Prevalence of urinary catheterization in UK nursing homes

McNulty, C.; Freeman, Elaine; Smith, Grace; Gunn, Kim; Foy, Chris; Tompkins, David; Brady, Angela; Cartwright, Keith

doi:10.1016/s0195-6701(03)00224-x

Cited by 38 publications

(35 citation statements)

References 8 publications

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“…Fifty five per cent of care home residents with urinary catheters were discharged from the hospital with urinary catheters in situ: this is similar to previous care home surveys in the UK in 2002(McNulty et al, 2003Lomas et al, 2009). However there was a significant difference between areas, varying between 35% and 86%, suggesting there is an opportunity to reduce this.…”

Section: Discussionsupporting

confidence: 82%

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

McNulty

Verlander

Turner

et al. 2014

Journal of Infection Prevention

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Peer reviewed article he extent to which the use of catheter care bundles and other interventions has led to a reduction in urinary catheterisation rates is unknown. We aimed to determine current urinary catheterisation rates in care homes with residents over 65 years old, and determine the extent to which residents are discharged from the hospital setting with urinary catheters. A point prevalence questionnaire survey was used in care homes that looked after residents over 65 years in six UK health boards or primary care trusts, to determine urinary catheterisation rates, and where these catheters were inserted. Questionnaires for 445 of 461 care homes (96.5%) were completed, 425 of 445 care homes cared for residents over 65 years; 888 (6.9%) of 12,827 residents had a urethral (82.5%) or supra-pubic (17.5%) urinary catheter. Over half of all catheters (both urethral and suprapubic, 57.4%, 509 of 888 catheters), and 3.1% of all residents had a catheter inserted while the residents were hospital inpatients, and then discharged back to the care home still catheterised. There was a significant variation in urinary catheterisation rates in the care homes surveyed, and rates remain similar to previous English surveys in 2003 and 2009. More still needs to be done to understand the variation in urinary catheterisation rates in care homes and reduce these rates, including the numbers of residents that are discharged from hospital with a urinary catheter. IntroductionRecent surveys in UK care homes found that about 8% of residents in registered homes had long-term urinary catheters (McNulty et al, 2006;Lomas et al, 2009). This mean UK figure conceals a wide range of prevalence of urinary catheterisation from zero to almost 50% (Lomas et al, 2009), indicating that there is an opportunity to reduce catheterisation rates. Urinary catheterisation is associated with significant morbidity; residents with urinary catheters in care homes have up to an eightfold greater risk of harbouring resistant bacteria such as extended-spectrum β-lactamase-producing Gram-negative bacteria (Tinelli et al, 2012) and these patients are significantly more likely to be taking antimicrobials (Cotter et al, 2012), develop healthcare associated infections (Eriksen et al, 2007) and bacteraemia (Chazan et al, 2009).Care home staff have indicated that many of their residents are discharged from hospital after an inpatient stay with a catheter (McNulty et al, 2008) and indeed our 2008 survey confirmed that 57% of urinary catheters in Gloucestershire care homes were inserted in hospitals (Lomas et al, 2009). Over the last five years there have been a series of care bundles introduced for community and hospital care (Wilson, 2011, pp. 16-25), with the aim of reducing urinary catheterisation rates and catheter associated urinary tract infections (CAUTI). Study aims

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Section: Discussionsupporting

confidence: 82%

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

McNulty

Verlander

Turner

et al. 2014

Journal of Infection Prevention

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“…Despite the fact that catheterization is generally considered a last resort for bladder management, it has been estimated that ϳ26% of hospital patients in the United Kingdom are fitted with urinary catheters during their stays, while the prevalence of long-term bladder catheterization among elderly nursing home patients may be as high as 40% in some locations (6,41). Measures to prevent CAUTIs, such as the use of sterile, closed drainage systems and antimicrobial coatings or lubricants, in addition to proper aseptic handling and fitting of catheters, can have significant benefits for patients subjected to short-term catheterization.…”

Section: Discussionmentioning

confidence: 99%

“…It has been estimated that more than 100 million urethral catheters are fitted each year, with many used for longterm bladder management in community or nursing home settings (2)(3)(4)(5)(6). For the most part, these simple devices offer significant benefits to patients and improve the quality of life, but they also provide a route through which bacteria may enter and colonize the normally sterile, nutrient-rich bladder (4,7,8).…”

mentioning

confidence: 99%

Elucidating the Genetic Basis of Crystalline Biofilm Formation in Proteus mirabilis

et al. 2014

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b; Queen Victoria NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom c Proteus mirabilis forms extensive crystalline biofilms on urethral catheters that occlude urine flow and frequently complicate the management of long-term-catheterized patients. Here, using random transposon mutagenesis in conjunction with in vitro models of the catheterized urinary tract, we elucidate the mechanisms underpinning the formation of crystalline biofilms by P. mirabilis. Mutants identified as defective in blockage of urethral catheters had disruptions in genes involved in nitrogen metabolism and efflux systems but were unaffected in general growth, survival in bladder model systems, or the ability to elevate urinary pH. Imaging of biofilms directly on catheter surfaces, along with quantification of levels of encrustation and biomass, confirmed that the mutants were attenuated specifically in the ability to form crystalline biofilms compared with that of the wild type. However, the biofilm-deficient phenotype of these mutants was not due to deficiencies in attachment to catheter biomaterials, and defects in later stages of biofilm development were indicated. For one blocking-deficient mutant, the disrupted gene (encoding a putative multidrug efflux pump) was also found to be associated with susceptibility to fosfomycin, and loss of this system or general inhibition of efflux pumps increased sensitivity to this antibiotic. Furthermore, homologues of this system were found to be widely distributed among other common pathogens of the catheterized urinary tract. Overall, our findings provide fundamental new insight into crystalline biofilm formation by P. mirabilis, including the link between biofilm formation and antibiotic resistance in this organism, and indicate a potential role for efflux pump inhibitors in the treatment or prevention of P. mirabilis crystalline biofilms.

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“…Catheterization rates ranged from 0% to 43% of residents. 4 Following requests from owners and managers, and those responsible for statutory registration and infection control, the Department of Health has published guidelines on the control of infection for residential and nursing homes. 5 These mainly cover hand hygiene and only contain a brief section on urinary catheterization.…”

mentioning

confidence: 99%

Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff

McNulty¹,

Bowen²,

Foy³

et al. 2006

Journal of Hospital Infection

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Prevalence of urinary catheterization in UK nursing homes

Cited by 38 publications

References 8 publications

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

Elucidating the Genetic Basis of Crystalline Biofilm Formation in Proteus mirabilis

Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff

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