title: Impact of an aseptic procedure for breaking the integrity of the urinary drainage system on the development of catheter-associated urinary tract infections in the intensive care unit.
abstract: BACKGROUND
  Catheter associated urinary tract infections (CAUTI) are a common complication in the hospital, especially in intensive care units (ICU). These infections are directly linked to the use of an indwelling urinary catheter. One commonly identified factor related to the development of CAUTI has been thought to be violating the integrity of the closed drainage system. However, a paucity of research exists to support or refute this practice.
  
  
  OBJECTIVE
  The primary purpose of this observational study was to assess if there is a relationship between CAUTI incidence and breaking the closed drainage system using an aseptic procedure.
  
  
  METHODS
  A process improvement effort was developed to ensure an aseptic technique was utilised when there was a need to break the integrity of the urinary drainage system. Because this was a new practice and not supported by the Centres for Disease Control (CDC) recommendations, this change in practice was evaluated as an observational study.
  
  
  RESULTS
  In an eight month period there were 53 documented breaks in the urinary drainage system. There were 28 total cases of CAUTI overall during this same time period. Only four patients with a system break developed a CAUTI (7.5%). In almost 93% of the patients where aseptic technique was used for breaks in the drainage system, there was no occurrence of CAUTI. A follow-up evaluation was performed after a year of this practice in three adult ICUs. During this three month evaluation period, there were 47 documented cases of breaking this system using aseptic technique. Of the patients who had a documented break in their drainage system, none developed subsequent CAUTIs.
  
  
  CONCLUSIONS
  One commonly identified factor related to the development of CAUTI has been thought to be violating the integrity of the closed drainage system. However, a paucity of research exists to support or refute this practice. This observational study found that utilising an aseptic technique to break the integrity system did not result in an associated increase in CAUTI.
authors.affiliation: Parkview Health System, Fort Wayne, IN, United States. Electronic address: Janpowers25@yahoo.com.
authors.forename: Jan
authors.initials: J
authors.lastname: Powers
mesh_terms: D055499:Catheter-Related Infections / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration; D017064:Process Assessment, Health Care / Q000592:standards*; D015397:Program Evaluation / Q000379:methods*; D014552:Urinary Tract Infections / Q000209:etiology*
keywords: Aseptic technique; Catheter associated urinary tract infection; Closed drainage system; System integrity