Catheter-associated urinary tract infection is a common clinical condition among hospitalized patients with numerous health and economic implications. With judicious use of indwelling urinary catheters, along with strict adherence to basic infection prevention measures, such as hand hygiene and aseptic technique during catheter insertion, these infections are most often preventable. However, these devices continue to be used inappropriately or unnecessarily, which has led the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and numerous infectious disease professional societies to focus attention on how these infections can be diagnosed, prevented, and managed. Despite these efforts, consensus on how best to identify cases of CAUTI has been elusive. Perhaps the most widely used guidelines for the diagnosis, prevention, and treatment of CAUTI are those published in 2010 in the American Journal of Infection Control by Hooton and colleagues. These authors are very clear that CAUTI is a problem if, and only if, it is associated with clinical manifestations; the presence of urinary microorganisms alone is not a clear indication for antimicrobial therapy. Moreover, these authors provide a list of accepted clinical manifestations of CAUTI, which are substantially different from those in previous guidelines. Among others, the manifestations listed include: fever, suprapubic tenderness, flank tenderness, and delirium. However, these are supported by expert opinion only, and neither their diagnostic validity nor their inter-rater reliability have been reported in the literature. The purpose of this study was to examine the diagnostic validity and inter-rater reliability of fever, suprapubic tenderness, flank tenderness, and delirium in hospitalized adult with an indwelling urinary catheter. Briefly, these clinical manifestations were compared against three diagnostic criteria for CAUTI based on microbiologic and molecular methods, and their inter-rater reliability was examined using assessments conducted by three advanced practice nurses. Because significant microbial growth was only present in two urine samples, the diagnostic validity of these manifestations could not be established. However, it was possible to examine the inter-rater reliability of these manifestations. To summarize these findings, the nurse raters were in perfect agreement with the identification of fever, moderate agreement with the identification of delirium, and fair agreement with the identification of suprapubic tenderness and flank tenderness. With the exception of flank tenderness, these findings are statistically significant, and they provide evidence that nurses can consistently identify the presence and absence of fever, suprapubic tenderness, and delirium in hospitalized patients with indwelling urinary catheters. As CAUTI receives more attention from multiple stakeholders, nurses must take an active role in correctly identifying patients with this condition. However, this study had several limitations, and further research is necessary to understand the overall clinical utility and value of these manifestations in terms of patient outcomes and cost.

Catheter-associated urinary tract infections (CAUTIs) contribute to increased patient length of stay and health care costs. The literature has shown that one plausible cause of CAUTIs is improper Foley catheter insertion techniques among nurses. The purpose of this project was to answer the project-focused question that asked if there was a difference in nurses' practice skills following an educational intervention involving aseptic Foley insertion. Benner's novice-to-expert theory was the conceptual model for the study. Nurses from a college nursing program were asked to demonstrate Foley catheter insertion on a simulation model, and their technique was evaluated using a standardized checklist. Following the simulation demonstration, an educational intervention was conducted with ample opportunity for the nurses (n = 16) to practice catheter insertion. Following the practice opportunity, the nurses completed a 2nd return demonstration. Percentages of correct skills from the preintervention observation were compared with percentages of correct skills from the postintervention observation to determine the effectiveness of the education intervention in enhancing Foley catheter skills in an acute care setting. Results of a paired t test revealed a significant increase (p < .01) in performance scores on the demonstrations after the intervention and catheter insertion techniques were taught. Hospitals and nursing education programs could implement simulation interventions to improve nurses' Foley catheter insertion skills. This study has the potential to contribute to social change by providing evidence that simulation training can lead to improved competence and confidence with nursing skills.

Healthcare-Associated Infections (HAIs) continue to be an epidemiological issue burdening patients and public health systems worldwide. The purpose of this study was to determine if specific healthcare facility types (Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities) were associated with particular categories of HAIs: Ventilator-Associated Pneumonias (VAPs), Central Line-Associated Bloodstream Infections (CLABSIs), and Catheter-Associated Urinary Tract Infections (CAUTIs). The theoretical framework for this study was the environmental determinants of infectious disease framework. A single research question focused on whether an association existed among the specified health care facility types and HAIs. Three independent categorical variables were used, including Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities, and 3 dependent variables were used, comprising of VAPs, CAUTIs, and CLABSIs. A quantitative design engaged the chi-square test of association, using a 2012 population-level report of archival data collected by the Centers for Disease Control and Prevention's National Healthcare Safety Network. Seven groups of HAIs and facility types were tested, and the results revealed that 6 groups had statistically significant differences. This study may contribute to positive social change by helping to identify whether healthcare facility types are associated with HAIs and to supply evidence to stakeholders to support standardization of best practices across all facility types, thus contributing to the reduction of HAIs in the United States.

Introduktion: Kateterassocierade urinvägsinfektioner är den främst förekommande vårdrelaterade infektionen världen över. Sjuksköterskans roll är att arbeta med förebyggande omvårdnadsåtgärder för att undvika komplikationer vid användning av urinkateter. Syftet: Litteraturstudiens syfte var att belysa effekterna av sjuksköterskans förebyggande åtgärder för att förhindra kateterassocierade urinvägsinfektioner på sjukhus. Metod: Utifrån Polit och Becks (2021) niostegsmodell utfördes en litteraturstudie. Databaserna CINAHL och PubMed användes för att söka artiklar. Efter kvalitetsgranskning återstod tio kvantitativa artiklar relevanta för syftet, vilka utgör resultatet.  Resultat: Betydelsen av att arbeta preventivt genom dagliga utvärderingar och diskussioner runt indikationer för urinkateter är central. Resultatet visar också att genom utbildning och checklistor kan kateterassocierade urinvägsinfektioner minskas. Åtgärderna behöver vara fler än en för att ge effekt i det förebyggande arbetet. Slutsats: Genom att sjuksköterskan arbetar med en samling av preventiva åtgärder som visat sig ge effekt kan kateterassocierade urinvägsinfektioner minskas.

Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections and is caused by a range of different uropathogens, particularly by uropathogenic Escherichia coli (UPEC). Amongst the different virulence factors, biofilm formation and bacterial aggregation, often mediated by cell surface structures such as fimbriae, are common traits among uropathogens that cause CAUTI. In this study, a collection of UPEC isolates were screened for virulence genes and phenotypes associated with urinary tract infections such as biofilm formation and mannose-sensitive haemagglutination. Two strains, E. coli MS2027 (which formed a strong biofilm) and E. coli M184 (which aggregated strongly) were analysed in detail to determine the molecular mechanisms associated with these phenotypes. Transposon mutagenesis of E. coli MS2027 identified type 3 fimbriae as the factor responsible for its strong biofilm growth. Further screening revealed the presence of type 3 fimbriae in uropathogenic Citrobacter freundii, Citrobacter koseri, Klebsiella oxytoca, Klebsiella pneumoniae and other E. coli. Phylogenetic analysis of the type 3 fimbrial (mrkABCD) genes from these strains revealed they clustered into five distinct clades (A-E) ranging from one to twenty-three members. The majority of the sequences grouped in clade A, which was represented by the mrk gene cluster from the genome sequenced K. pneumoniae strain MGH78578. We demonstrated that type 3 fimbriae are functionally expressed by different Gram negative nosocomial pathogens and present evidence to suggest that they contribute significantly to catheter colonisation. The type 3 fimbrial genes from E. coli MS2027 were found to be located on a conjugative plasmid. Sequencing and annotation revealed that this 42,644 bp plasmid, named pMAS2027, contains 58 putative genes. Bioinformatic analysis identified pMAS2027 as an incompatibility X (IncX1) plasmid. Plasmid pMAS2027 contained genes encoding two important virulence factors, type 3 fimbriae and a type IV secretion (T4S) system. The biofilm ability was solely based on the expression of type 3 fimbriae and not the T4S system. The T4S system, however, accounted for the conjugative ability of pMAS2027. Differential tagging with fluorescent reporter genes demonstrated conjugative transfer of pMAS2027 between cells during biofilm growth. Finaly, transposon mutagenesis of E. coli M184 revealed a number of putative genes potentially responsible for bacterial aggregation. Of these, genes involved in the synthesis of the enterobacterial common antigen (ECA) were shown to be associated with an aggregation phenotype.

Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections and is caused by a range of different uropathogens, particularly by uropathogenic Escherichia coli (UPEC). Amongst the different virulence factors, biofilm formation and bacterial aggregation, often mediated by cell surface structures such as fimbriae, are common traits among uropathogens that cause CAUTI. In this study, a collection of UPEC isolates were screened for virulence genes and phenotypes associated with urinary tract infections such as biofilm formation and mannose-sensitive haemagglutination. Two strains, E. coli MS2027 (which formed a strong biofilm) and E. coli M184 (which aggregated strongly) were analysed in detail to determine the molecular mechanisms associated with these phenotypes. Transposon mutagenesis of E. coli MS2027 identified type 3 fimbriae as the factor responsible for its strong biofilm growth. Further screening revealed the presence of type 3 fimbriae in uropathogenic Citrobacter freundii, Citrobacter koseri, Klebsiella oxytoca, Klebsiella pneumoniae and other E. coli. Phylogenetic analysis of the type 3 fimbrial (mrkABCD) genes from these strains revealed they clustered into five distinct clades (A-E) ranging from one to twenty-three members. The majority of the sequences grouped in clade A, which was represented by the mrk gene cluster from the genome sequenced K. pneumoniae strain MGH78578. We demonstrated that type 3 fimbriae are functionally expressed by different Gram negative nosocomial pathogens and present evidence to suggest that they contribute significantly to catheter colonisation. The type 3 fimbrial genes from E. coli MS2027 were found to be located on a conjugative plasmid. Sequencing and annotation revealed that this 42,644 bp plasmid, named pMAS2027, contains 58 putative genes. Bioinformatic analysis identified pMAS2027 as an incompatibility X (IncX1) plasmid. Plasmid pMAS2027 contained genes encoding two important virulence factors, type 3 fimbriae and a type IV secretion (T4S) system. The biofilm ability was solely based on the expression of type 3 fimbriae and not the T4S system. The T4S system, however, accounted for the conjugative ability of pMAS2027. Differential tagging with fluorescent reporter genes demonstrated conjugative transfer of pMAS2027 between cells during biofilm growth. Finaly, transposon mutagenesis of E. coli M184 revealed a number of putative genes potentially responsible for bacterial aggregation. Of these, genes involved in the synthesis of the enterobacterial common antigen (ECA) were shown to be associated with an aggregation phenotype.

Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections and is caused by a range of different uropathogens, particularly by uropathogenic Escherichia coli (UPEC). Amongst the different virulence factors, biofilm formation and bacterial aggregation, often mediated by cell surface structures such as fimbriae, are common traits among uropathogens that cause CAUTI. In this study, a collection of UPEC isolates were screened for virulence genes and phenotypes associated with urinary tract infections such as biofilm formation and mannose-sensitive haemagglutination. Two strains, E. coli MS2027 (which formed a strong biofilm) and E. coli M184 (which aggregated strongly) were analysed in detail to determine the molecular mechanisms associated with these phenotypes. Transposon mutagenesis of E. coli MS2027 identified type 3 fimbriae as the factor responsible for its strong biofilm growth. Further screening revealed the presence of type 3 fimbriae in uropathogenic Citrobacter freundii, Citrobacter koseri, Klebsiella oxytoca, Klebsiella pneumoniae and other E. coli. Phylogenetic analysis of the type 3 fimbrial (mrkABCD) genes from these strains revealed they clustered into five distinct clades (A-E) ranging from one to twenty-three members. The majority of the sequences grouped in clade A, which was represented by the mrk gene cluster from the genome sequenced K. pneumoniae strain MGH78578. We demonstrated that type 3 fimbriae are functionally expressed by different Gram negative nosocomial pathogens and present evidence to suggest that they contribute significantly to catheter colonisation. The type 3 fimbrial genes from E. coli MS2027 were found to be located on a conjugative plasmid. Sequencing and annotation revealed that this 42,644 bp plasmid, named pMAS2027, contains 58 putative genes. Bioinformatic analysis identified pMAS2027 as an incompatibility X (IncX1) plasmid. Plasmid pMAS2027 contained genes encoding two important virulence factors, type 3 fimbriae and a type IV secretion (T4S) system. The biofilm ability was solely based on the expression of type 3 fimbriae and not the T4S system. The T4S system, however, accounted for the conjugative ability of pMAS2027. Differential tagging with fluorescent reporter genes demonstrated conjugative transfer of pMAS2027 between cells during biofilm growth. Finaly, transposon mutagenesis of E. coli M184 revealed a number of putative genes potentially responsible for bacterial aggregation. Of these, genes involved in the synthesis of the enterobacterial common antigen (ECA) were shown to be associated with an aggregation phenotype.

Urinary catheters are indispensable in healthcare and, with an ageing population, their use will continue to increase. However, they are commonly associated with colonisation and urinary tract infections (UTIs) caused by the attachment of bacteria to the catheter surface. Application of a novel cationic compound as a catheter coating may have a significant impact on the costs associated with treatment of UTIs and reduce the need for catheter replacement, as well as decreasing the number of UTI associated morbidity and mortality. Cationic compounds in particular are known to interact with the negatively charged outer membrane of bacteria, therefore have a broad spectrum of activity. The purpose of this study was to source and evaluate a novel cationic antimicrobial for use as a potential coating to impede biofilm formation on urinary catheters, and to investigate the cellular response to the selected lead compound. This research has demonstrated that the antimicrobial activity of commercially available Byotrol™ was superior to that of polyamines and quaternary ammonium compounds that were screened. Using high-throughput antimicrobial assays, such as the minimum inhibitory concentration and microtitre plate biofilm forming assays, the inhibitory concentrations of Byotrol™ were found to range from 3 µg/mL to 15 µg/mL for planktonic cultures, and 3 µg/mL to 20 µg/mL for the biofilm growth of uropathogenic bacteria. Furthermore, the minimum biofilm eradication concentration assay demonstrated that 200-1000 µg/mL Byotrol™ was able to eradicate an established biofilm. Byotrol™ may also have significant potential as a device coating, as pre-coating data on glass slides and microtitre plates with the compound inhibited bacterial growth on the surface at concentrations of 400 µg/mL for E. coli, and 1000 µg/mL K. pneumoniae. Atomic force microscopy validated the expectation that higher concentrations of Byotrol™ coated a surface more evenly than lower concentrations. Using two-dimensional gel electrophoresis, the metabolic protein tryptophanase was seen to be significantly over-expressed when E. coli K12 was treated with sub-inhibitory concentrations of Byotrol™. A transcriptomic approach using RNA-Seq demonstrated that a majority of the differentially expressed genes were identified in cells that were challenged with 4 times the minimum inhibitory concentration of Byotrol™. Genes associated with protein synthesis and stress response were significantly up-regulated. Interestingly, the global gene regulators AI-2 and indole were significantly up-regulated, which may have an influence on the expression of genes related to motility, biofilm formation and acid-resistance. Genes associated with chemotaxis and motility, acid-resistance and iron transport were significantly down-regulated, particularly in cells challenged with Byotrol™.Byotrol™ displayed antimicrobial activity both in suspension and as a coating. Identification of differentially expressed genes and proteins, when the bacteria were treated and challenged with Byotrol™, has, for the first time, revealed the bacterial cell’s response to this biocide. The findings may enable the development of strategies to prevent or better manage catheter associated urinary tract infection (CAUTI).

No description available.

Catheter-Associated Urinary Tract Infections are considered a clinical indicator of quality of care. A descriptive research study was conducted to identify the strategies used by hospitals to reduce or eliminate CAUTIs. Infection Control Preventionists were surveyed. In a predominately rural southeastern state, this study demonstrated that about 40% of hospitals surveyed are implementing CAUTI prevention processes.