CDC issues updated guidelines for catheter-associated UTI prevention

The Centers for Disease Control and Prevention has issued new guidelines to update and expand the original Guideline for Prevention of Catheter-associated Urinary Tract Infections (CAUTI) published in 1981.

This revised guideline reviews the available evidence on CAUTI prevention for patients requiring chronic indwelling catheters and individuals who can be managed with alternative methods of urinary drainage.

"Despite all the time that has passed between the two guidelines, the principles of prevention really haven't changed," first author Carolyn Gould, MD, MSCR, of the CDC, told Urology Times. "Those are: ensuring that catheters are only placed for appropriate indications; that catheters are inserted with aseptic technique and sterile equipment, which primarily applies to the acute care setting; and that the closed drainage systems are maintained and urinary flow is not obstructed."

Specifically, the guidelines cover appropriate urinary catheter use, proper techniques for catheter insertion, proper techniques for catheter maintenance, quality improvement programs to enhance appropriate use of indwelling catheters and to reduce the risk of CAUTI based on a facility risk assessment, administrative infrastructure (including provision of guidelines and education and training), and surveillance.

Technologies that were not available prior to 1981 are addressed in the updated guidelines, including the following:

• The use of a portable bladder ultrasound device should be considered to assess urine volume and reduce unnecessary catheterizations. "This is a Category II recommendation just because there’s not a lot of data out there yet, but it’s a very promising technology and there’s a lot of rationale for using it,” Dr. Gould said.
• Further research is needed on the effect of antimicrobial/antiseptic-impregnated catheters, primarily silver-coated catheters."There's a lot of data showing that they may reduce the risk of bacteriuria," said Dr. Gould, "but there's not a lot of data on whether they really improve clinical outcomes and which patient populations may benefit."
• Complex drainage systems, including those that release antiseptics into the drainage spout as a prevention measure when emptying the collection bag, are not necessary for routine use.

Also new are updated surveillance definitions for CAUTI, based on revisions by the CDC’s National Healthcare Safety Network in 2009. Most significant was the removal of asymptomatic bacteriuria from the definitions, as its clinical significance is not clear. However, based on input from AUA, the guidelines acknowledge that systemic antibiotics may be beneficial as prophylaxis for UTI in certain situations, including in patients with bacteriuria upon catheter removal post-urologic surgery.

The complete guidelines can be viewed at http://www.cdc.gov/ncidod/dhqp/dpac_uti_pc.html.