Prävention katheterassoziierter Harnwegsinfektionen: ein Update

Katheterassoziierte Harnwegsinfektionen gehören zu den häufigsten nosokomialen Infektionen. Ihnen liegen unbeeinflussbare, aber auch eine Reihe beeinflussbarer Risikofaktoren zugrunde – allen voran die ungenügende Beachtung von Hygieneregeln bei der Katheteranlage und -pflege sowie eine nicht stattfindende tägliche Überprüfung der Indikation. Dieser Beitrag beschreibt die leitliniengerechten Präventionsmaßnahmen und Implementierungsstrategien.

Schlüsselwörter

katheterassoziierte Harnwegsinfektionen - Urindauerkatheter - Indikationen - Präventionsmaßnahmen - Urinkatheterpflege

• Literatur

• 1 Behnke M, Aghdassi SJ, Hansen S. et al. The prevalence of nosocomial infection and antibiotic use in German hospitals. Dtsch Arztebl Int 2017; 114: 851-857
• 2 Robert Koch-Institut. Deutsche Daten im Rahmen der ersten europäischen Prävalenzerhebung zum Vorkommen nosokomialer Infektionen und zur Antibiotikaanwendung. Epidemiol Bull 2012; 26: 239-245
• 3 Rüden H, Gastmeier P, Daschner FD. et al. Nosocomial and community-acquired infections in Germany. Summary of the results of the First National Prevalence Study (NIDEP). Infection 1997; 25: 199-202
• 4 Magill SS, OʼLeary E, Janelle SJ. et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med 2018; 379: 1732-1744
• 5 European Centre for Disease Prevention and Control. Healthcare-associated Infections acquired in intensive Care Units. In: ECDC. Annual epidemiological Report for 2016. Stockholm: ECDC; 2018
• 6 Klingenberg A, Noll I, Willrich N. et al. Antibiotikaresistenz von E. coli bei ambulant erworbener unkomplizierter Harnwegsinfektion. Dtsch Arztebl Int 2018; 115: 494-500
• 7 Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Prävention und Kontrolle Katheter-assoziierter Harnwegsinfektionen. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2015; 58: 641-650 doi:10.1007/s00103-015-2152-3
• 8 Lo E, Nicolle LE, Coffin SE. et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 Update. Infection Control Hospital Epidemiol 2014; 5: 464-479
• 9 Schulz-Stübner S. Katheter-assoziierte Harnwegsinfektionen: Prävention in Theorie und Praxis. Krankenhaushygiene up2date 2015; 10: 197-209
• 10 Cooper FP, Alexander CE, Sinha S. et al. Policies for replacing long-term indwelling urinary catheters in adults. Cochrane Database Syst Rev 2016; (07) CD011115
• 11 Chant C, Smith DM, Marshall JC. et al. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med 2011; 39: 1167-1173
• 12 Leticia-Kriegel AS, Salmasian H, Vawdrey DK. Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open 2019; 9: e022137 doi:10.1136/bmjopen-2018-022137
• 13 Smith DR, Pouwels KB, Hopkins S. et al. Epidemiology and health-economic burden of urinary catheter-associated infection in English NHS hospitals: a probabilistic modelling study. J Hosp Infect 2019;
• 14 Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am J Control 2007; 35: 589-593
• 15 Gokula RM, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a mid-western community teaching hospital. Am J Infect Control 2004; 32: 196-199
• 16 Jerkemann M, Braconier JH. Bacteremic and non-bacteremic febrile urinary tract infection–a review of 168 hospital-treated patients. Infection 1992; 20: 143-145
• 17 Saint S, Wiese J, Amory JK. et al. Are physicians aware of which of their patients have indwelling urinary catheters?. Am J Med 2000; 109: 476-480
• 18 Meddings J, Rogers MAM, Macy M. et al. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalizes patients. Clin Infect Dis 2010; 51: 550-560
• 19 Fakih MG, Gould CV, Trautner BW. et al. Beyond infection: device utilization ratio as a performance measure for urinary catheter harm. Infect Control Hosp Epidemiol 2016; 37: 327-333
• 20 Zaouter C, Wuethrich P, Miccoli M. et al. Early removal of urinary catheter leads to greater post-void residuals in patients with thoracic epidural. Acta Anaesthesiol Scand 2012; 56: 1020-1025
• 21 Daurat A, Choquet O, Bringuier S. et al. Diagnosis of postoperative urinary retention using a simplified ultrasound bladder measurement. Anesth Analg 2015; 120: 1033-1038
• 22 Centofanti JE, Duan EH, Hoad NC. et al. Use of daily goal checklist for morning ICU rounds: A mixed-methods study. Crit Care Med 2014; 42: 1797-1803
• 23 Menegueti MG, Ciol MA, Bellissimo-Rodrigues F. et al. Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine (Baltimore) 2019; 98: e14417
• 24 Stav K, Ohlgisser R, Siegel YI. et al. Pain during female urethral catheterization: intra-urethral lubricant injection versus catheter tip lubrication – a prospective randomized trial. J Urol 2015; 194: 1018-1021 doi:10.1016/j.juro.2015.03.097
• 25 Fasugba O, Koerner J, Mitchell BG. et al. Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. J Hosp Infect 2017; 95: 233-242
• 26 Lam TB, Omar MI, Fisher E. et al. Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2014; (09) CD004013
• 27 Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Empfehlungen zur Prävention und Kontrolle Katheter-assoziierter Harnwegsinfektionen. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 1999; 42: 806-809
• 28 Von Rundstedt FC, Roth S, Degener S. et al. Bundesweite Umfrage zur Katheterversorgung in Deutschland. Urologe 2015; 54: 542-547
• 29 Zingg W, Holmes A, Dettenkofer M. et al. for the systematic review and evidence-based guidance on organization of hospital infection control programmes (SIGHT) study group. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis 2015; 15: 212-224 doi:10.1016/S1473-3099(14)70854-0
• 30 Naik AD, Skelton F, Amspoker AB. et al. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria. PLoS One 2017; 12: e0174415 doi:10.1371/journal.pone.0174415
• 31 Jones LF, Meyrick J, Barth J. et al. Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review. J Hosp Infect 2019; 102: 200-218