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Abstract
Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided.
Keywords
Audit, infection prevention and control, urinary tract infections
NATIONALLY, APPROXIMATELY20% of all hospital-acquired infections are urinary tract infections, with an estimated 80% of these being linked to urinary catheters (Hospital Infection Society 2007). The Third Prevalence Study of Healthcare Associated Infections in Acute Hospitals in England 2006 found that 31% of hospital inpatients in England had a urinary catheter in situ at the time of the survey or within the previous seven days (Hospital Infection Society 2007). A hospital-acquired infection means the patient did not have any signs or symptoms of this infection before admission and the infection occurred after being in hospital for at least 48 hours (Weston 2008). It has been estimated that the risk of bacteriuria in catheterised patients increases by 3-10% per day every day the catheter remains in situ(Warren 1997), and 50% of patients with a catheter in place for ten days will have a bacteriuria (Saint and Chenoweth 2003). Patients who develop a hospital-acquired infection can expect to remain in hospital two and a half times longer, and incur higher hospital and community costs, than non-infected patients (Plowman 2000).
Indwelling urinary catheters are associated with significant mortality and morbidity, and should be avoided or used for the minimum time possible (Saint and Chenoweth 2003). The greatest risk factor for contracting a urinary tract infection is having a urinary catheter; once inserted, the longer the duration of catheterisation the greater the risk of infection (Pellowe et al 2003). Therefore using alternative urine collection strategies when appropriate and reducing the duration of catheterisation are critical in the prevention of urinary tract infections.
Audit
The Department of Health began mandatory reporting of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias in April 2001. This quickly demonstrated...