title: Relationship between catheter care and catheter-associated urinary tract infection at Japanese general hospitals: a prospective observational study.
abstract: BACKGROUND
  The risk factors for catheter-associated urinary tract infections (CAUTIs) that are associated with catheter care have not been examined in detail by prospective studies or randomised clinical trials.
  
  
  OBJECTIVE
  To examine the patterns of catheter care and to identify the CAUTI risk factors associated with catheter care.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Between January and December 2004, 555 adult patients who were catheterised for 3 days in five general hospitals in Japan were surveyed. One researcher collected the following data twice a week: catheter insertion method, catheter management, and signs and symptoms of urinary tract infections. The relative risk exceeding 1 by the Poisson regression were selected for Cox proportional hazard analysis in order to calculate adjusted risks. In addition, expected reductions in the incidence of CAUTIs by elimination of the risk factors were estimated using the population attributable risk percent.
  
  
  RESULTS
  The mean duration of catheterisation was 25 days. The overall incidence of CAUTIs was 3.9 cases per 1000-device days; the incidence of CAUTIs ranged from 0.6 to 7.2 cases per 1000-device days among the five hospitals. Only fecal incontinent patients were analysed since they accounted for 94% of the CAUTI cases. In the univariate analysis, the silver-alloy catheter, which contains antimicrobial property, emerged as a potential risk. Since silver-alloy catheters were used in only one hospital, silver-alloy catheter care was compared with that of the other types of catheter, and a significantly higher percentage of inappropriate care was observed. In the final Cox model, two variables remained: 'non-pre-connected closed system (standard system)' (RR 2.35, 95%CI 1.20-4.60, p = 0.013) and 'no daily cleansing of the perineal area' (RR 2.49, 95%CI 1.32-4.69, p = 0.005). The population attributable risk percent suggested that the use of a 'pre-connected closed system' and 'daily cleansing of the perineal area' could reduce the incidence of CAUTIs by nearly 50%.
  
  
  CONCLUSIONS
  Our investigation identified fecal incontinence as the major risk factor for CAUTIs in the study population. However, attributable risk percent indicates that the implementation of two basic elements of catheter care could reduce CAUTIs by nearly 50%. The hospital using silver-alloy catheters had the highest CAUTI rates, strongly suggesting the hazards of relying on the antimicrobial property of silver and the resultant laxity in care.
authors.affiliation: Department of Nursing, Osaka University, Suita city, Osaka, Japan. tosie@a2.mbn.or.jp
authors.forename: Toshie
authors.initials: T
authors.lastname: Tsuchida
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Makimoto
authors.forename: Shinobu
authors.initials: S
authors.lastname: Ohsako
authors.forename: Miyoko
authors.initials: M
authors.lastname: Fujino
authors.forename: Midori
authors.initials: M
authors.lastname: Kaneda
authors.forename: Taeko
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Fusae
authors.initials: F
authors.lastname: Fujiwara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sugimoto
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000382:microbiology; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D018030:Silver Compounds; D017592:Skin Care; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods / Q000451:nursing*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D018030:Silver Compounds