Top Source of Hospital Infections Needlessly Kills Thousands Annually in the U.S
According to Dr. Craig Lockwood, non-standardized urinary catheter practices in hospitals worldwide have made the insertion and management of urinary catheters the top source of hospital infections. In the U.S. alone, substandard practices needlessly cause thousands of deaths annually that could easily be prevented.
"Poor catheter management is the single biggest cause of hospital-acquired infection in the world, with more than half a million infections every year," says Dr. Craig Lockwood, Director of Translation Science at the Joanna Briggs Institute. "These infections can have a devastating impact on patients. Even if they survive the infection, the result for patients can be drawn out and painful, with recurring infections that affect their overall recovery, and an enormous cost to the healthcare system because of extended hospital stays.”
To combat the problem, Dr. Lockwood and colleagues from the University of Adelaide have created a new international study involving over 2,000 acute care beds in 43 hospitals and clinics located in the U.S., Australia, Finland, Spain and Singapore. The goal of the study is to develop a universal best practice guideline for the use and management of catheters based on their observations and research of what does and does not work in the clinics studied.
However, the challenge of developing a best practice guideline for catheter use in hospitals is both biological and behavioral.
For the biological part of the equation, the bladder is a sterile environment that is only relatively isolated via the urethra from the significantly less-sterile environment of the external genitalia in both men and women. As long as the urethra is not disturbed, it usually does an excellent job of keeping out harmful bacteria.
However, when the urethra is disturbed from mechanical force or trauma such as the insertion of a catheter, the likelihood of bacteria getting into the bladder is greatly increased. Urinary catheters are often used for:
• Difficulty with urinating
• Obstructions that prevent urine flow caused by conditions such as enlarged prostate, prostate cancer or narrowing of the urethra
• Urine output monitoring during illness, injury or disease
• Sterile urine specimen collection
• Medical imaging of the urinary tract
The behavioral part of developing a working best practice guideline involves both the medical equipment and the healthcare worker.
The most common type of urinary catheter used is the Foley catheter, which consists of a thin flexible plastic tube of varying sizes with one end possessing an encircling, inflatable balloon and the other end possessing two ports. One of the ports is for attaching a syringe to inflate the balloon at the opposite end to prevent the catheter from slipping out. The other port is for urine collection/drainage.
The typical procedure for inserting a packaged, sterile urinary catheter is to:
1. Clean the urethra and the surrounding areas with a cotton-ball dipped in an antiseptic solution by starting at the urethral opening and wiping outward in a circular motion toward the surrounding areas.
2. Adding a sterile, water-soluble jelly to the balloon-end tip of the Foley catheter and gently inserting the tube through the urethra into the bladder.
3. Inflate the balloon using a syringe with 10 cc’s of sterile water.
4. If successful, urine should begin to flow through the catheter and into a sterile drainage bag attached to the drainage port.
While aseptic insertion of a urinary catheter is relatively simple, complications typically arise when the catheter is left in over extended periods and/or removed and reinserted multiple times—both of which increases the opportunities for bacteria to find its way to the bladder. Human error becomes a contributing factor as continual sterile cleaning required of the catheter and urogenital region near the point of entry at the urethra is only as good as an individual’s technique and diligence toward cleaning.
"The main problem arises because the urinary system is a sterile environment. Once you introduce a catheter into that system, it becomes a portal of entry for bacteria—either during the insertion process or in the day-to-day care of the patient," says Dr. Lockwood, adding that "Something extremely simple, such as doctors and nurses making sure they've washed their hands properly, can be the difference between a quality recovery for the patient or serious illness and death."
Dr. Lockwood explains that there is often no standard procedure among hospitals for inserting and maintaining a urinary catheter, and that their hope is that they can create a useful best practice guideline—a type of quality control if you will—that will change health providers’ behavior and thereby improve health outcomes by avoiding what should be easily preventable infection.
"…tens of thousands of patients die from these infections every year, with numbers in the United States alone at around 13,000 deaths per annum. Most of these deaths are preventable," states Dr. Lockwood.
Image Source: Courtesy of Wikipedia
University of Adelaide press release: “Killer infections targeted by hospital study”
Emedicinehealth.com: Foley Catheter