A prevalence survey of patients with indwelling urinary catheters on district nursing caseloads in the United Kingdom: The Community Urinary Catheter Management (CCaMa) Study

Abstract

Background: Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community. Aim: To investigate the prevalence of indwelling urinary catheters on district nursing caseloads in the UK. Methods: Participants were recruited through the Infection Prevention Society (IPS). An electronic survey was undertaken on a single day between November 2017 and January 2018. Data were analysed using descriptive statistics. Findings: A total of 49,575 patients were included in the survey, of whom 5352 had an indwelling urinary catheter. This gave a point prevalence of 10.8% (95% confidence interval [CI] = 10.53–11.07), which varied between organisations, ranging from 2.36% (95% CI = 2.05–2.73) to 22.02% (95% CI = 20.12–24.05). Of catheters, 5% were newly placed (within four weeks). Of these, most (77%) had a documented indication for insertion. Only half of patients with a newly placed catheter had a plan for its removal. This varied between organisations in the range of 20%–96%. Only 13% of patients had a patient-held management plan or ‘catheter passport’ but these patients were significantly more likely to also have an active removal plan (28/36 [78%] vs. 106/231 [46%]; P < 0.0001). Alternative bladder management strategies had been considered for 70/267 (26%) patients. Discussion: The management of patients with an indwelling urinary catheter represents a significant component of district nursing caseloads. Given the high proportion of newly catheterised patients without an active management plan for removal of the catheter, the establishment of an optimal management pathway should be the focus of future prevention efforts.

Revisiting the Frequency and Antimicrobial Resistance Patterns of Bacteria Implicated in Community Urinary Tract Infections

“…Both bacteria were more frequently associated with male infections (8.8% and 8.1% for E. faecalis and P. aeruginosa , respectively, versus 1.8% and 1.6% in females). Amna et al [ 19 ] concluded that non- E. coli bacteria are more likely to infect men, attributing this to the fact that UTIs in men are frequently more complicated due to the use of catheters [ 20 , 21 ]. In fact, Enterococcus and Pseudomonas have been associated with infections related to catheters in the urinary tract [ 22 , 23 , 24 , 25 ].…”

Epidemiological insights into seasonal, sex‑specific and age‑related distribution of bacterial pathogens in urinary tract infections

“…demonstrated notable sex disparities, with a higher prevalence in women compared with men (P<0.001). Amna et al (38) determined that non-E. coli bacteria were more prone to infect men, citing the increased complexity of UTIs in men, often attributed to the frequent use of catheters (39,40). Specifically, Enterococcus and Pseudomonas have been linked to infections associated with urinary tract catheters (41,42).…”

To what extent is education for urinary catheter insertion and management offered to registered nurses in the United Kingdom?

“…Many community patients who have catheters do not have a management plan which consequently means, the catheter may be in place for longer than necessary, therefore, the patient is at risk of CAUTI. 23 CAUTI is a problem of international concern and RNs are ideally placed to improve infection rates by ensuring best practices are carried out. Education increases knowledge of best practices, which when translated into behaviour in the clinical environment, results in a decrease in catheter days and therefore CAUTI.…”

“…However, factors contributing to community acquired CAUTI may be more complex than hospital acquired infections and therefore the results of the hospital‐based research already discussed, may not be generalized to the community setting. Many community patients who have catheters do not have a management plan which consequently means, the catheter may be in place for longer than necessary, therefore, the patient is at risk of CAUTI 23 …”