Multimicronutrient Supplementation And Asymptomatic: Preventing Catheter-Related UTI In Elderly

Research and Analysis

Discuss about the Multimicronutrient Supplementation and Asymptomatic.

Urinary tract infection is one of the most common infections that worsen the heath status of patients in long-term hospital stay, especially for older people in ager care facilities. UTI is often associated with the catheter-related infections. In this essay, the preventable measures for the catheter related UTI would be analyzed with the help of evidences in the recently published journal resources. Based on the findings, recommendations would also be provided. Its relevance relies upon the promotion of safe catheter usage in hospitals through the implementation of new and effective measures of preventing catheter associated urinary tract infection (CAUTI) in elderly.

In order to carry out the research, a series of search were applied and authentic databases were searched to access high quality research papers. The search terms were: urinary catheter, catheter related infections, hospital-acquired infection, aged population and catheter infection. The databases were PubMed, EbescoHost and Science Direct. To make the search more precise, exclusion and inclusion criteria have been applied. Research papers published in English language, within last 6years, peer-reviewed and full text articles were accessed. Boolean operators like OR, AND, NOT were applied to make the literature search more specific. Literature search generated almost 30 papers and application of Boolean operators narrowed down the search to 15 most relevant papers.

Lee et al., (2015) conducted an RCT for evaluating effects of nurse-family partnership model on the occurrence of the catheter-associated UTI in 61 patients, in which the author revealed significant improved patient outcomes through nurse-family partnership (level IIa).  Whereas, an implementation of the national initiative for CAUTI prevention “On the CUSP: STOP CAUTI” in 500 nursing homes in 50 states was done by Mody et al., (2015); the study revealed involvement of technical and socio-adaptive principles and improved leadership in nursing can be helpful in ensuring the efficacy of future initiatives for reducing other infections (level I). The effectiveness of novel silver-impregnated Foley catheter system was evaluated by Leuck et al., (2015) in a single-centre RCT trial (level IIa), revealing that the system can protect against asymptomatic bcteriuria due to gram negative bacilli infection associated with catheter usage for longer time. Schwenger, Tejani and Loewen (2015) selected 9 RCT studies to review 735 susceptible patients through medical records, however, the study did not receive any significant action of probiotics along with placebo to reduce CAUTI rate on patients (level Ia).

Effective Interventions for Preventing CAUTI

The first initiative of “no preventable harms campaign: creating the safest health care system in the world” was studied by Saint et al., (2015), where a quantitative and qualitative trial of 1000 patients was done. The evaluation revealed some major areas of improvement for preventing CAUTI rate, including consideration of local policies, procedures, individualized initiatives, providing time between initiatives and involving all stakeholders along with the need for partnership with national centre for patient safety on a CAUTI collaborative initiative. Juthani-Mehta et al., (2016) reviewed an innovative intervention through a double blind RCT trial for preventing CAUTI prevalence, by administering cranberry capsules among 185 65-years old women (level IIa), but the study did not reveal a significant effect. “Commission for Hospital Hygiene and Infection Prevention (KRINKO)” provided recommendation for CAUTI preventive measures in hospitals. Heudorf et al., (2016) investigated the effectiveness of the recommendations (level IV). The author investigated operations in 40 nursing homes and revealed that following the recommendations, the rate of UTI has been lowered along with lowered usage of antibiotic therapy for users of urinary tract catheter. The author reveled resistance-based antibiotic stewardship is an efficient strategy.

Mulcare et al., (2015) analyzed the perceptions of care providers regarding the use of indwelling urinary catheters in older adults, by conducting a qualitative focused group study (level VI) with 38 participants and reported the overutilization of indwelling urinary catheters in emergency departments for older adults for which an evidence-based clinical protocol for IUC management can reduce CAUTI rate. Freeman-Jobson, Rogers and Ward-Smith (2016) conducted an evidence based education program to assess the effectiveness of education sessions enhancing awareness of health care staffs regarding UTI prevention by involving 42 participants and revealed improved patient outcomes with enhanced care provider’s knowledge (level VI). Christ-Libertin et al., (2015) conducted a pilot study for evaluating the effectiveness of evidence-based guidelines for preventing CAUTI rate in burn-injured patient population. The evidence-based guidelines helped the nurses to reduce CAUTI rate and reduced catheter days along with significant reduction of infection incident within 248 days (level IV).

Trautner et al., (2015) evaluated the effectiveness of a multifaceted guideline implementation intervention to reduce the antibiotic overtreatment to the catheter-associated ASB. The researcher emphasized on the fact that most professionals face difficulties in distinguishing between CAUTI and ASB and providing a clinical guidelines regarding diagnosis showed reduced overtreatment and unnecessary screening and improved patient outcomes compared to the standard protocol (level IIa). Mody et al., (2015) conducted a RCT study (level IIa) evaluating the effectiveness of multimodal targeted infection program (TIP) including active surveillance for MDROs, CAI, preemptive barrier precautions and staff training and the intervention reduced overall CAUTI and MDRO rates in NH residents (level IIa). In addition to the previous articles, Boekitwetan et al., (2016) evaluated the effectiveness of a significant measure, multimicronutrient supplement to reduce UTI incident in older patients, especially in residency care homes, by conducting a double blind RCT (level IIa), which revealed significant reduction of UTI incident caused by predominant organism E. coli in test group patients compared to the control group.

Recommendations and Conclusion

Carter, Nina M., et al. (2014) reviewed existing literatures related CAUTI prevention and implemented those interventions in a 28 bed unit showing a significant reduction of catheter-associated UTI, supporting the findings of Mulcare et al., (2015) and Christ-Libertin et al., (2015) (level IV). The final article that has been reviewed represented the review of clinical cases for identifying the effective interventions to reduce CAUTI rates in patients. The article revealed the use of fixation devices can enhance patient satisfaction rate along with reduction of care cost (Holroyd, 2016).

From the above fifteen articles, several unique and effective interventions has been found which can be recommended for reducing the rate of CAUTI in the health care settings. Boekitwetan et al., (2016) recommended the multimicronutrient supplement as a prevention measure of CAUTI in older adults, as it has been seen that opportunistic pathogens are predominant in CAUTI incidents, which are raised due to reduced immunity of older patients, thus, multinutrient supplement would help older patients to improve immunity reduce the opportunity for infection.  On the other hand, several articles revealed the importance of care provider’s knowledge and skills for using catheter, which reduces the replacement of catheter and reduces the recurrence of infection due to infrequent replacement of catheter tube (Christ-Libertin et al., 2015).  The importance of staff’s training and knowledge is always important for enhancing the quality of health care services provided to the catheter users.

All the articles indicated the high rate of CAUTI rate in older patients and represented different strategies for controlling or preventing the incident of CAUTI rate in patients, who are in long term care. One study presented the use of fixation devices in catheterization. It showed improved patient outcomes with enhanced patient and health care staff’s satisfaction. Thus, this strategy can be recommended to be used in the hospitals or residential care homes for patients with catheters. The author presented one innovative device known as Ugo Fix gentle, which is a purpose-designed medical device that is used for fixing and supporting patient catheters at the catheter bifurcation. It can be recommended in the hospitals to be used in the case of long-term patients, as it’s use has shown reduced risk of CAUTI, trauma and reduced discomfort due to catheter pulling or rubbing the urethra. It is evident that catheterization is significantly discomfortable for patients, as it increases pain and difficulties in moving; thus using this fixative device would enhance patient’s comfort and improve the overall health status (Holroyd, 2016).

Moreover, the articles also highlighted the importance of following proper guidelines in handling, inserting and removing catheter from the patient. It has been revealed that inefficient handling of catheter increase pain, discomfort and incident of CAUTI in older and long-term patients. Reviewing the above literature, another recommendation for the nursing staffs was revealed that is, the nurses or other medical staffs should be able to distinguish between the ASB and CAUTI, as the screening period is responsible for worsening the CAUTI symptoms in patients.

All the articles showed the scope of implementation in new Zealand nursing care, as in most cases, the primary data were revealed along with the review of evidence based practices. However, in one article by Schwenger, Tejani and Loewen (2015) did not revealed relevant results that can be applicable in New Zealand nursing setting.

From the above literature review, it has been revealed that there are several significant strategies for preventing CAUTI incident in the older patients in long term care, but further research regarding the best fixative device and the details of multimicronutrient required for preventing the CAUTI incident is required.

Reference List

Boekitwetan, P., Surjawidjaja, J. E., Aidilfit, M., & Lesmana, M. (2016). Multimicronutrient supplementation and asymptomatic urinary tract infections in the elderly. Universa Medicina, 28(1), 25-33.

Carter, Nina M., et al. (2014) "An evidence-based approach to the prevention of catheter-associated urinary tract infections." Urologic Nursing, p. 238+. Academic OneFile,

Christ-Libertin, C., Black, S., Latacki, T., & Bair, T. (2015). Evidence-based prevent catheter-associated urinary tract infections guidelines and burn-injured patients: a pilot study. Journal of Burn Care & Research, 36(1), e1-e6.

Freeman-Jobson, J. H., Rogers, J. L., & Ward-Smith, P. (2016). Effect of an education presentation on the knowledge and awareness of urinary tract infection among non-licensed and licensed health care workers in long-term care facilities. Urologic nursing, 36(2), 67-72.

Heudorf, U., Gasteyer, S., Müller, M., Samoiski, Y., Serra, N., & Westphal, T. (2016). Prevention and control of catheter-associated urinary tract infections–implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in nursing homes for the elderly in Frankfurt am Main, Germany. GMS Hygiene and Infection Control, 11.

Holroyd, S. (2016). Innovation in catheter securement devices: minimising risk of infection, trauma and pain. British journal of community nursing, 21(5).

Juthani-Mehta, M., Van Ness, P. H., Bianco, L., Rink, A., Rubeck, S., Ginter, S., ... & Quagliarello, V. (2016). Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial. JAMA.

Lee, K. C., Chao, Y. F. C., Wang, Y. M., & Lin, P. C. (2015). A nurse–family partnership intervention to increase the self?efficacy of family caregivers and reduce catheter?associated urinary tract infection in catheterized patients. International journal of nursing practice, 21(6), 771-779.

Leuck, A. M., Johnson, J. R., Hunt, M. A., Dhody, K., Kazempour, K., Ferrieri, P., & Kline, S. (2015). Safety and efficacy of a novel silver-impregnated urinary catheter system for preventing catheter-associated bacteriuria: A pilot randomized clinical trial. American journal of infection control, 43(3), 260-265.

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.

Mody, L., Meddings, J., Edson, B. S., McNamara, S. E., Trautner, B. W., Stone, N. D., ... & Saint, S. (2015). Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes. Clinical Infectious Diseases, 61(1), 86-94.

Mulcare, M. R., Rosen, T., Clark, S., Scherban, B. A., Stern, M. E., & Flomenbaum, N. E. (2015). Provider perspectives on the use of indwelling urinary catheters in older adults in emergency department settings: Developing a novel clinical protocol. American journal of infection control, 43(4), 341-347.

Saint, S., Fowler, K. E., Sermak, K., Gaies, E., Harrod, M., Holland, P., ... & Krein, S. L. (2015). Introducing the No Preventable Harms campaign: Creating the safest health care system in the world, starting with catheter-associated urinary tract infection prevention. American journal of infection control, 43(3), 254-259.

Schwenger, E. M., Tejani, A. M., & Loewen, P. S. (2015). Probiotics for preventing urinary tract infections in adults and children. The Cochrane Library.

Trautner, B. W., Grigoryan, L., Petersen, N. J., Hysong, S., Cadena, J., Patterson, J. E., & Naik, A. D. (2015). Effectiveness of an antimicrobial stewardship approach for urinary catheter–associated asymptomatic bacteriuria. JAMA internal medicine, 175(7), 1120-1127.