Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 7, Number 2—April 2001
THEME ISSUE
4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections
State of the Art

Engineering out the Risk of Infection with Urinary Catheters

Dennis G. Maki*Comments to Author  and Paul A. Tambyah†
Author affiliations: *University of Wisconsin Medical School, Madison, Wisconsin, USA; †National University of Singapore Medical School, Singapore

Main Article

Table 5

Cost-benefit evaluation (restricted to direct hospital costs) of the silver-hydrogel catheter

Assumptions of analysis
Proportion of CAUTIs diagnosed clinically 65%
Cost of each diagnosed CAUTI ~$1000a
Added acquisition cost of a silver-hydrogel catheter ~$5
Incremental hospital costs, per 100 catheters:
Using standard urinary catheters
(26 CAUTIs, 17 diagnosed) $17,000
Using silver-hydrogel catheters
(15 CAUTIs, 10 diagnosed) $10,000
Added cost of catheters $500b
Total costs $10,500
Potential savings per 100 catheters $6,500

aBased on studies showing that a diagnosed nosocomial CAUTI adds approximately $1,000 to direct costs of hospitalization (14); CAUTI = catheter-associated urinary tract infection.
bCost of preventing a CAUTI: approximately $71.

Main Article

References
  1. Stamm  WE. Catheter-associated urinary tract infections: Epidemiology, pathogenesis, and prevention. Am J Med. 1991;91(Suppl 3B):65S–71S. DOIPubMedGoogle Scholar
  2. Burke  JP, Riley  DK. Nosocomial urinary tract infection. In: Mayhall CG, editor. Hospital epidemiology and infection control. Baltimore: Williams and Wilkins; 1996. p. 139-53.
  3. Warren  JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am. 1997;11:609–22. DOIPubMedGoogle Scholar
  4. Kunin  CM. Care of the urinary catheter. In: Urinary tract infections: detection, prevention and management. Fifth ed. Baltimore: Williams and Wilkins; 1997. p. 227-99.
  5. Kunin  CM, McCormack  RC. Prevention of catheter-induced urinary-tract infections by sterile closed drainage. N Engl J Med. 1966;274:1155–61. DOIPubMedGoogle Scholar
  6. Garibaldi  RA, Mooney  BR, Epstein  BJ, Britt  MR. An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter associated UTI. Infect Control. 1982;3:466–70.PubMedGoogle Scholar
  7. Stark  RP, Maki  DG. Bacteriuria in the catheterized patient. N Engl J Med. 1984;311:560–4. DOIPubMedGoogle Scholar
  8. Maki  DG. Nosocomial bacteremia. An epidemiologic overview. Am J Med. 1981;70:719–32. DOIPubMedGoogle Scholar
  9. Krieger  JN, Kaiser  DIL, Wenzel  RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis. 1983;148:57–62. DOIPubMedGoogle Scholar
  10. Bryan  CS, Reynolds  KL. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol. 1984;132:494–8.PubMedGoogle Scholar
  11. Platt  R, Polk  BF, Murdock  B, Rosner  B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med. 1982;307:637–41. DOIPubMedGoogle Scholar
  12. Kunin  CM, Douthitt  S, Dancing  J, Anderson  J, Moeschberger  M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol. 1992;135:291–301.PubMedGoogle Scholar
  13. Tambyah  PA, Maki  DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med. 2000;160:678–82. DOIPubMedGoogle Scholar
  14. Patton  JP, Nash  DB, Abrutyn  E. Urinary tract infection: economic considerations. Med Clin North Am. 1991;75:495–513.PubMedGoogle Scholar
  15. Jarvis  WR, Martone  WJ. Predominant pathogens in hospital infections. J Antimicrob Chemother. 1992;29:19–24.PubMedGoogle Scholar
  16. Tambyah  PA, Halvorson  K, Maki  DG. A prospective study of the pathogenesis of catheter-associated urinary tract infection. Mayo Clin Proc. 1999;74:131–6. DOIPubMedGoogle Scholar
  17. Daifuku  R, Stamm  WE. Association of rectal and urethral colonization with urinary tract infection in patients with indwelling catheters. JAMA. 1984;252:2028–30. DOIPubMedGoogle Scholar
  18. Garibaldi  RA, Burke  JP, Britt  MR, Miller  MA, Smith  CB. Metal colonization and catheter-associated bacteriuria. N Engl J Med. 1980;303:316–8. DOIPubMedGoogle Scholar
  19. Nickel  JC, Costerton  JW, McLean  RJ, Olson  M. Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections. J Antimicrob Chemother. 1994;33(Suppl A):31–41.PubMedGoogle Scholar
  20. Maki  DG, Knasinski  V, Halvorson  KT, Tambyah  PA, Holcomb  RG. A prospective, randomized, investigator-blinded trial of a novel nitrofurazone-impregnated urinary catheter [abstract M49]. Infect Control Hosp Epidemiol. 1997;18(Suppl):50.
  21. Darouiche  RO, Smith  A, Hanna  H, Dhabuwala  CB, Steiner  MS, Babaian  RJ, Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteriuria: a prospective, randomized multicenter clinical trial. Urology. 1999;54:976–81. DOIPubMedGoogle Scholar
  22. Lundeberg  T. Prevention of catheter-associated urinary tract infections by use of silver-impregnated catheters [letter]. Lancet. 1986;1:1031. DOIPubMedGoogle Scholar
  23. Liedberg  H, Lundeberg  T. Silver alloy coated catheters reduce catheter-associated bacteriuria. Br J Urol. 1990;65:379–81. DOIPubMedGoogle Scholar
  24. Liedberg  H, Lundeberg  T, Ekman  P. Refinements in the coating of urethral catheters reduce the incidence of catheter-associated bacteriuria. An experimental and clinical study. Eur Urol. 1990;17:236–40.PubMedGoogle Scholar
  25. Liedberg  H, Lundeberg  T. Prospective study of incidence of urinary tract infection in patients catheterized with bard hydrogel and silver-coated catheters or bard hydrogel-coated catheters [abstract 405A]. J Urol. 1993; 149.PubMedGoogle Scholar
  26. Maki  DG, Knasinski  V, Halvorson  K, Tambyah  PA. A novel silver-hydrogelimpregnated indwelling catheter reduces CAUTIs: a prospective double-blind trial [abstract]. In: Programs and abstracts of the Society for Healthcare Epidemiology in America Annual Meeting; April 5-7, 1998; Orlando, Florida.
  27. Maki  DG, Knasinski  V, Tambyah  PA. Risk factors for catheter-associated urinary tract infection: a prospective study showing the minimal effects of catheter care violations on the risk of CAUTI [abstract]. Infect Control Hosp Epidemiol. 2000;21:165.
  28. Platt  R, Polk  BF, Murdock  B, Rosner  B. Risk factors for nosocomial urinary tract infection. Am J Epidemiol. 1986;124:977–85.PubMedGoogle Scholar
  29. Johnson  JR, Roberts  PL, Olsen  RJ, Moyer  KA, Stamm  WE. Prevention of catheter-associated urinary tract infection with a silver oxide-coated urinary catheter: Clinical and microbiologic correlates. J Infect Dis. 1990;162:1145–50. DOIPubMedGoogle Scholar
  30. Riley  DK, Classen  DC, Stevens  LE, Burke  JP. A large randomized clinical trial of a silver-impregnated urinary catheter: Lack of efficacy and staphylococcal superinfection. Am J Med. 1995;98:349–56. DOIPubMedGoogle Scholar
  31. Rabkin  DG, Stifelman  MD, Birkhoff  J, Richardson  KA, Cohen  D, Nowygrod  R, Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc. 1998;30:4314–6. DOIPubMedGoogle Scholar
  32. Shapiro  J, Hoffmann  J, Jersky  J. A comparison of suprapubic and transurethral drainage for postoperative urinary retention in general surgical patients. Acta Chir Scand. 1982;148:323–7.PubMedGoogle Scholar
  33. Warren  JW. Urethral catheters, condom catheters, and nosocomial urinary tract infections. Infect Control Hosp Epidemiol. 1996;17:212–4. DOIPubMedGoogle Scholar
  34. Maki  DG, Hennekens  C, Bennet  J. Prevention of catheter-associated urinary ract infection. JAMA. 1972;221:1270–1. DOIPubMedGoogle Scholar
  35. van der Wall  E, Verkooyen  RP, Mintjes-de-Groot  J, Oostinga  J, Van Dijk  A, Hustius  WN, Prophylactic ciprofloxacin for catheter-associated urinary tract infection. Lancet. 1992;339:946–51. DOIPubMedGoogle Scholar
  36. Maki  DG. Risk factors for nosocomial infection in intensive care. "Devices vs nature" and goals for the next decade. Arch Intern Med. 1989;149:30–5. DOIPubMedGoogle Scholar
  37. Warren  JW, Platt  R, Thomas  RJ, Rosner  B, Kass  EH. Antibiotic irrigation and catheter-associated urinary tract infections. N Engl J Med. 1978;299:570–3. DOIPubMedGoogle Scholar
  38. Platt  R, Polk  BF, Murdock  B, Rosner  B. Reduction of mortality associated with nosocomial urinary tract infection. Lancet. 1983;1:893–6. DOIPubMedGoogle Scholar
  39. Huth  TS, Burke  JP, Larsen  RA, Classen  DC, Stevens  LE. Clinical trial of junction seals for the prevention of urinary catheter-associated bacteriuria. Arch Intern Med. 1992;152:807–12. DOIPubMedGoogle Scholar
  40. Classen  DC, Larsen  RA, Burke  JP, Stevens  LE. Prevention of catheter-associated bacteriuria: clinical trial of methods to block three known pathways of infection. Am J Infect Control. 1990;19:136–42. DOIPubMedGoogle Scholar
  41. Gabriel  MM, Sawant  AD, Simmons  RB, Hearn  DG. Effects of silver on adherence of bacteria to urinary catheters: in vitro studies. Curr Microbiol. 1995;30:1722. DOIPubMedGoogle Scholar
  42. Saint  S, Elmore  JG, Sullivan  SD, Emerson  SS, Koepsell  TD. The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis. Am J Med. 1998;105:236–4. DOIPubMedGoogle Scholar
  43. Maki  DG, Stolz  SM, Wheeler  S, Mermel  LA. Prevention of central venous catheterrelated bloodstream infection by use of an antiseptic-impregnated catheter. Ann Intern Med. 1997;127:257–66.PubMedGoogle Scholar
  44. Nissenkorn  I. The intraurethral catheter-three years of experience. Eur Urol. 1993;24:27–30.PubMedGoogle Scholar
  45. Johnson  DE, O'Reilly  JL, Warren  JW. Clinical evaluation of an external urine collection device for nonambul

Main Article

Page created: April 17, 2012
Page updated: April 17, 2012
Page reviewed: April 17, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external