Urology Care Today

COST AND COMPLICATIONS OF CATHETERISATION

UROLOGY AND CONTINENCE CARE TODAY

2018,Vol 1, No 1

rinary incontinence affects

people of any age and

gender and can vary in

severity from mild to very severe

(National Institute for Health and

Care Excellence [NICE], 2013). It is a

common problem, with the Bladder

& Bowel Community estimating

that 12 million people in the UK

are affected with a bladder or bowel

problem, a figure that is probably

underestimated (Bladder & Bowel

Community, 2018).

While catheterisation is a

common procedure undertaken by

healthcare professionals, it is neither

simple nor risk-free (Booth and

Clarkson, 2012).

According to the Health

Economics Research Unit (HERU),

about 15–25% of patients admitted

to NHS hospitals each year will

An overview of the cost and

complications of catheterisation

Mariama Barrie, continence clinical nurse

specialist, Berkshire Healthcare NHS

Foundation Trust

IN BRIEF

Urinary tract infection (UTI) is an important cause of morbidity

and mortality in the healthcare setting, accounting for 19% of all

nosocomial infections (Loveday et al, 2014).

It is estimated that 43–56% of these are catheter-associated urinary

tract infections (CAUTI) (Loveday et al, 2014).

If inadequately treated, CAUTI may progress to bacteraemia and

consequent urosepsis syndrome, multiplying the risk of mortality

and extending hospital stay (Centers for Disease Control and

Prevention, 2009).

KEY WORDS:

Prevalence

Urinary tract infection

(UTI)

Cost

Complications

Mariama Barrie

need urethral catheterisation, and

approximately 5% are at risk of

developing bacteriuria per day

(HERU, 2015).

Bacteriuria is defined as the

‘presence of bacteria in the urine

revealed by quantitative culture

or microscopy’ (Fisher et al, 2017).

Between 2 and 7% of catheterised

patients will acquire bacteriuria

every day despite best practice

(Scottish Intercollegiate Guidelines

Network [SIGN], 2012), with culture

positive urine being effectively

universal by 30 days across all

clinical settings (Nicolle, 2014).

Causative pathogens may

contaminate the urinary tract via

a variety of sources. Endogenous

bacteria are typically meatal, vaginal

or rectal commensals. Exogenous

sources include the contaminated

hands of patients and healthcare

personnel, as well as hospital

equipment. Although

Escherichia

coli

is classically the most common

pathogen, many other strains have

been isolated, including

Pseudomonas

aeruginosa

, coagulase negative

Staphylococcus

and

Candida

species

(Centers for Disease Control and

Prevention, 2014). In long-term

catheterised patients, two or more

strains are commonly isolated

(SIGN, 2012).

When entering the urinary

tract, pathogens may migrate

extraluminally via the outside of the

catheter, or intraluminally through

the catheter drainage system itself.

There is little evidence to differentiate

which route is more important in the

pathogenesis of catheter-associated

urinary tract infection (CAUTI),

Practice point

Bacteriuria is the presence of

bacteria in urine — more than

100,000 pathogenic bacteria

per millilitre of urine is usually

considered significant and

diagnostic of urinary tract infection

(Richards et al, 2006). CAUTI is

an infection involving any part

of the urinary system, including

the urethra, bladder, ureters and

kidneys and is the most common

type of hospital care-associated

infection reported to the National

Healthcare Safety Network

(NHSH) (Centers for Disease

Control and Prevention, 2015).