Literature Review: Adherence to Urinary Catheter Guidelines

This literature review examines the management of indwelling urinary catheters, focusing on evidence-based guidelines to prevent catheter-associated urinary tract infections (CAUTIs). The review synthesizes findings from various studies, including those by Modey et al. (2015), Loveday et al. (2014), and Conway and Larson (2012), highlighting the importance of aseptic techniques, hand hygiene, and appropriate catheter use. It emphasizes the need for strict adherence to protocols, such as the use of catheter bundles, and the implementation of nurse-driven protocols to reduce CAUTI incidence. The review also discusses the significance of timely screening, antimicrobial stewardship, and the judicious use of indwelling catheters, advocating for their removal when no longer necessary. Furthermore, it underscores the importance of institutional policies, education of healthcare workers, and the use of closed drainage systems to minimize the risk of infection. The review concludes by stressing the need for further research to improve catheter management and prevent UTIs.

Running head: LITERATURE REVIEW
LITERATURE REVIEW
Name of the Student
Name of the university
Author’s note

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LITERATURE REVIEW
Topic: Adherence to evidence-based guidelines and indwelling urinary catheter management
Search strategy
Electronic databases like the Google Scholar has been used for searching relevant papers.
Keywords like “Indwelling urinary catheter”, “hospital acquired infection “needs to be used for
searching the papers. Inclusion criteria were the publication years, between 2013-2019 has been
considered and English papers were chosen.
Literature review
An indwelling catheter helps in the drainage of urine from the body, when one cannot
urinate on their own. Some of the common complication related to the urinary catheter involves
allergic reaction due to the material used in the catheter, like latex, bladder stones, urinary
infections septicemia, and kidney damage due to prolonged use. A catheter associated urinary
tract infection is one of the most common heath complications occurring in a hospital setting.
The risk increase with the prolonged period of the time of the catheter. The catheterized patients
usually display manifestation of asymptomatic bacteriuria within 24-48 hours of catheterization.
Several clinical protocols have been designed for preventing and controlling. Modey et al, (2015)
have found that a multimodal infection program had been appropriate in reducing the prevalence
of DROs and the incidence of device related infections. The paper had also stated that the
application of catheter bundle such as maintaining strict hand hygiene and adherence to strict
aseptic techniques while performing the catheterization. Loveday et al., (2014) have provided
some guidelines for preventing hospital acquired infection, which was based on the best critically

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appraised. The recommendations that has been provided included hygiene maintenance in
hospital environment, maintenance of hand hygiene, utilization of personal protective equipment.
Safety use and proper disposal of sharps and tools that can cause infections. The paper has
emphasized on the use of the process of hand and hygiene like the use of alcohol based hand rub.
It is the necessary that health care workers should ensure safety and protection by the removal of
all the wrist and hand jewelry.
Conway and Larson (2012), have also put forward some recommendations like
catheterization should only be done when necessary and using asceptic techniques, obtaining
small volume of urine samples aseptically from the sampling port and placing the drainage bag
below the bladder level and avoidance of routine irrigation. Majority of the papers have
emphasized on the guidelines that includes a routine use of antimicrobials and antiseptic for the
treatment of the asymptomatic bactereuria, for symptomatic prophylaxis against any CAUTIs.
Conway and Larson, (2012), have also emphasized on the different administrative controls and
qualitative measures for introducing evidence based measures for preventing CAUTI infections.
Loveday et al., (2014), have stated that timely screening of infections can prevent CAUTI. Most
of the studies have suggested that antimicrobial prophylaxis is not beneficial in the prevention of
the CA-UTI, treatment with asymptomatic antibiotic, on the basis of the local antibiograms, as
well as the replacement of the urinary catheters. Indwelling catheters should only be placed when
they are indicated. Urinary catheter should not be used for managing urinary incontinence. The
institution should be able to develop a list of indications for the insertion of the indwelling
urinary catheter and should educate the staffs regarding the indications and should periodically
educate the health care workers about such indications. Indwelling catheters needs to be
removed when they are not required ever for reducing the risk of bacteriuria. Assadi, (2018) have

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suggested that a unobstructed flow of urine needs to be maintained at all the time. If the catheter
and the collecting system breaks needs to be replaced flow of urine needs to be maintained all
the time. Indwelling catheter needs to be secured properly to the thigh of the patient for
preventing the urethral meatus injury.
Study by Conway and Larson, (2012) have suggested that the hospitals and the LTCFs
should be able to cultivate, uphold and disseminate the policies and procedures for the protocols
of catheter insertion indications, its attachment and the discontinuation approaches and the
indications for replacement.
Evidence based studies by Andrade and Fernandes, (2016) have suggested that a closed
catheter drainage system along with the ports in the distal catheter for the aspiration of the needle
of the urine needs to be used for reducing the CA –bacteriuria and CA-UTI. Especially, in
patients bearing with short term indwelling urethral or the suprapubic catheters. In patients
having short term indwelling urethral catheterization, antimicrobial material coated urinary
catheter can be considered for reducing or delaying the onset of the bacterium. Antibiotic coated
catheter has been found to decrease CAUTI and this should be used as routine measure of
prevention (Assadi, 2018).
In conclusion, it can be said that effective policies needs to be implemented for the
promotion of the early removal of the catheter. More researches are necessary in this field to
prevent UTI.

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References
Andrade, V. L., & Fernandes, F. A. (2016). Prevention of catheter-associated urinary tract
infection: implementation strategies of international guidelines. Revista latino-americana
de enfermagem, 24, e2678. doi:10.1590/1518-8345.0963.2678
Assadi F. (2018). Strategies for Preventing Catheter-associated Urinary Tract Infections.
International journal of preventive medicine, 9, 50. doi:10.4103/ijpvm.IJPVM_299_17
Conway, L. J., & Larson, E. L. (2012). Guidelines to prevent catheter-associated urinary tract
infection: 1980 to 2010. Heart & lung, 41(3), 271-283.
Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., ... & Wilcox, M.
(2014). epic3: national evidence-based guidelines for preventing healthcare-associated
infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.
Mody, L., Krein, S. L., Saint, S., Min, L. C., Montoya, A., Lansing, B., ... & Rye, R. A. (2015).
A targeted infection prevention intervention in nursing home residents with indwelling
devices: a randomized clinical trial. JAMA internal medicine, 175(5), 714-723.