The purpose of this video is to provide general information and education about the care of
a critically ill child.
It is in no way a substitute for the independent decision making and judgment by a qualified
health care professional.
The information contained in this video should not be used to make a diagnosis or to overrule
the advice of a qualified health care provider, nor should it be used to provide advice for
emergency medical treatment.
Prevention of Urinary Tract Infections.
By Deb Morrow.
Hello, my name is Deb Morrow, and I am a Staff Nurse III and the Infection Prevention Coordinator
in the Cardiac Intensive Care Unit at Children's Hospital Boston.
Today I'd like to talk to you about our strategies to prevent urinary tract infections that we
have implemented at Children's Hospital Boston.
Epidemiology.
Urinary tract infections are the most common health care associated infection in both adults
and pediatrics.
75 to 80% of urinary tract infections are associated with the use of a urinary catheter.
And the three highest risk factors for urinary tract infections are duration of catheterization,
female gender, and catheter care violations.
Pathogenesis.
Catheter-associated urinary tract infections are preventable.
Let's talk about biofilm for a moment.
Biofilm is a thin mucus film that develops on the inside and outside of catheters inserted
into the body.
Bacteria colonize the surfaces of these catheters and secrete a mucus film which can protect
the bacteria from antibiotics.
Bacterial multiplication takes place under the biofilm.
Urine is an excellent medium for bacterial growth and the development of biofilm is rapid.
Catheter contamination can occur in three ways.
External contamination occurs due to a patient's own perineal and colonic flora or from bacteria
on the hands of the health care worker.
The bacteria can be introduced at insertion or ascend up the urethral tract in the biofilm
along the outside of the catheter.
Internal contamination occurs due to unsterile entry into the collecting system, allowing
microorganisms to contaminate the urine.
It only takes 24 to 48 hours for microorganisms in the collecting bag to ascend up the tubing
and contaminate the bladder.
And finally, non-biofilm related infections occur when contaminated urine is allowed to
reflux back up into the bladder.
Urinary Tract Infection Prevention Bundle.
At Children's Hospital Boston, our urinary tract infection prevention bundle includes
the following components -- hand hygiene, which is the basis of all infection prevention
initiatives, inserting catheters only when medically necessary as defined by the hemodynamically
unstable patient with the need for strict intake and output, the chemically paralyzed
patient, who is unable to void spontaneously.
The patient with a wound or breakdown in the sacral area.
Or the patient with physical obstruction of the bladder.
Catheter insertion is a sterile procedure.
And catheters should only be inserted by educated personnel.
We have a urinary catheter insertion kit, which has all the supplies needed for catheter
insertion.
Having a kit will prevent breaks in sterility, which could occur when doctors or nurses are
missing supplies.
There is also a maintenance component of our bundle.
Studies show that daily cleaning of the urinary catheter itself contributes to an increase
in urinary tract infection.
Therefore, gently clean the skin of the urethral area, especially after bowel movements.
Use a closed drainage system that hangs below the patient's abdomen so urine does not collect
in the catheter or the catheter tubing.
And do not lift the tubing or bag above the patient so that urine refluxes back up into
the bladder.
The tubing catheter connection should not be broken, for example, to untangle the catheter.
And if it is, disinfect the connection with alcohol first.
If we feel that a urinary catheter may be malfunctioning, we would choose to replace
the entire system rather than introduce bacteria through repeated irrigations.
We also do not require a urinary catheter when a patient has a femoral line or when
a patient is in renal failure The use of a daily goals sheet, which includes a section
on indwelling catheters, is a powerful reminder to doctors and nurses to assess the continued
need for the urinary catheter every day.
Our daily goals sheet contains a column that identifies the number of days the catheter
has been in place.
And if a catheter must remain in place, the daily goal addresses strategies for catheter
removal.
Early urinary catheter removal is the number one intervention to prevent the development
of urinary tract infections.
Conclusion.
Evidence-based practices can reduce urinary tract infection rates.
One should implement bundles for urinary catheter management, assess the need for the urinary
catheter every day, observe practice for compliance with policy, and feedback infection rates
and results of practice observation to doctors and nurses.
Units should establish policy for the insertion and maintenance of urinary catheters and educate
doctors and nurses on urinary tract infection prevention.
Communication training will help staff to speak up when practice to prevent urinary
tract infections is not followed.
That concludes our video on Prevention of Urinary Tract Infections.
Thank you.
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