Urinary tract infections (UTI) are the most common infections acquired in hospitals and longterm care facilities (LTCF). A number of risk factors have been independently associated with HAI and it is now well established that the major predisposing factor for healthcare associated UTI is the presence of an indwelling urethral catheter. The use of catheters is common in LTFC and many patients are catheterised for long periods, thus increasing their risk of acquiring a catheter associated urinary tract infection (CAUTI).
Following a review of the current methodology for CAUTI surveillance in Scotland it was highlighted that the existing definitions and methodologies were not applicable for the care of the elderly patient population. A protocol was developed by Health Protection Scotland (HPS) incorporating infection definitions based on clinical signs and symptoms rather than microbiology criteria. These definitions are recommended for use in LTFC by the European Centre for Disease Prevention and Control (ECDC) as they hope to reduce the over estimation of UTI by excluding asymptomatic bacteriuria. A pilot study of the protocol was carried out in volunteer care of the elderly facilities in hospital settings across Scotland.
During the pilot study period, a total of 659 patients were admitted to the care of the elderly facilities participating in CAUTI surveillance in the six pilot hospitals and a total of 122 catheters were inserted. During the study period a total of 19 UTIs were identified of which 15 met the criteria for CAUTI.
The CAUTI surveillance protocol and data definitions appeared to be robust. The study was therefore able to provide valuable data regarding catheter use and CAUTI incidence rates.
The surveillance protocol and collection tool is easily adapted for use in care home settings providing a valuable surveillance tool for these resident populations.