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Guideline for Prevention of CAUTI (4)Published:5/19/2009

February 1981

Summary of Major Recommendations

Category I. Strongly Recommended for Adoption*

  • Educate personnel in correct techniques of catheter insertion and care.
  • Catheterize only when necessary.
  • Emphasize handwashing.
  • Insert catheter using aseptic technique and sterile equipment.
  • Secure catheter properly.
  • Maintain closed sterile drainage.
  • Obtain urine samples aseptically.
  • Maintain unobstructed urine flow.

Category II. Moderately Recommended for Adoption

  • Periodically re-educate personnel in catheter care.
  • Use smallest suitable bore catheter.
  • Avoid irrigation unless needed to prevent or relieve obstruction.
  • Refrain from daily meatal care with either of the regimens discussed in text.
  • Do not change catheters at arbitrary fixed intervals.

Category III. Weakly Recommended for Adoption

  • Consider alternative techniques of urinary drainage before using an indwelling urethral catheter.
  • Replace the collecting system when sterile closed drainage has been violated.
  • Spatially separate infected and uninfected patients with indwelling catheters.
  • Avoid routine bacteriologic monitoring.


*Refer to Introduction of manual for full explanation of the ranking scheme for recommendations.

References

1. Center for Disease Control. National Nosocomial Infections Study Report, Atlanta: Center for Disease Control, November 1979: 2-14.

2. Martin CM, Bookrajian EN. Bacteriuria prevention after indwelling urinary catheterization. Arch Intern Med 1962;110:703-11.

3. Turck M, Goffe B, Petersdorf RG. The urethral catheters and urinary tract infection. J Urol 1962;88:834-7.

4. Kass EH. Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians 1956;69:56-63.

5. Kunin CM, McCormack RC. Prevention of catheter-induced urinary tract infections by sterile closed drainage. N Engl J Med 1966;274:1155-62.

6. Garibaldi RA, Burke JP, Dickman ML, Smith CB. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 1974;291:215-8.

7. Brumfitt W, Davies BL, Rosser E. The urethral catheter as a cause of urinary tract infection in pregnancy and puerperium. Lancet 1961;2:1059-61.

8. Kunin CM. Detection, prevention, and management of urinary tract infections. 3rd ed. Philadelphia: Lea and Febiger, 1979.

9. Steere AC, Stamm WE, Martin SM, Bennett JV. Gram-negative rod bacteremia. In: Bennett JV, Brachman PS, eds. Hospital infections. Boston: Little, Brown and Company. 1979:507-18.

10. Kreger BE, Craven DE. McCabe WR. Gram-negative bacteremia IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980,68:344-55.

11. Selden R, Lee S, Wang WLL, et al. Nosocomial Klebsiella infections: intestinal colonization as a reservoir. Ann Intern Med 1971;74:657-64.

12. McLeod JW. The hospital urine bottle and bedpan as reservoirs of infection by Pseudomonas. Lancet 1958;1:394-5.

13. Maki DG, Hennekens CH, Bennett JV, et al. Nosocomial urinary tract infection with Serratia marcesens: an epidemiologic study. 1973; J Infect Dis 128:579-87.

14. Kaslow RA, Lindsey JO, Bisno AL, Price A. Nosocomial infection with highly resistant Proteus rettgeri. Report of an epidemic. Am J Epidemiol 1976; 104:278-86.

15. Norden CW, Green GM, Kass EH. Antibacterial mechanisms of the urinary bladder. J Clin Invest 1968;47:2689-700.

16. Kass EH, Schneiderman LJ. Entry of bacteria into the urinary tract of patients with inlying catheters. N Engl J Med 1957;256:556-7.

17. Garibaldi RA, Burke JP, Britt MR, Miller WA, Smith CB. Meatal colonization and catheter-associated bacteriuria. N Engl J Med 1980;303:316-8.

18. Hirsh DD, Fainstein V, Musher DM. Do condom catheter collecting systems cause urinary tract infection? JAMA 1979;242:340-1.

19. Hodgkinson CP, Hodari AA. Trocar suprapubic cystostomy for postoperative bladder drainage in the female. J Obstet Gynecol 1966;96:773-83.

20. Marcus RT. Narrow-bore suprapubic bladder drainage in Uganda. Lancet 1967;1:748-50.

21. Guttman L, Frankel H. The value of intermittent catheterization in the early management of traumatic paraplegia and tetraplegia. Paraplegia 1966;4:63-83.

22. Lapides J, Diokno AC, Gould FR, Lowe. BS. Further observations on self-catheterization. J Urol 1976; 116:169-71.

23. Sanford JP. Hospital-acquired urinary tract infections. Ann Intern Med 1964;60:903-14.

24. Garibaldi RA, Britt MR, Miller WA, Steinmuller P, Burke JP. Evaluation of periurethral colonization as a risk factor for catheter-associated bacteriuria. In: Proceedings of the 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1976;142.

25. Britt MR, Burke JP, Miller WA, Steinmiller P, Garibaldi RA. The non-effectiveness of daily meatal care in the prevention of catheter-associated bacteriuria. In: Proceedings of the 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1976; 141.

26. Burke JP, Garibaldi RA, Britt MR, Jacobson JA, Conti M, Alling DW. Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens. In: Proceedings of the 2nd International Conference on Nosocomial Infections. Atlanta, August 4-8, 1980. Am J Med 1981;70:655-8.

27. Warren JW, Platt R, Thomas KJ, Rosner B, Kass EH. Antibiotic irrigation and catheter-associated urinary tract infections. N Engl J Med 1978;299:570-73.

28. Britt MR, Garibaldi RA, Miller WA, Hebertson RM, Burke JP. Antimicrobial prophylaxis for catheter-associated bacteriuria . Antimicrob Agents Chemother 1977;11:240- 3.

29. Maki DG, Hennekens CH, Bennett JV. Prevention of catheter-associated urinary tract infection: an additional measure. JAMA 1972;221:1270-1.

30. Steere AC, Mallison GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975; 83:683-90.

31. Desautels RF, Walter CW, Graves RC. et al. Technical advances in the prevention of urinary tract infection. J Urol 1962;87:487-90.

32. Viant AC, Linton KB, Gillespie WA. Improved method for preventing movement of indwelling catheters in female patients. Lancet 1971;1:736-7.

33. Marrie TJ, Major H, Gurwith M, et al. Prolonged outbreak of nosocomial urinary tract infection with a single strain of Pseudomonas aeruginosa. Can Med J 1978;119:593-6.

34. Stamm WE. Guidelines for the prevention of catheter-associated urinary tract infections. Ann Intern Med 1975;82:386-90.

35. Mooney BS, Garibaldi RA, Britt MR. Natural history of catheter-associated bacteriuria (colonization, infection, bacteremia): implication for protection. In: Proceedings of the 11th International Congress of Chemotherapy and the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy. Boston. October 8-12, 1979. Washington, D.C.; American Society of Microbiology 1980:1083-5.
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