December 31, 2009 | | Comments 0
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Recognizing CAUTIs

Hospitals with a focus on providing safe patient care through evidence-based practices have been working to reduce preventable conditions such as central line-associated bloodstream infections and ventilator-associated pneumonia for the past few years.

A urinary tract infection (UTI) is defined as an inflammatory response of the urinary epithelium to invasion by a pathogen and can be divided into two forms:

Uncomplicated: Occurs in otherwise healthy community-dwelling women and produces characteristic symptoms such as dysuria (burning and pain with urination), suprapubic discomfort, and frequent urination.

Complicated: Occurs in patients with an abnormality of the urinary system or other health problem that compromises host defenses or treatment responses.

Catheter-associated urinary tract infection (CAUTI) are considered complicated because of the presence of an indwelling urinary catheter.

CAUTI is diagnosed only when signs and symptoms of an infection coexist with evidence of bacteriuria (> 100,000 colony-forming units per ml [CFU/ml] and a host response to the presence of bacteriuria [diagnosed on urinalysis as pyuria]).

Asymptomatic bacteriuria is not routinely treated in the catheterized patient, regardless of whether it occurs in the critical care unit, inpatient hospital unit, or long-term care facility. Treatment should not occur even when asymptomatic bacteriuria coexists with pyuria. Patients with indwelling urinary catheters typically develop pyuria because of the inflammation associated with the presence of the catheter itself. Asymptomatic bacteriuria is treated only in highly selected cases, such as patients undergoing certain abdominopelvic or urologic procedures, or selected immunocompromised patients.

Signs and symptoms of a CAUTI include the presence of two or more of the following:

* Fever (> 2.0°F or > 1.1°C)

* Flank, abdominal, or suprapubic tenderness

* Change in urine character

* Hematuria

* Sudden change in mental or functional status


Source: Preventing Catheter-Associated Urinary Tract Infections, author Mikel L Gray, PhD, CUNP, CCCN, FAANP, FAAN

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Sarah Kearns About the Author: Sarah is an Editorial Assistant in the patient safety group at HCPro, Inc. She contributes to two monthly newsletters; Briefings on the Joint Commission and Briefings on Patient Safety, and manages four e-zines; Accreditation Connection, AHAP Staff Challenge, Nurse Manager Weekly, and Healthcare Training Weekly. She also helps research new products for the patient safety and nursing market. She graduated from the University of Connecticut in 2008 where she earned her bachelor's degree in English.

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