Neuro Patients have Higher Rates of CAUTIs?
I decided to report on this article since it incorporates a bit of our NRS420 topic of sepsis (prevention) and current topic of neuro. As we know, preventing HAI is paramount in the hospital setting, and the neuro ICU seems to be no exception.
According to the CDC’s National Healthcare Safety Network which tracks national infection statistics, 30% of infections are UTIs and 75% of UTIs acquired from the hospital occur from catherization (CDC, 2015). Since 15%-20% of hospitalized patients receive catherization, this can amount to large numbers.
Due to the possible delicate nature/acuity of neuro-spine conditions, these patients are especially prone to longer ICU stays, increased needs for invasive devices (central lines, ventilators), limited mobility and urine retention. Reduction of CAUTIs (catheter-associated urinary tract infections) is especially difficult in the NSICU due to the neuro-spine patient’s debility which generally requires long-term foley-catheterization and longer stays. Topping the list of neuro conditions seen in neuro ICUs is the incidence of acute ischemic stroke, which averages a hospital stay of 5-14 days average (George et al,2013). Considering that occurrence of CAUTIs peaks at 12 days (plus) puts these particular stroke patients at high risk if catheterized with a foley-catheter (George et al,2013).
This article was written about a study done at one hospital’s neuro-spine ICU unit, as it represented that hospital’s unit with the greatest number of HAI/UTI. This is not unusual I surprisingly found, as neuro-spine ICUs have been found to nationally represent the unit with the most incidences of CAUTI, (Edwards, 2008).
Great concern has arisen for the neuro-spine patient population; the hospital cited in the study decided to utilize their in-house Infection Prevention team to assess and advise the neuro-spine ICU staff. Their conclusion was to implement a plan where either nursing leadership or Infection Prevention staff performed separate rounding to identify at-risk patients. Assessments and recommendations were made on the following gathered criteria: catheter presence, indication and possibility of removal. Their NSICU now includes an increased mindfulness when evaluating catheter necessity, care, and removal.
It is eye-opening that neuro-spine ICU units have been identified as the top needs-to-be-watched unit concerning catheter associated UTIs. I found no less than 5 studies about CAUTI concern conducted in neuro units during my research regarding infection. I originally began research on infection (general) and neuro topics, but found this one topping the list of searches…and it turned out to be enlightening and has served to increase my overall vigilance during my clinical rotations.
REFERENCES:
Center for Disease Control (2015, October 16). Catheter-associated Urinary Tract Infections (CAUTI). Retrieved November 10, 2015, fromhttp://www.cdc.gov/HAI/ca_uti/uti.html
Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC (2008). Center for Disease Control and Healthcare safety network (NHSN) report, data summary for 2006 through 2007. Retrieved November 10, 2015, from http://www.cdc.gov/nhsn/NationalAm J Infect Control. 2009 Jun;37(5):425.
George, A., Boehme, A., Siegler, J., Monlezun, D., Fowler, B., Shaban, A., Martin-Schild, S. (2013). Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay. Am J Infect Control; 36:609-26.
Schelling, K., Palamone, J., Thomas, K., Naidech, A., Silkaitis, C., Henry, J., Zembower, T. (2015). Reducing catheter-associated urinary tract infections in a neuro–spine intensive care unit. American Journal of Infection Control, 83(1), 892-894.
