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Chelsea Kritzman
McKall Mayner
Julia Snyder
Megan Litwiller
Jordyn Turkiewicz
Catheter Associated Urinary
Tract Infections (CAUTI)
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Recommendations
There is strength A evidence to support
that early removal of urinary catheters is
the highest priority intervention in the
prevention of CAUTI.
All interventions included in the articles
regarding early removal have no
superiority over the other. The articles
recommend that interventions, such as
nurse-led and informatics led, be used in
order to promote early removal.
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PICO Question
For adult patients does the removal
of catheters as soon as possible
versus leaving them in longer,
decrease the incidence of catheter
associated urinary tract infections?
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Search Technique/ Methods
Databases searched included Science Direct
and CINAHL using the following keywords:
timely removal of catheter*, CAUTI
prevention, CAUTI and studies, Catheter
infection, Catheter Associated Urinary Tract
Infection, Early removal of indwelling urinary
catheters. The articles include one level IA,
one level IIA, and one level V.
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Findings
There were 17 articles that were
initially found, but only 3 articles
were found to be relevant to
CAUTI associated with early
removal as a key intervention for
prevention. These 3 articles
were used for the review.
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Bernard, M.S., Hunter, K.F., & Moore, K.N. (2012). A review of
strategies to decrease the duration of indwelling urethral
catheters and potentially reduce the incidence of catheter
associated urinary tract infections. Urologic Nursing. 32(1), 29-37.
(Level V)
Nine studies were reviewed that focused on reducing the duration
of catheter use.
Evidence from this review supports that nurse-led and informatics-
led interventions reduced the length of catheterizations and
incidence of CAUTI.
Nurse-led interventions in requesting discontinuation of unneeded
catheters resulted in a 67% reduction in the number of days of
catheter use and a 26% reduction in the number of CAUTI.
Timely removal was the intervention investigated since the
greatest factor causing CAUTI is the length of time of
catheterization.
There was a significant reduction in the number of catheter-
utilization days, with a mean reduction from 11 to 3 days, as well
as a significant reduction in CAUTIs.
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Moola, S. & Konno, R. (2010). A systematic review of
the management of short-term indwelling urethral
catheters to prevent urinary tract infections. JBI
Library of Systematic Reviews. 8(17), 695-729.
(Level IA)
This study looked at immediate versus delayed catheter
removal, in relation to the prevalence of a UTI.A
randomized trial of 96 women who just underwent
surgery was performed. They were separated into three
groups of 32.Group A had immediate catheter removal in
the OR, group B had catheter removal 6 hours after
surgery, and group C had catheter removal 12 hours after
surgery.
The prevalence of UTI was lower in group A (3.1%)
compared to group B(13.3%) and group C (15.6%)
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Kelleher, M.MB. (2002). Removal of urinary catheters: midnight vs
0600 hours. British Journal of Nursing. 11(2), 84-90.
(Level IIA)
The study was performed to determine whether patients who had their
IDCs removed at midnight resumed normal voiding patterns earlier
than patients who had them removed at 0600 hour.
The study included 160 urology patients who were randomly assigned
to the 0600 hour or 2400 (midnight) group.
Nurses recorded the time the catheter was removed, the time and
volume of 1
st
and 2
nd
voids, and the time between removal and patient
discharge.
The study found that midnight removal was much more beneficial than
0600 hour removal including lower patient anxiety, decreased
occurrence of CAUTI due to earlier removal and frequent voiding,
earlier retention treatment, increased volume of urine passed, and
higher percentage of same day discharge.
Early voiding was more common in the midnight group where 80% of
all patients had passed urine at least once before 0600. 53% of these
patients had voided at least twice before this time.
64% of patients in the midnight group were discharged from the
hospital on the same day of catheter removal, compared with 23% of
the 0600 group.
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Recommendations
There is strength A evidence to support that silver
alloy coated catheters compared to other types
prevent the incidence of CAUTI in the healthcare
setting.
There have not been enough studies done to support
the cost effectiveness of silver alloy vs. other various
types of catheters since the silver alloy are more
costly then standard catheters.
However, various articles take into consideration the
cost for treating a patient after acquiring CAUTI. The
amount for the cost of treatment exceeded the cost of
the silver alloy coated catheter.
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PICO Question
Does the use of silver alloy coated catheters
versus other types of catheters decrease the
incidence of catheter associated urinary tract
infections?
Silver alloy catheter: combination of noble metals
and hydrogel coats both the inside and outside
surfaces of that catheter, allowing a slow release
of silver ions into hydrogel which prevents bacteria
from settling on the catheter surface
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Search Technique/ Methods
Databases searched included CINAHL,
JoAnna Briggs, Science Direct, and
Google Scholar using the following
keywords: CAUTI, silver alloy catheters,
cost of silver alloy catheters, coated
catheters, CAUTI and interventions. The
articles include one level IA, one level IB,
and one level IV.
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Findings
There were 17 articles that were initially
found, but only 3 articles supported the
evidence that silver alloy was the best
type of catheter to use for prevention of
CAUTI. These 3 articles were included in
the review.
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Saint, S., Elmore, J.G., Sullivan, S.D., Emerson, S.S., &
Koepsell, T. (1998). The efficacy of silver alloy-coated urinary
catheters in preventing urinary tract infection: a meta-analysis.
The American Journal of Medicine. 105, 236-240.
(Level IB)
Study was done in 1998, however standard catheter material has not
changed, so information is still relevant.
A meta-analysis was completed which estimated the effectiveness of
silver coated urinary catheters that included eight trials with a total of
2,355 patients.
Summary odds ratio for urinary tract infection was 0.59 indicating a
statistically significant benefit in patients treated with silver-coated
catheters.
Silver alloy catheters were the most beneficial when protecting against
bacteriuria than silver oxide catheters.
Further analysis needed to determine cost effectiveness of using silver
alloy catheter ($13 US dollars) vs standard catheters ($7 US dollars).
However, this study found that the cost to treat a UTI exceeded the cost
of silver alloy catheters.
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Seymour, C. (2006). Audit of catheter-associated UTI
using silver alloy-coated foley catheters. British
Journal of Nursing. 15(11), 598-603.
(Level IV)
Patients using a standard catheter system were followed and
compared to patients with a silver alloy catheter, over a 20 week
period.
10 weeks using the standard catheter and 10 weeks using the silver
alloy catheter.
This study involved 117 patients, with the mean age of 79 years old. 54
people in the baseline group (standard catheter) and 63 people in the
Evaluation group (those with silver alloy catheters).
Rates of CAUTI fell during the evaluation period when silver alloy
coated catheters were used.
The audit demonstrated a risk rate of CAUTI higher than the standard
during the baseline period. The rate fell to below the standard during
the evaluation period when silver alloy-coated catheters were used,
demonstrating a reduction in risk rate of 71.2%, exceeding the audits
aim of 20%.

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Schumm, K. & Lam, T.BL. (2010). Types of urethral
catheters for management of short-term voiding
problems in hospitalized adults. The Cochrane
Library. 11, 1-44.
(Level IA)
The objective of the review was to determine the effect of
the type of indwelling urethral catheter on the risk of urinary
tract infection in adults who undergo urinary catheterization.
Nine trials compared silver alloy catheters with standard
catheters.
Silver alloy catheters reduced incidence of bacteriuria at
both less than and more than one week of catheterization.
For those catheterized less than one week, the estimated
risk of bacteriuria was at least half with the silver alloy
catheter than with a standard catheter.
Overall Recommendations
Early removal is the best prevention of CAUTI.
Interventions such as nurse-led and informatics-
led should be used to promote early removal of
catheters.
The catheter of choice in the prevention of CAUTI
is the silver alloy coated catheter.
The cost of silver alloy coated catheters exceeds
the cost of standard catheters. However, the
amount of the cost of treatment exceeds the
amount it would cost to use a silver alloy coated
catheter.

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