Urinary Tract Infections are caused by colonization of the urinary epithelium by bacteria. The bacteria may arise from sites where they serve as normal flora such as Escherichia coli in the skin or rectal epithelium or may be pathogenic such as Klebsiella pneumoniae or Pseudomonas aeruginosa . The urinary epithelium and bladder are usually sterile and free of any microbes. Therefore, the colonizing bacteria may gain access to the tract during procedures such as urinary catheterization. This paper aims to discuss two studies revealing methods through which urinary catheter infections can be prevented.
Qualitative study
Abstract
Background : Recurring urinary tract contaminations are a regularly registered ailment in individuals using clean intermittent self-catheterization. The knowledge on the impact of the problem in the lives of people who experience it is inadequate, thus far the use of prophylactic antibiotics, and experiences of the affected individuals on their application.
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Objectives : To investigate the experiences and observations of adults employing clean irregular self-catheterization for prolonged bladder illnesses focusing on the experiences on infections on the urinary tract and use of prophylactic antibiotics.
Design : A qualitative expressive analysis.
Approaches : Through semi-structured qualitative question and answer session totaling twenty-six conducted in collaboration with people drafted from the ANTIC Trial (Antibiotic treatment for intermittent bladder catheterization: A randomized controlled test of once-daily prophylaxis). Members of the study were irregular self-catheter users whose minimum age was 18 years. Interviews were conducted from August 2015 to January 2016 followed by a thematic analysis of the transcript data.
Findings : The study found out three key topics with consistent themes: the experiences of urinary tract infections and erratic self-catheterization, the apparent burden and normalization; thoughts towards treatment of urinary tract infections through antibiotics- casual attitudes and doubts on antibiotics resistance; and knowledge on use prophylaxis antibiotics on low doses- supportive accountability and habitual behavior.
Conclusion : There is a significant practical and emotional burden due to the urinary tract infection and catheter use while the beliefs on use of antibiotics is primarily created by the perceived efficacy of the drugs, gravity of need and utility.
The study by Dorren McClurg et al. (2018) analyses patient groups that practice clean intermittent self-catheterization. Patients that suffer from bladder control post-surgery, prostate enlargement, and urinary incontinence can benefit from self-catheterization. However, there is a 12% to 88% occurrence of urinary tract infections not related to methods or precautions used during the insertion of the catheter (McClurg et al., 2018). The use of prophylactic antibiotics in low doses has shown prophylactic capabilities in patients who experience recurrent urinary tract infections. The study assessed whether similar low dose prophylactic antibiotics can be used by patients practicing clean intermittent self-catheterization as prophylaxis from urinary tract infection.
Quantitative study
Abstract
Background: An efficient method of catheter-associated urinary tract infections (CAUTI) is through a quicker, on-delayed removal of an indwelling urinary catheter, which can pose challenges in clinical settings. To assess possible effects of an educational program on healthcare workers and a development of a daily use checklist to detect incidences of CAUTI among critical patients with an indwelling urinary catheter.
Methods: The investigation was a quasi-experimental inquiry conducted in a general critical care unit of a tertiary-care medical facility for a span of twelve years from 2005, January to 2016, December. Rates of use of urinary catheter as well as density of the incidences of CAUTI were evaluated on a monthly basis through a criterion provided by Centers for Disease Control and Prevention (CDC) during the analysis time. Phase I of the study conducted between 2005 and2006 was referred as pre-invention period while Phase II took three years from 2007 to 2010. Throughout the study period, training of healthcare workers (HCWs) was conducted twice a year. The trainings focused on CAUTI prevention. Phase III of the study between 2011 and 2014 focused on implementing the day-to-day worksheet for indwelling urinary catheter signs besides the trainings conducted on biannual basis.
Outcomes: The mean rate of use of urinary tract catheters declined by 73.1 per cent in Phase I, 74.1% in Phase II and 54.9% in Phase III while in Phase IV, the recorded a 45.6 % decline. Between phase I and phase IV 54.9%, and 45.6%, respectively. Likewise, the density of CAUTI incidences dropped between phase I and phase IV - 14.9, 7.3, 3.8, and 1.1 per 1000 catheter days, respectively).
Conclusion: The biannual training of HCWs combined with the daily appraisal of indwelling catheter signs proved effective in the decreasing incidence density of CAUTI and rates of catheter utilization.
The study by Mayra Menegueti et al. (2019) analyses how maintenance programs can reduce urinary tract infections in hospitalized patients. Patients in intensive care units require long-term urinary tract catheterization to allow for urine output monitoring preventing further deterioration due to kidney injury. A hospital predisposes vulnerable patients to nosocomial infections. The study has shown that training such as septic techniques significantly reduced urinary tract infections by up to 30% (Menegeuti et al., 2019).
References
McClurg, D., Walker, K., Pickard, R., Hilton, P., Ainsworth, H., Leonard, K., Suresh, S., Nilsson, A., & Gillespie, N.(2018). Participant experiences of clean intermittent self-catheterisation, urinary tract infections, and antibiotic use on the ANTIC trial–A qualitative study. International journal of nursing studies , 81 , pp.1-7.
Menegueti, M.G., Ciol, M.A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G.G., da Silva Canini, S.R.M., Basile-Filho, A. & Laus, A.M.(2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine , 98 (8)
