Infectious Diseases II
| (d) | Practice hand hygiene before insertion of the catheter, as well as before and after any |
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manipulation of the catheter site or apparatus.
| (e) | Proper care and maintenance of indwelling catheter and collection system |
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ii.
Additional approaches
| (a) | Establish a system for analyzing and reporting data on catheter use. |
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| (b) | Develop and implement a protocol to manage postoperative urinary retention. |
| d. | Strategies that should NOT be considered (all of these practices have low-quality evidence |
suggesting no benefits in preventing CAUTIs):
Routine use of silver or antibiotic-impregnated catheters. According to the CDC, silver or
antibiotic-impregnated catheters can be considered if a comprehensive strategy to reduce
CAUTI rates has failed. The ACS NSQIP best-practices guidelines suggest that use of
antimicrobial urinary catheters can be considered for high-risk patients, such as those who
may require prolonged (greater than 7β10 days) catheterization.
ii.
Addition of antibiotics to drainage bag
iii.
Use of systemic antibiotic prophylaxis solely due to catheter placement
iv.
Routine screening or treatment of asymptomatic bacteriuria
Bladder irrigation with antibiotics
Diagnosis, management, and treatment of CAUTIs: See Infectious Diseases I chapter.
Patient Case
C.L is a 55-year-old man admitted to the surgical ICU after exploratory laparotomy for duodenal perforation
and peritonitis. The patient was transferred from the operating room to the surgical ICU with a urinary cath-
eter in place. On day 4 of the surgical ICU stay, the patient is extubated, and his urinary catheter is removed.
On day 6 of the surgical ICU stay, the patient develops signs and symptoms of UTI with fever, urgency, and
frequency. Urinalysis reveals no nitrites or leukocyte esterase. Urine cultures show 100,000 CFU/mL of E.
coli. You are asked by the quality officer of the surgical ICU to discuss this case and determine whether this
patient will qualify for the definition of CAUTI according to CDC criteria. Which statement regarding the
diagnosis of CAUTI in this patient is most appropriate?
Prevention of Catheter-Related Bloodstream Infections
Definitions
CDC definition: Must satisfy both criteria
Laboratory-confirmed bloodstream infection
| (a) | Definition 1: A recognized pathogen (not a common skin contaminant) found in one or |
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more blood cultures AND the organism is not related to an infection at a separate site
| (b) | Definition 2: At least one sign or symptom of infection (temperature greater than 100.4Β°F |
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[38Β°C], chills, hypotension) AND a common skin flora is cultured from two or more blood
samples AND organism is not related to an infection at a separate site
ii.
Central line placed for more than 2 days before the date of event and central line must be
present or removed within 24 hours of blood cultures being obtained.