There has been a continuous increase in the number of urinary tract infections among residents of a local long-term care facility over the last 5 years. Due to comorbidities, many residents are incontinent of urine and have indwelling urinary catheters.
Which of the following measures will most likely decrease the frequency of urinary tract infections in these patients?

Question

There has been a continuous increase in the number of urinary tract infections among residents of a local long-term care facility over the last 5 years.  Due to comorbidities, many residents are incontinent of urine and have indwelling urinary catheters.
Which of the following measures will most likely decrease the frequency of urinary tract infections in these patients?

Quizplus · Accepted Answer

It is estimated that 25%-50% of all hospitalized patients have an indwelling catheter placed sometime during their stay. The most common inappropriate use of indwelling catheters is to manage urinary incontinence. Catheters also should not be used to measure residual urine volume. A portable ultrasound unit can be used for this purpose as it accurately measures residual urine volume > 50 mL. Common appropriate indications for placement of catheters include: Management of acute urinary retention Measurement of urine output in critically ill patients Management of neurogenic bladder Management of hematuria with clots During surgery to assess volume status End-of-life care Management of acute urinary retention Measurement of urine output in critically ill patients Management of neurogenic bladder Management of hematuria with clots During surgery to assess volume status End-of-life care Measures to avoid complications of urinary catheters include: Using catheters only when appropriately indicated Prompt removal of catheters when no longer required Using alternatives to catheters (eg, condom catheters for male patients, diapers) Not routinely replacing or irrigating catheters Using catheters only when appropriately indicated Prompt removal of catheters when no longer required Using alternatives to catheters (eg, condom catheters for male patients, diapers) Not routinely replacing or irrigating catheters The only measure that has been shown to reduce risk of catheter-associated bacteriuria is removal of indwelling catheters as soon as they are not required. (Choices A, B, C & E) Acidification of urine is not recommended to decrease the incidence of catheter-associated urinary tract infections. Administration of prophylactic systemic antibiotics should be avoided due to risks of antimicrobial resistance. There is insufficient evidence to suggest that routine catheter change in patients with long-term indwelling catheters will reduce the risk of bacteriuria. Catheter replacement is indicated only for specific clinical indications such as infection and obstruction. Catheter irrigation with antimicrobials is not recommended. Educational objective: Urinary incontinence is not an indication for indwelling catheters. When not required, indwelling catheters should be removed promptly to avoid the risk of catheter-associated urinary tract infection. __________ References: Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units. (http://www.ncbi.nlm.nih.gov/pubmed/22200187) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. (http://www.ncbi.nlm.nih.gov/pubmed/20175247)

There Has Been a Continuous Increase in the Number of Urinary