Prevention of Nosocomial Urinary Tract Infection

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???????????????????????????????????????Prevention
of Nosocomial Urinary Tract Infection

??????? ???????? ICN sujinda1672_at_yahoo.com
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??????????

Nosocomial Urinary Tract Infection

• ???????????? 2 ?????????????????????????
• (?????? 40 )
• ????????????? ????????????????????????
• 80-90

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Study on Efficacy of Nosocomial Infection
Control SENIC Study 1992

• Nosocomial Infection 2.39
• Nosocomial UTI 900,000 ?????/??
• ??????????????????? 500 ???? US.
• ???? ??. ??????? 3.8 ???/??
• ????????????????? 3803 US
• (3000 ???? US./??)

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??????????

???????????????????????? ??????? 33 ??????
?????????? 3-6 ??????

• 10 - 20 ??????? bacteria ?????????
• 2-6 ??????????? Symptomatic infection
• 1-4 ????????????????????
• ???????????????? 30
• ??????? UTI ??????????????????????????? UTI 3
  ????

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??????????

??????? ??????
?????????????? 26 - 41 ???????????? 14 -
25 ??????? 11 - 21 ????????? 10 -
20 ?????????? 6 - 10 ???????????? 1 - 8
?????? ????????????? ??????????????????????
2544 .
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??.????????????????
??????????????????????????? ?? 2543 - 2548
VAP
?????????? / device days
CAUTI
BSI-line
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Catheter associated urinary tract infection
(CA-UTI)

Causative Pathogen of CA-UTI
Pathogen Hosp wide ICU

E.coli 26 18 Enterococci 16
13 P.aeruginosa 12
11 Candida spp. 9
25 K.pneumoniae 7
NNIS1998
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Definitions CDC

• Symptomatic Bacteriuria
• Asymptomatic Bacteriuria
• Other Infection of the urinary tract

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Symptomatic Bacteriuria (1)

1. Clinical one of the sign symptom
??? gt38ºC, ?????????????????????/??????
????????????/???? ????????????????? 2. Urine
C/S ??????? gt105 per cm3 ??????????????
2 ????
???????
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Symptomatic Bacteriuria (2)

1. Clinical Two of the sign symptom
???gt38ºC, ?????????????????????/??????
????????????/???? ????????????????? 2.
????????????????????? a. pyuria (gt10
wbc/mm3) or gt 3 Wbc/HPF of unspun
urine b. Gram stain positive
???????
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Asymptomatic Bacteriuria (1)

Criteria 1. ??????? retain foley cath ?????
7 ????????????????
1. Urine C/S ??????? gt105 per cm3
?????????????? 2 ???? 2. ??????????????????????
??????????????? ???gt38ºC,
?????????????????????/??????
????????????/???? ?????????????????
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Asymptomatic Bacteriuria (2)

Criteria 2. ???????????????????????????? 7 ???
?????????????
1. Urine C/S ??????? gt105 per cm3
??????????????????? 2 ??????????????? 2 ????
2. ?????????????????????????????????????
???gt38ºC, ?????????????????????/??????
????????????/???? ?????????????????
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Catheter Associated UTICA-UTI

1. Criteria for Dx. of Nosocomial UTI
2. Indwelling urinary catheter -
Duration gt48 hrs. - weaning off within
7 days
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??????????? CAUTI
???????? LAB
1. ??????? gt10 5 / WBC lt10 Contaminate
?????????????????
2. ??????? gt10 5 / WBC gt10 Asymptomatic UTI
?????????????????
3. ??????? gt10 5 / WBC gt10 Symptomatic UTI
??????????????
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??????????????????????????

Alterable factors

• Indication for catheterization
• Length of catheterization
• Catheter care techniques
• Type of drainage system
• Receipt of antimicrobials

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??????????????????????????

??????? Retained foley catheter

• ????????????????????????? UTI ????? 5-10
• 10 ??? ???????? UTI 50
• 30 ??? ???????? UTI 100

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??????????????????????????

Unalterable factors

• Female gender
• Old age
• Severe underlying illness
• Meatal colonization

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Pathogenesis

• Role of catheter
• Continuously open channel
• Foreign material
• Biofilm
• Bacterial factors
• Mutiple drug Resistant

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??????? Biofilm

• ?????????????????????????????????????
• ??????????? ????????? ????? glycocalyx
• ?????????????? ?????? ??????????????????????Biofil
  m
• Biofilm ????????? ???????????????????????????????
  ???????????

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Biofilm on Catheter Connecter 24 hours after
Insertion
Scanning Electron Micrograph

• Link to Biofilms and device-associated infections

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Pathogenesis

• Pathway of infection
• Catheter insertion push microorganism
• Large bacterial inoculum
• Never truly Closed system
• urine bag was emptied frequency improper
• non sterile disconnection of junction

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Pathogenesis

• Colonization
• perineum
• meatal urethra

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??????????????????????????? UTI

• 1. ???????????????????????
• 2. ???????????????????????????????????????????
• ????????????????????????
• ??????????????????????????????
• ????????????????? closed system
• 3. ???????????????????????????????????????????

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Emergency department

• ??????? 118 ??
• 24 (20.34 ) ??????????
• 10 (41.67) urine C/S positive

• 12(50) ???????????
• 2 (17) CAUTI

• 12(50) ??????????????
• 3(25) CAUTI

Gardam.M . Canada 1996
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?????????????????????????????
?????????????
1. ???????????????????????? ARF 2.
????????????????????????????????-????
????????? 3. ?????????????????????? - ??? 4.
??????????????????????????? ????????????
??????? Intermittent
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?????????????????????????????
????????
1. ???????????????????? ??????? gt 2 ??. 2.
????????????????????????????????????/?????????????
?? 3. ?????????????????????? Bed sore 4.
????????????????? ????????????????? SIADH 5.
????????????????????????????????????????????
??????? ???? rupture bladder

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?????????????????????????????
????????????????????

• 1. ???????????????????????????????????????????????
  ??
• Paraplegia, Quadriplegia
• Cauda equina syndrome

• 2. ?????????????????????????????????????????????
• Multiple fracture with shock
• Septic shock
• CHF or pulmonary edema

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?????????????????????????????
????????????????????

• 3. ?????????????????????????? ??????
• ???????????????? gt 2 ??.
• ??????????????????? ???? ORIF with
• recontruction plate

• 4. ??????????????????????? ??????????????????????
  ??
• ?????????????????????
• ?????? laminectomy ???????? sacral nerve root
• involvement

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??????????????????????????????
??????????????????????
1. ????????????????????????????? I/O 2.
?????????????????????? bed sore ?????? flap
??????????????? 3. ????????????? invasive
cardiac ???? radiological procedure 4.
????????????????????-??????????
????????????????? ?????????
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Center for Disease Control (CDC 1981) Guideline
for Prevention of catheter-associated Urinary
Tract Infection

Category I Strongly recommended Category II
Moderately recommended Category III Weakly
recommended
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Recommendation for Prevention of
catheter-associated UTI
Category I Strongly recommended

• Educate personnel in correct techniques of
• catheter insertion and care catheterized
• Emphasize handwashing
• Insert catheter using aseptic technique and
• sterile equipment
• Secure catheter properly
• closed system, unobstructed urine flow

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Recommendation for Prevention of
catheter-associated UTI
Category II Moderately recommended

• Re-educate personnel in catheter care
• Use smallest suitable bore catheter
• Avoid irrigate bladder
• Refrain from daily meatal care
• Do not change catheters at arbitrary
• fixed interval

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Recommendation for Prevention of
catheter-associated UTI
Category III Weakly recommended

• Consider alternative techniques of urinary
• drainage before using urinary catheter
• Replace the collecting system when sterile
  closed
• drainage has been violated
• Spatially separate infected and uninfected
  patients
• with indwelling catheter
• Avoid routine bacteriologic monitoring

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Protocol for Prevention of CAUTI

• ???????????????????????????
• ????????????????????????????????????????????????
  ??
• ??????????????? Closed System
• ????????????????????????????
• ??? Urine bag ?????????????????????
• Flush perineum ????? 2 ?????
• ?????????????????????????????????

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Protocol for Prevention of CAUTI

• ????????????????????
• ?????????????????????????????? Alcohol handrub
• ??????????????????????-???? ?????? 70 Alcohol
• ???????????????????????? ???? 0.5 Hypo
• ????? irrigate bladder ?????????????????
• ????????????????????? CAUTI ???????????????????
  ???
• ????????????????????
• ??????????????????????????? Routine

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