title: Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals.
abstract: BACKGROUND
  Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric patients.
  
  
  OBJECTIVE
  After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group implemented and evaluated corrective measures.
  
  
  METHODS
  In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and indications for catheter drainage; limit available medical devices; and improve prescription and traceability procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was repeated in 2012 to assess the impact of the programme.
  
  
  RESULTS
  Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%. The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P = 0.1013) which contradicts the literature. In 2010, the 269 responses to the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff had poor knowledge of the recommended indications and techniques, and the equipment varied widely between units. Following implementation of the programme, the study was repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature.
  
  
  CONCLUSIONS
  Multi-modal programmes are an effective means to control UTI.
authors: Unité d'hygiène et épidémiologie, Hôpitaux de Gériatrie des Hospices Civils de Lyon, Pierre Bénite, France. Electronic address: raphaele.girard@chu-lyon.fr.
authors: R
authors: R
authors: Girard
authors: Pole d'activité médicale de Gériatrie, Hospices Civils de Lyon, Pierre Bénite, France.
authors: S
authors: S
authors: Gaujard
authors: Unité d'hygiène et épidémiologie, Hôpitaux de Gériatrie des Hospices Civils de Lyon, Pierre Bénite, France.
authors: V
authors: V
authors: Pergay
authors: Unité d'hygiène et épidémiologie, Hôpitaux de Gériatrie des Hospices Civils de Lyon, Pierre Bénite, France.
authors: P
authors: P
authors: Pornon
authors: Pole d'activité médicale de Gériatrie, Hospices Civils de Lyon, Pierre Bénite, France.
authors: G
authors: G
authors: Martin Gaujard
authors: Unité d'hygiène et épidémiologie, Hôpitaux de Gériatrie des Hospices Civils de Lyon, Pierre Bénite, France.
authors: C
authors: C
authors: Vieux
authors: Pharmacie, Hôpitaux de Gériatrie des Hospices Civils de Lyon, Pierre Bénite, France.
authors: L
authors: L
authors: Bourguignon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000382:microbiology; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D005853:Geriatrics / Q000379:methods; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D057928:Intermittent Urethral Catheterization / Q000009:adverse effects*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D001743:Urinary Bladder / Q000382:microbiology; D014552:Urinary Tract Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Catheter; Epidemiology; Geriatric; Urinary tract infection