic techniques are adopted when handling a catheter and that its drainage system remains sterile.
To help prevent infections, the CDC recommends that patients with a urinary catheter follow the precautions below:
- Understand why a catheter is needed and ask the healthcare provider frequently if the catheter is still needed.
- If the patient has a long-term catheter, they must clean their hands before and after touching the catheter.
- Check the position of the urine bag – it should always be below the level of the bladder.
- Do not tug or pull on the catheter tubing.
- Do not twist or kink the catheter tubing.
Takeaway
Urinary tract infections are the most common type of HAI and a majority of them are associated with the use of urinary catheters (CAUTIs). The main risk of using a urinary catheter is that it provides more opportunities for germs to enter the urinary tract directly and cause an infection in the urethra, bladder or sometimes even the kidneys. The risks of getting CAUTIs can be reduced by ensuring that urinary catheters are only used when it is necessary and removed as soon as possible when they are no longer needed. In addition, appropriate hygiene practice should be maintained by both healthcare professionals and the patients.
Reference & recommended sites
1. Background | CAUTI Guidelines | Guidelines Library | Infection Control | CDC. (2015). US Centers for Disease Control and Prevention.
https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html
2. Catheter-Associated Urinary Tract Infection (CAUTI). (2019). Florida Department of Health. http://www.floridahealth.gov/diseases-and-conditions/cauti-catheter-associated-urinary-tract-
infection/index.html
3. Catheter-associated Urinary Tract Infections (CAUTI). (2015). US Centers for Disease Control and Prevention. https://www.cdc.gov/hai/ca_uti/uti.html
4. Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis. (2008). US National Library of Medicine, National Institutes of Health.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223845/
5. Frequently Asked Questions about Catheter-associated Urinary Tract Infections. (2010). US Centers for Disease Control and Prevention. https://www.cdc.gov/hai/ca_uti/cauti_faqs.html
6. NHS website. (2020). Risks of a urinary catheter. National Health Service UK. https://www.nhs.uk/conditions/urinary-catheters/risks/
7. Novel Approaches to the Diagnosis, Prevention and Treatment of Medical Device-Associated Infections. (2012). US National Library of Medicine, National Institutes of Health.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269005/
