Recommendations on Prevention

of Catheter-associated Urinary
Tract Infection

2nd Edition

Scientific Committee on Infection Control, and

Infection Control Branch, Centre for Health Protection,
Department of Health
衞生防護中心乃衞生署
轄下執行疾病預防
March 2017
及控制的專業架構
The Centre for Health
Protection is a
professional arm of the
Department of Health for
disease prevention and
control
Membership (2016)

Chairlady : Dr. LIM Wei Ling, .Wilina

Members : Ms CHING Tai Yin, Patricia
Dr. CHOI Kin Wing
Dr. FUNG Sau Chun, Kitty
Dr. HO Pak Leung
Prof. Ip Pik Yiu, Margaret
Dr. LEUNG Chi Chiu
Dr. LEUNG Lai Man, Raymond
Prof. LI Yuguo
Dr. QUE Tak Lun
Dr. LAW Chi Ming, Norman
Dr. TSANG Ngai Chong. Dominic
Dr. SETO Wing Hong
Dr. WANG Kin Fong, Teresa
Dr. WONG Tin Yau, Andrew
Ms. YIP Kam Siu, Ida
Dr. YUNG Wai Hung, Raymond
Secretary : Dr. Wong Wai Ying, Ada

Correspondence

Address : Scientific Committee on Infection Control Secretariat

Centre for Health Protection
4/F Programme Management and Professional Development Branch,
147C Argyle Street, Kowloon, Hong Kong
Telephone : 2125 2182
Fax : 2761 3272
E-mail : [email protected]

2
Background

The Recommendations on Prevention of Catheter-associated Urinary

Tract Infection (CAUTI) represent the third accomplishment of The Scientific
Committee on Infection Control (SCIC) in the promulgation of preventive measures
for the four major systems - namely, surgical site infection, intravascular catheter
associated bloodstream infection, ventilator-associated pneumonia and catheter-
associated urinary tract infection. It is believed that the recommendations presented in
this report will provide guidance on good practice for the prevention of Catheter-
associated Urinary Tract Infection, which would ideally set the standard of care in
Hong Kong.

Acknowledgements

The SCIC would like to express the most sincere thanks to the following
parties for their dedication and valuable contribution to the review of the
“Recommendations on Prevention of Catheter-associated Urinary Tract Infection”.

I. Guideline review group (2nd edition)

External reviewer:
Dr. William R. Jarvis (Jason and Jarvis Associates, Limited Liability
Corporation, USA)

Internal reviewers:
Dr. Wong Tin Yau, Andrew (Head, ICB)
Dr. Lui, Leo (AC, ICB)
Dr. Chen Hong (AC, ICB)
Ms. Leung Suk Yee, Jane (APN, ICB)
Ms. Fu Kit Yee (APN, ICB)
Ms. Tsang Yuen Ki, Candy (APN, ICB)

II. Ex-members of guideline development group (1st edition)

i. Previous Scientific Committee on Infection Control Members
Dr. Kwan Kai Cho, Joseph
Dr. Tong Cheuk Yan, William

ii. Infection Control Branch Members

Ms. Lung Wan Tin (APN, ICB)
Ms. Chan May May, Cindy (RN, ICB)
Doctors and nurses who gave comments and feedbacks during the
process of recommendation development

iii. External Consultation Parties

Mr. So Nai Yeung, Sony (NO, Infection Control Team, KWH)
Task Force in Infection Control, Hospital Authority

3
Recommendations on Prevention of Catheter-associated Urinary
Tract Infection

Contents
Introduction .......................................................................................................................................... 5
1. Education, Training and Competence Assessment ......................................................... 6
2. Avoid Unnecessary Urinary Catheterization..................................................................... 6
3. Shorten the Duration of Indwelling Urinary Catheterization ....................................... 7
4. Proper Hand Hygiene and Using of Gloves ...................................................................... 7
5. Aseptic Urinary Catheter Insertion ...................................................................................... 8
6. Maintain Unobstructed Urine Flow ..................................................................................... 8
7. Maintain a Sterile and Closed Urinary Drainage System .............................................. 8
8. Individualized Catheter Change Intervals .......................................................................... 9
9. Good Meatal Care..................................................................................................................... 9
10. Aseptic Urine Specimen Collection .................................................................................. 10
11. Avoid Bladder Washout........................................................................................................ 10
12. Role of Antimicrobial Agents ............................................................................................. 11
13. Type of Catheter ..................................................................................................................... 11
14. Documentation and Monitoring .......................................................................................... 11
15. Surveillance and Quality Improvement Programs ......................................................... 12
Appendix I: Hong Kong Bundle to Prevent CAUTI ……………………………...….13

Appendix II: Reminder to wean off Indwelling Urinary Catheter (Sample) ……...….14
References .......................................................................................................................................... 15

4
Introduction

Urinary catheter is a commonly used device for different patients in

various healthcare settings. Their use may put patients at increased risk of catheter-
associated urinary tract infection (CAUTI). Indwelling urinary catheter, as a foreign
body, allows bacteria to colonize and enter the body. It is well established that the
duration of catheterization is directly related to risk for developing a CAUTI. With a
catheter in place, the daily risk of developing bacteriuria ranges from 3% to 7%. (1)
CAUTIs account for a significant proportion (up to 30-40%) of healthcare-associated
infections which in turn may have great financial impact to the healthcare system. (2–4)

Other non-infective negative outcomes associated with catheter use include

nonbacterial urethral inflammation, urethral strictures, mechanical trauma, patient
discomfort and mobility impairment. (1)

2. The most effective strategy to prevent CAUTI is prompt removal of

unnecessary urinary catheters. If the use of catheter is deemed necessary, care should
be taken to minimize unnecessary manipulation, prevent trauma and maintain a closed,
patent and non-kinked system. Further well-designed studies are needed to generate
high quality evidence regarding types and techniques of catheterization. (5–8)

3. This recommendation provides the principles for best practice of urinary

catheter care to healthcare professionals. It can serve as a model in formulation of
strategies, programmes and plans for prevention of CAUTIs in individual institutions.

5
1. Education, Training and Competence Assessment

1.1 Educate staff on the preventive insertion and maintenance measures of

CAUTIs in the orientation program and the in-service refresher training.
(1,3,9–12)

1.2 Ensure health care personnel, who are involved in urinary catheter
insertion or care, are trained and competent to perform the procedure
with aseptic technique. (1,3,9–14)

1.3 Keep an updated written Standard Operating Procedures (SOP) on

urinary catheter care. (1,12,15)

1.4 Provide clear instruction to patients and caregivers on proper care of the
urinary catheter and drainage system. (11,16)

2. Avoid Unnecessary Urinary Catheterization

2.1 Limit the use of indwelling urinary catheters to patients with strong
clinical indication and that the benefits outweigh the risks of CAUTI
and its complications. (3,13–21)

2.2 Do not use indwelling urinary catheter for the following purposes: (13)
2.2.1 as a means to obtain urine specimen when the patient can
void voluntarily.
2.2.2 as a substitute for nursing care in incontinent patients.

2.3 Restrict the use of indwelling urinary catheter for the following
purposes (1,3,10,16,20,22,23)
2.3.1 to relieve urinary obstruction and/or acute urinary retention.
2.3.2 to monitor urine output in critically ill patients, where
calculation of input and output is important.
2.3.3 to aid in urologic surgery.
2.3.4 in urinary incontinent patients with open wounds or skin
graft in the sacral and/or perineal area.
2.3.5 in terminally ill patients, as request for comfort care.

2.4 Consider use of alternative methods with lower infection risk, such as
suprapubic catheterization, condom catheters, intermittent urethral
catheterization, or use of disposable nappies as far as possible in
appropriate patients. (1,3,11,13–19,21)

Condom catheter is appropriate for non-cognitively impaired male

patients with minimal post-void residual urine. (24)

6
 2.5 Use of bedside ultrasound to assess post-voiding residual volume can
prevent a significant proportion of patients (including post-operative)
from unnecessary catheterization. (1,3,11,24). Efforts should be
initiated to train doctors and nurses to use bedside ultrasound.

3. Shorten the Duration of Indwelling Urinary Catheterization

Establish a system to ensure the urinary catheter is removed promptly when it

is no longer indicated. (1,3,4,10,11,13,14,17,19,22,25–27)

3.1 Develop evidence-based criteria for indications of continuous urinary

catheterization. (1,3)

3.2 Assess and document clearly the indication for continuous urinary
catheterization on daily basis. (1,3) Educate all healthcare personnel and
then use reminders (electronic or paper) of presence of urinary catheter
and criteria for continued use for physicians and nurses. (1)

3.3 Nurse to remind physician to remove the catheter if it is no longer

indicated. Physician should document justification for continued use if
indication not meeting listed criteria. (1,3)

3.4 Consider use of automatic urinary catheter stop order whenever

applicable. (1,3)

3.5 Restrict indications for placement or duration of catheterization are

major components to prevent CAUTI. Routine use of indwelling bladder
catheters for surgical procedures of short duration, such as caesarean
section is not recommended. (1,28,29)

4. Proper Hand Hygiene and Using of Gloves

4.1 Practice hand hygiene immediately before insertion of the catheter and
before and after any manipulation of the catheter site or apparatus.
(1,3,9,10,13,16)

4.2 Decontaminate hands and wear a new pair of clean gloves before
manipulating each patient’s catheter. Sterile gloves must be worn for
catheter insertion. (1,3,11,13,15)

4.3 Change gloves between patients to prevent cross-infection. (15,16)

7
5. Aseptic Urinary Catheter Insertion
5.1 Ensure the catheter is inserted by trained and competent persons (e.g.
health care workers, family members or patients). (12–14,16,19,21)

5.2 Maintain aseptic technique during catheter insertion. (1,10,13,14,16)

5.3 Use sterile equipment and supplies: use single-use packet of sterile
lubricant jelly, sterile urinary catheter, sterile gloves and sterile drape.
(1,3,12–14) Do not reprocess/sterilize used urinary catheters for re-use.
(12)

5.4 Use appropriate antiseptic solution to clean the peri-urethral skin

thoroughly before insertion. (1,3,10,13,14)

5.5 Minimize the risk of urethral trauma

5.5.1 Use the smallest possible size, good drainage urinary catheter
unless otherwise clinically indicated. (1,10,11,13,15,16)
5.5.2 Apply adequate lubricant on the catheter before insertion.
(1,10,11,13,15,16)
5.5.3 Ensure the catheter is always firmly secured to prevent in-
and-out movement and urethral traction to decrease catheter
dislodgement and meatal erosion. (1,3,13,21,30,31)

6. Maintain Unobstructed Urine Flow

6.1 Prevent kinking or sagging of the urinary catheter to ensure
unobstructed flow of urine. (3,9,10,13)

6.2 Prevent retrograde flow of urine from collection bag to the bladder.
6.2.1 Keep the drainage bag below the level of bladder and
connecting tube at all times. The outlet should never rest on
the floor. (3,9,11,13,32)
6.2.2 Clamp the drainage tube before raising the drainage bag
above bladder level. (12)
6.2.3 Do not allow the drainage bag to be overfilled (never more
than three-quarters full). (3,11,33)

7. Maintain a Sterile and Closed Urinary Drainage System

7.1 Minimize opening and manipulating the catheter and the drainage
system. (1,3,10,11,13,14,16,19)

7.2 Do not re-use the drainage bag. (12)

7.3 During emptying of the drainage bag:

7.3.1 Use a designated urine-collecting container for each patient.

8
 Disinfect the container and keep it dry after each use. (3,10–
12,33,34)
7.3.2 Perform hand hygiene and wear clean gloves for the
procedure. (11,12,33) Gloves should be removed and hand
hygiene should be performed immediately afterwards. (11)
7.3.3 Disinfect the outlet of the drainage bag with alcohol before
and after each opening. (9,33)
7.3.4 Prevent the outlet of drainage bag from touching the
collecting container while emptying. (3,13,33)

7.4 Changing of urinary bag:

7.4.1 Change the urinary drainage bag according to the
manufacturer’s recommendation and/or when the urinary
catheter is changed or the bag leaks. (17)
7.4.2 Follow the manufacturer’s recommendation on frequency of
changing of catheter valve. (33)
7.4.3 Disinfect the catheter-tubing junction before disconnecting
the drainage system. (10)

8. Individualized Catheter Change Intervals

8.1 Do not change the urinary catheter at routine, fixed intervals for all
patients. (3,10,11,13) The optimal time for changing the urinary catheter
depends on the manufacturers’ instructions and patients’ characteristics.
Some patients form deposits in the catheter lumen quicker than others
and they may require more frequent catheter changes. (12,33,35) It is
preferable to change the catheter before blockage is anticipated to occur.
(15,33,36)

8.2 Replace the catheter whenever it is contaminated, e.g. accidental

opening. (21)

9. Good Meatal Care

9.1 Routine daily cleansing with soap and water is adequate to maintain
good hygiene of the meatal area. Use of antiseptic solution is
unnecessary. (1,3,10–13,37)

9.2 Keep the peri-urethal area clean and dry. (12)

9.3 Remove gross debris from the catheter tubing during bathing or
showering. (3,11,14,33)

9.4 Additional cleansing is indicated for patients with diarrhoea or

incontinence. (19)

9
10. Aseptic Urine Specimen Collection

10.1 Apply aseptic technique; perform hand hygiene and wear clean gloves
for urine collection. (3,33)

10.2 To collect a small volume urine sample or urine for culture:

10.2.1 Disinfect the sampling port or distal end* of the urinary
catheter with appropriate disinfectant (70% alcohol) and
allow time (>30 seconds) for the disinfectant to dry/work
before puncture. (1,9,12)
*Never puncture silicone urinary catheters with a needle as it
cannot reseal over the puncture holes. (21)
10.2.2 Use a sterile small size syringe to aspirate urine. (10,12,13)

10.3 Follow point 7.3 aseptic procedures for collecting large volume urine
sample from urinary drainage bag, e.g. urine electrolytes analysis.
(9,10,13) However, collecting the urine sample from the drainage bag is
unsuitable for culture purposes.

11. Avoid Bladder Washout

11.1 Do not perform bladder washout or irrigation as a means to prevent

infection. (3,10–13,33)

11.2 Remove and replace a blocked catheter rather than attempting bladder
washout. (12,13,33)

11.3 When bladder irrigation is necessary, e.g., prevention of blood clot

formation after bladder or prostate surgeries:
11.3.1 Perform the procedure in a closed irrigation and drainage
system with a three-way catheter to decrease the frequency of
opening. (10)
11.3.2 Use sterile irrigation solutions and administration set.
11.3.3 Manipulate the system with aseptic technique. Before each
change or disconnection, thoroughly disinfect the junction
with alcohol and allow it to dry. (10)

11.4 Ensure adequate hydration in patients with indwelling urinary catheters

to dilute the urine and make it acidic to prevent or dissolve the
encrustation. (33)

12. Role of Antimicrobial Agents

12.1 Routine prophylactic antibiotics for urinary catheterization are not

10
 recommended, as it increases the risk of emergence of antimicrobial-
resistant bacteria. (1,15)

12.2 Routine antibiotics for asymptomatic catheter-associated bacteriuria is

not recommended as it promotes antimicrobial resistance and C. difficile
infection, unless in high risk patients such as pregnant women or before
urological surgery in which visible mucosal bleeding is anticipated.
(1,21,24,28)

12.3 Routine application of topical antibiotics to the catheter, urethra or

meatus is not recommended. (15)

12.4 Addition of antibacterial solutions to drainage bags is not recommended.

(15,37)

13.Type of Catheter

13.1 Select the type and gauge of urinary catheter based on assessment of the
patient’s individual characteristics including age, allergy history, gender,
history of UTI, patient’s preference, previous catheter history and
reason of catheterization. (38)

13.2 Use of antimicrobial impregnated or antiseptic-coated urinary catheter

as an infection preventive measure is not routinely recommended.
(6,7,15,38–43). These catheters should only be considered if the CAUTI
rate does not decrease after implementing a comprehensive CAUTI
prevention bundle. (3,7,13,16)

14. Documentation and Monitoring

14.1 Maintain proper documentation in the patient’s medical record on

clinical parameters, such as the need for catheterization, who inserted
the catheter, the date and time of catheter insertion, care and removal of
catheter. (1,3,10,17) This is important for all patients, but particularly
important at the time of patient discharge or transfer. (11)

14.2 Monitor all urinary catheterized patients for signs and symptoms of
CAUTI.

15. Surveillance and Quality Improvement Programs

15.1 Maintain a surveillance system to monitor for symptomatic CAUTI.

CAUTI rate is usually reported as per 1,000 catheter-days. (3,11,18,44)

11
 Analysis of surveillance data should take into account that when the use
of urinary catheters is reduced, CAUTI rate may paradoxically increase.
(1)

15.2 Routine bacteriologic monitoring in urinary catheterized patients is not

recommended as an infection control measure. (10,13,14,24)

15.3 Regularly feedback of performance measures and surveillance results to

physicians, nurses and the hospital or nursing management.
(1,3,33,45,46) Performance measures include:
15.3.1 Compliance with documentation of catheter insertion &
removal date.
15.3.2 Compliance with documentation of indication for catheter
placement.
15.3.3 Compliance with the standard procedure.
15.3.4 Compliance with CAUTI prevention bundle.

15.4 Continue to identify chances of quality improvement on CAUTI.

(1,3,5,16,33,47) Use CAUTI PREVENTION BUNBLE to reduce
urinary catheter utilization and its complications. (1,3,11,16)

15.5 Use standardized criteria, such as NHSN definitions or clinical criteria,

to identify patients who have a CAUTI.(1,3,13,48–51)

Centre for Health Protection

June 2010
(Last reviewed March 2017)

The copyright of this paper belongs to the Centre for Health Protection, Department of Health, Hong Kong
Special Administrative Region. Contents of the paper may be freely quoted for educational, training and
non-commercial uses provided that acknowledgement be made to the Centre for Health Protection,
Department of Health, Hong Kong Special Administrative Region. No part of this paper may be used,
modified or reproduced for purposes other than those stated above without prior permission obtained from
the Centre.

12
Appendix I: Hong Kong Bundle to Prevent CAUTI

1. The indication for urinary catheter needs to be reviewed daily

2. Nurse to remind physician stop catheter when no longer indicated

3. Implement auto-stop reminder whenever applicable

4. Observe hand hygiene before and after urinary catheter care and use
aseptic technique for insertion of catheter

5. Consider using bedside ultrasound to screen for post-voiding residual urine

volume before insertion of catheter in selected groups of patients

13
Appendix II: Reminder to wean off Indwelling Urinary Catheter (IUC) - Sample

Patient Gum Label

Date of insertion of catheter (day 0): ______________________________

Please tick the indication(s) of IUC for this patient daily. If none of the indications is present, the catheter should be removed.

Indication Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

To relieve urinary obstruction and/or acute urinary retention

To monitor urine output in critically ill patients

To aid in urologic surgery

Patient has urinary incontinence with open wounds and/or skin graft in
sacral or perineal areas
To improve comfort for terminally ill patient

Staff Signature
(Physician/Nurse)
Remark: Use a new form if continuous urinary catheterization is indicated.

14
References
1. Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, et al.
Strategies to prevent catheter-associated urinary tract infections in acute care
hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 May;35(5):464–
79.

2. Burke J, Pombo D. Nosocomial urinary tract infections. In: Mayhall CG,

editor. Hospital epidemiology and infection control. 4th ed. Baltimore:
William & Wilkins; 2012. p.270-85

3. Institute for Healthcare Improvement. How-to Guide: Prevent Catheter-

Associated Urinary Tract Infection [Internet]. 2011 [updated 2011 Dec 31;
cited 2016 Dec 15]. Available from:
http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCatheterAssoci
atedUrinaryTractInfection.aspx

4. Niël-Weise BS, van den Broek PJ, da Silva EMK, Silva LA. Urinary catheter
policies for long-term bladder drainage. Cochrane Database Syst Rev. 2012
Aug 15;(8): DOI: 10.1002/14651858.CD004201.pub3.

5. Phipps S, Lim YN, McClinton S, Barry C, Rane A, N’Dow J. Short term

urinary catheter policies following urogenital surgery in adults. Cochrane
Database Syst Rev. 2006 Apr 19;(2): DOI:
10.1002/14651858.CD004374.pub2.

6. Jahn P, Beutner K, Langer G. Types of indwelling urinary catheters for long-

term bladder drainage in adults. Cochrane Database Syst Rev. 2012 Oct 17;10:
DOI: 10.1002/14651858.CD004997.pub3.

7. Lam TBL, Omar MI, Fisher E, Gillies K, MacLennan S. Types of indwelling

urethral catheters for short-term catheterisation in hospitalised adults.
Cochrane Database Syst Rev. 2014 Sep 23;(9): DOI:
10.1002/14651858.CD004013.pub4.

8. Prieto J, Murphy CL, Moore KN, Fader M. Intermittent catheterisation for

long-term bladder management. Cochrane Database Syst Rev. 2014 Sep
10;(9): DOI: 10.1002/14651858.CD006008.pub3.

9. Leone M, Garnier F, Avidan M, Martin C. Catheter-associated urinary tract

infections in intensive care units. Microbes Infect. 2004 Sep;6(11):1026–32.

10. Canada Department of National Health and Welfare. Infection Control

Guidelines: Prevention of catheter associated urinary tract infections. 1988.
p.53-62

11. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, et al. epic3:
national evidence-based guidelines for preventing healthcare-associated

15
 infections in NHS hospitals in England. J Hosp Infect. 2014 Jan;86 Suppl
1:S1-70.

12. Damani NN. Prevention of infections associated with urinary catheterization.

Manual of Infection Control Procedures. 2nd ed. London: Greenwich Medical
Media; 2003. p.273-82

13. Centers for Disease Control and Prevention. Guideline for prevention of
catheter-associated urinary tract infections 2009 [Internet]. 2009 [cited 2009
Dec 09]. Available from:
https://www.cdc.gov/hai/pdfs/cautiguideline2009final.pdf

14. Department of Health. Guidelines for preventing infections associated with

the insertion and maintenance of short-term indwelling urethral catheters in
acute care. J Hosp Infect. 2001;47 Suppl 1:S36–43.

15. Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA,

Naber KG. European and Asian guidelines on management and prevention of
catheter-associated urinary tract infections. Int J Antimicrob Agents. 2008
Feb;31 Suppl 1:S68-78.

16. Health Protection Scotland, National Health Services. Bundle for preventing
infection when inserting and maintaining a Urinary Catheter (acute settings).
Version 1.0 [Internet]. 2013 [cited 2016 Dec 15]. Available from:
http://www.documents.hps.scot.nhs.uk/hai/infection-control/bundles/cauti/uc-
acute-v1.pdf

17. Pellowe CM, Pratt RJ, Harper P. Prevention of healthcare –associated

infection in primary and community care. J Hosp Infect. 2003;55(S2):1–27.

18. Nicolle LE, SHEA Long-Term-Care-Committee. Urinary tract infections in

long-term-care facilities. Infect Control Hosp Epidemiol. 2001
Mar;22(3):167–75.

19. Salgado C, Karchmer T, Farr, BM. Prevention of catheter-associated urinary

tract infections. In: Wenzel, RP, editor. Prevention and control of nosocomial
infections. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.

20. Apisarnthanarak A, Rutjanawech S, Wichansawakun S, Ratanabunjerdkul H,

Patthranitima P, Thongphubeth K, et al. Initial inappropriate urinary catheters
use in a tertiary-care center: Incidence, risk factors, and outcomes. Am J
Infect Control. 2007 Nov;35(9):594–9.

21. Castle, M, Ajemian, E. Nosocomial urinary tract infections. In Hospital

Infection Control Principles and Practice. 2nd ed. New York: John Wiley &
Sons; 1980. p.80-95

16
22. Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract
catheter in hospitalized medical patients. Arch Intern Med. 1995 Jul
10;155(13):1425–9.

23. Ireland Health Service Executive. Guidelines for the prevention of catheter
associated urinary tract infection. Published on behalf of Strategy for the
Control of Antimicrobial Resistance in Ireland (SARI) by Health Protection
Surveillance Centre 2011[Internet]. 2011 [cited 2016 Dec 15]. Available from:
https://www.hpsc.ie/A-
Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/
File,12913,en.pdf

24. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et
al. Diagnosis, prevention, and treatment of catheter-associated urinary tract
infection in adults: 2009 International Clinical Practice Guidelines from the
Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis
Soc Am. 2010 Mar 1;50(5):625–63.

25. Saint S, Wiese J, Amory JK, Bernstein ML, Patel UD, Zemencuk JK, et al.
Are Physicians Aware Of Which of Their Patients Have Indwelling Urinary
Catheters? Am J Med. 2000 Oct 15;109(6):476–80.

26. Huang WC, Wann SR, Lin SL, Kunin CM, Kung MH, Lin CH, et al.
Catheter-associated urinary tract infections in intensive care units can be
reduced by prompting physicians to remove unnecessary catheters. Infect
Control Hosp Epidemiol. 2004 Nov;25(11):974–8.

27. Crouzet J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D. Control of

the duration of urinary catheterization: impact on catheter-associated urinary
tract infection. J Hosp Infect. 2007 Nov;67(3):253–7.

28. El-Mazny A, El-Sharkawy M, Hassan A. A prospective randomized clinical

trial comparing immediate versus delayed removal of urinary catheter
following elective cesarean section. Eur J Obstet Gynecol Reprod Biol. 2014
Oct;181:111–4.

29. Li L, Wen J, Wang L, Li YP, Li Y. Is routine indwelling catheterisation of the

bladder for caesarean section necessary? A systematic review. BJOG Int J
Obstet Gynaecol. 2011 Mar;118(4):400–9.

30. Viant AC, Linton KB, Gillespie WA, Midwinter A. Improved method for
preventing movement of indwelling catheters in female patients. Lancet Lond
Engl. 1971 Apr 10;1(7702):736–7.

31. Darouiche RO, Goetz L, Kaldis T, Cerra-Stewart C, AlSharif A, Priebe M.

Impact of StatLock securing device on symptomatic catheter-related urinary
tract infection: a prospective, randomized, multicenter clinical trial. Am J
Infect Control. 2006 Nov;34(9):555–60.

17
32. European Association of Urology. Guidelines on urological infections
[Internet]. 2015 [updated 2015 Mar 30; cited 2016 Dec 15]. Available from:
http://uroweb.org/wp-content/uploads/EAU-Guidelines-Urological-Infections-
v2.pdf

33. Banfield K. Catheterization and urinary infection. In: Infection Control

Science Management and Practice. London, Philadelphia: Whurr Publishers;
2000. p.242-61.

34. Rutala WA, Kennedy VA, Loflin HB, Sarubbi FA. Serratia marcescens
nosocomial infections of the urinary tract associated with urine measuring
containers and urinometers. Am J Med. 1981 Mar;70(3):659–63.

35. Anders, K. The female patient with a catheter. Womens Health Med.
2005;2(6):50–3.

36. Evans A, Painter D, Feneley R. Blocked urinary catheters: nurses’ preventive

role. Nurs Times. 2001 Jan 4;97(1):37–8.

37. Lockwood C, Page T, Nurs H, Conroy-Hiller T, Florence Z. Management of

short-term indwelling urethral catheters to prevent urinary tract infections. JBI
Reports 2004;2(8):271-91.

38. National Institute of Health and Care Excellence. Healthcare-associated

infections: prevention and control in primary and community care clinical
guidelines [CG139] [Internet]. 2012 [cited 2016 Dec 15]. Available from:
https://www.nice.org.uk/guidance/cg139

39. Stensballe J, Tvede M, Looms D, Lippert FK, Dahl B, Tønnesen E, et al.

Infection risk with nitrofurazone-impregnated urinary catheters in trauma
patients: a randomized trial. Ann Intern Med. 2007 Sep 4;147(5):285–93.

40. Johnson JR, Kuskowski MA, Wilt TJ. Systematic review: antimicrobial
urinary catheters to prevent catheter-associated urinary tract infection in
hospitalized patients. Ann Intern Med. 2006 Jan 17;144(2):116–26.

41. Srinivasan A, Karchmer T, Richards A, Song X, Perl TM. A prospective trial

of a novel, silicone-based, silver-coated foley catheter for the prevention of
nosocomial urinary tract infections. Infect Control Hosp Epidemiol. 2006
Jan;27(1):38–43.

42. Rupp ME, Fitzgerald T, Marion N, Helget V, Puumala S, Anderson JR, et al.
Effect of silver-coated urinary catheters: efficacy, cost-effectiveness, and
antimicrobial resistance. Am J Infect Control. 2004 Dec;32(8):445–50.

43. Lai KK, Fontecchio SA. Use of silver-hydrogel urinary catheters on the
incidence of catheter-associated urinary tract infections in hospitalized
patients. Am J Infect Control. 2002 Jun;30(4):221–5.

18
44. Dudeck MA, Edwards JR, Allen-Bridson K, Gross C, Malpiedi PJ, Peterson
KD, et al. National Healthcare Safety Network report, data summary for 2013,
Device-associated Module. Am J Infect Control. 2015 Mar 1;43(3):206–21.

45. Rosenthal VD, Guzman S, Safdar N. Effect of education and performance

feedback on rates of catheter-associated urinary tract infection in intensive
care units in Argentina. Infect Control Hosp Epidemiol. 2004 Jan;25(1):47–50.

46. Saint S, Kowalski CP, Kaufman SR, Hofer TP, Kauffman CA, Olmsted RN,
et al. Preventing hospital-acquired urinary tract infection in the United States:
a national study. Clin Infect Dis Off Publ Infect Dis Soc Am. 2008 Jan
15;46(2):243–50.

47. Goetz AM, Kedzuf S, Wagener M, Muder RR. Feedback to nursing staff as an
intervention to reduce catheter-associated urinary tract infections. Am J Infect
Control. 1999 Oct;27(5):402–4.

48. Bardossy AC, Jayaprakash R, Alangaden AC, Starr P, Abreu-Lanfranco O,

Reyes K, et al. Impact and Limitations of the 2015 National Health and Safety
Network Case Definition on Catheter-Associated Urinary Tract Infection
Rates. Infect Control Hosp Epidemiol. 2017 Feb;38(2):239–41.

49. Mullin KM, Kovacs CS, Fatica C, Einloth C, Neuner EA, Guzman JA, et al.
A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract
Infections in the Intensive Care Unit With an Emphasis on “Stewardship of
Culturing.” Infect Control Hosp Epidemiol. 2017 Feb;38(2):186–8.

50. Epstein L, Edwards JR, Halpin AL, Preas MA, Blythe D, Harris AD, et al.
Evaluation of a Novel Intervention to Reduce Unnecessary Urine Cultures in
Intensive Care Units at a Tertiary Care Hospital in Maryland, 2011-2014.
Infect Control Hosp Epidemiol. 2016 May;37(5):606–9.

51. Saint S, Greene MT, Krein SL, Rogers MAM, Ratz D, Fowler KE, et al. A
Program to Prevent Catheter-Associated Urinary Tract Infection in Acute
Care. N Engl J Med. 2016 Jun 2;374(22):2111–9.

19