Systematic Review of Interventions to Reduce Catheter-Associated Urinary Tract Infection in the Long-Term Care Setting
Background: Catheter-associated urinary tract infection (CAUTI) is a common, costly and morbid nosocomial infection for residents of long-term care (LTC).
Methods: We systematically searched for controlled interventions (randomized or non-randomized) aiming to reduce UTIs (categorized as nosocomial UTI, CAUTI or bacteriuria) and/or urinary catheter use (all types) in the LTC setting (nursing homes, skilled nursing facilities) or rehabilitation and spinal cord programs in English through November 13, 2013 using the electronic databases of Ovid MEDLINE, Cochrane Library via Wiley, CINAHL, Web of Science and Embase.com. Two authors abstracted data and assessed study quality using a modified Downs and Black Quality Index, with abstract discrepancies addressed by third author.
Results: 24 records (Figure) describing 23 controlled-interventions were included; several reported decreased UTIs, CAUTIs or urinary catheter use though often underpowered to assess significance. No analyses were pooled given heterogeneity of interventions, study designs, and outcomes. Study quality was variable (score range 4-27, median: 11.8). CAUTI prevention bundles have been implemented with some evidence of success in LTC, with similarities to acute-care bundles (e.g., hand hygiene, strategies to avoid placement and prompt removal of catheters, proper catheter insertion/maintenance) plus interventions focused on chronic catheter needs, incontinence and preemptive barrier precautions.
Conclusion: Reviewing the available evidence, we propose 5 "C.A.U.T.I" bundle components to prioritize for preventing CAUTI in the LTC setting:
1. Catheters in newly admitted patients should be removed to assess if still needed;
2. Aseptic insertion of indwelling catheters, hand hygiene before and after every resident contact, and barrier precautions during intimate care (i.e., toileting, bathing);
3. Use catheters only if indicated; routine assessments of catheter need (daily in short-term residents, otherwise monthly) should be conducted with alternatives considered;
4. Training and mentorship of staff and family regarding catheter care;
5. Incontinence plans to address individual resident challenges and solutions.
AHRQ: Grant Investigator, Salary
SHEA: Member, Speaker honorarium
QuantiaMD: invited speaker/developer for educational webinar, Speaker honorarium
S. Krein, Blue Cross and Blue Shield of Michigan Foundation: Grant Investigator, Research grant and Research support
Department of Veterans Affairs: Employee and Investigator, Research support and Salary
A. Hickner, AHRQ: Collaborator, Salary and staff member on AHRQ grants and contracts
VA HSR&D: Collaborator and Employee, Salary and was employee of Ann Arbor VA during this project
University of Michigan: Employee, employee (now part-time) of U of M during project, now works at Yale as primary job. and Salary
Yale Medical Library: Employee, Salary and Transitioned to Yale in February 2014 after work on this project completed
H. Reichert, AHRQ: Collaborator, Salary and statistician, analyst on AHRQ grant of Jennifer Meddings
E. Gaies, AHRQ: Collaborator, Research associate as staff on AHRQ grants and contracts and Salary
VA HSR&D: Employee, Salary
S. Mcnamara, University of Michigan - Geriatrics: Employee, Salary
AHRQ: Collaborator, Salary and staff member on AHRQ grants and contracts
NIH : Collaborator, Salary and staff member on NIH grants and contracts of Dr. Mody
L. Mody, None