Diane Kaschak Newman, DNP, FAAN, BCB-PMD
Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials
Division of Urology, University of Pennsylvania Medical Center
I have been in discussions with CAUTI Challenge users
Another area of gray for me surrounds removal of a urinary catheter / re-insertion of a new catheter before a urine culture is obtained. As you know, APIC guidelines state cultures from "recently inserted" catheters yield reliable results...suggest changing out urinary catheters, but does not give guidance as to a time frame. You mention in your pp that catheters should be changed if in longer than 10 days. Univ of CO Denver requires a urinary catheter be changed before culture if it has been in > 72 hrs.
I appreciate your guidance and expertise in helping me develop an accurate Computer Based Training (CBT) module for Memorial Health System's staff.
I am glad you have found the information on the CAUTI center on UroToday helpful. It gets lots of traffic and many inquiries, similar to yours.
There is no information or evidence-based recommendations on when a catheter should be removed/changed in a hospital patient. If a urinary tract infection is suspected and a urine C&S is to be obtained, it is strongly suggested that a new catheter and collection system be placed and the urine C&S obtained from the new system. But the evidence on this is very little. Look at this one reference:
Raz, R. (2000). Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection, Urol. 164:1254-58.
If it’s not possible or may cause the patient harm or burden to change the system then it is recommended that staff obtain the urine sample from the established system by clamping tubing distal to the collection port for short time to allow urine to accumulate, disinfect port with alcohol or chloroprep and allow to dry and use sampling port to draw samples.
As most experts believe that the course of treatment will be improved if the catheter and collection system is changed prior to or along with starting antibiotics, we will always change the system before starting antibiotics on a pt who has a CAUTI.
I hope this is helpful.