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Krankenhaushygiene up2date 2013; 08(01): 25-38
DOI: 10.1055/s-0032-1326392
Nosokomiale Infektionen
© Georg Thieme Verlag KG Stuttgart · New York

Die katheterassoziierte Harnwegsinfektion – was gibt es Neues?

Karl Lewalter
,
Helga Haefner
,
Sebastian Lemmen
,
Simone Scheithauer
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Publication History

Publication Date:
27 March 2013 (online)

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Kernaussagen

  • Die nosokomiale Harnwegsinfektion gehört zu den häufigsten nosokomialen Infektionen. Sie ist zu 80 % katheterassoziiert.

  • Hauptrisikofaktor ist der Harnwegskatheter und der damit verbundene Eintrag von Mikroorganismen in die Harnblase.

  • Zur Vermeidung von katheterassoziierten Harnwegsinfektionen stehen zahlreiche Interventionsmöglichkeiten zur Verfügung.

  • Insbesondere die Einführung einiger ausgewählter, evidenzbasierter Maßnahmen als Bundle hat sich in der klinischen Praxis bewährt.

  • Unbedingt durchgeführt werden sollten: strenge Indikationsstellung, tägliche Evaluation der Indikation, aseptische Katheteranlage, Standardhygienemaßnahmen (v. a. Händedesinfektion), aktive Surveillance der katheterassoziierten Harnwegsinfektionsrate und Schulungen des Personals.

  • Antimikrobiell beschichtete Katheter sollten nur bei persistierend hohen Infektionsraten und Ausschöpfung aller anderen infektionspräventiven Maßnahmen zum Einsatz kommen.

  • Nicht durchgeführt werden sollten: routinemäßiger Katheterwechsel und Spülungen der Harnblase mit Antiseptika/Antibiotika.

  • Der Erfolg der Implementierung von infektionspräventiven Maßnahmen sollte durch Teilnahme an Surveillanceprogrammen, wie z. B. KISS, evaluiert werden.

 

  • Literatur

  • 1 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
    CrossrefSearch in Google Scholar
  • 2 Robert-Koch-Institut RKI. Deutsche Daten im Rahmen der ersten europäischen Prävalenzerhebung zum Vorkommen nosokomialer Infektionen und zur Antibiotikaanwendung. Epid Bull 2012; 26: 239-240
    Search in Google Scholar
  • 3 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 Infect Control 2007; 35: 589-593
    CrossrefSearch in Google Scholar
  • 4 Nicolle LE. Urinary catheter-associated infections. Infect Clin Dis N Am 2012; 26: 13-27
    Search in Google Scholar
  • 5 Vonberg RP, Behnke M, Rüden H et al. Kosten durch Harnwegsinfektionen in Deutschland. Urologe 2008; 47: 54-58
    CrossrefSearch in Google Scholar
  • 6 Saint S, Olmsted RN, Fakih MG et al. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf 2009; 35: 449-455
    Search in Google Scholar
  • 7 Hooton TM, Bradley SF, Cardenas DD et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010; 50: 625-653
    CrossrefSearch in Google Scholar
  • 8 Gould CV, Umscheid CA, Agarwal RK et al. Guideline for the prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31: 319-326
    CrossrefPubMedSearch in Google Scholar
  • 9 Hameed A, Chinegwundoh F, Thwaini A. Prevention of catheter-related urinary tract infections. Br J Hosp Med 2010; 71: 148-152
    Search in Google Scholar
  • 10 Cornish J, Lecanwasam JP, Harrison G et al. Host defence mechanisms of the bladder. Br J Exp Path 1988; 69: 759-770
    Search in Google Scholar
  • 11 Jerkeman M, Braconier JH. Bacteremic and non-bacteremic febrile urinary tract infection: a review of 168 hospital-treated patients. Infection 1992; 20: 143-145
    CrossrefSearch in Google Scholar
  • 12 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
    CrossrefSearch in Google Scholar
  • 13 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
    CrossrefSearch in Google Scholar
  • 14 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 hospitalized patients. Clin Infect Dis 2010; 51: 550-560
    CrossrefSearch in Google Scholar
  • 15 Tambyah PA, Oon J. Catheter-associated urinary tract infection. Curr Opin Infect Dis 2012; 25: 365-370
    CrossrefSearch in Google Scholar
  • 16 Saint S, Kaufman SR, Rogers MA et al. Condom versus indwelling urinary catheters: a randomized trial. J Am Geriatr Soc 2006; 54: 1055-1061
    CrossrefSearch in Google Scholar
  • 17 Hakvoort RA, Thijs SD, Bouwmeester FW et al. Comparing clean intermittent catheterization and transurethral indwelling catheterization for incomplete voiding after vaginal prolapse surgery. Br J Obstet Gynaecol 2011; 118: 1055-1060
    Search in Google Scholar
  • 18 Sethia KK, Selkon JB, Berry AR et al. Prospective randomized controlled trial of urethral versus suprapubic catheterization. Br J Surg 1987; 74: 624-625
    CrossrefSearch in Google Scholar
  • 19 Stekkinger E, van der Linden PJQ. A comparison of suprapubic and transurethral catheterization on postoperative urinary retention after vaginal prolapse repair: a randomized controlled trial. Gynecol Obstet Invest 2011; 72: 109-116
    CrossrefSearch in Google Scholar
  • 20 McPhail MJW, Abu-Hilal M, Johnson CD. A meta-analysis comparing suprapubic and transurethral catheterization for bladder drainage after abdominal surgery. Br J Surg 2006; 93: 1038-1044
    CrossrefSearch in Google Scholar
  • 21 Piechota H, Brühl P, Hertle L et al. Katheterdrainage der Harnblase heute. Dtsch Ärztebl 1997; 4: 168-174
    Search in Google Scholar
  • 22 World Health Organization (WHO). WHO Guidelines for Hand Hygiene in Health Care. Geneva: WHO; 2009
    Search in Google Scholar
  • 23 Jaggi M, Pushpa S. Multimodal supervision programme to reduce catheter associated urinary tract infections and its analysis to enable focus on labour and cost effective infection control measures in a tertiary care hospital in India. J Clin Diagn Res 2012; 6: 1372-1376
    Search in Google Scholar
  • 24 Gastmeier P, Behnke M, Schwab F et al. Benchmarking of urinary tract infection rates: experiences from the intensive care unit component of the German national nosocomial infections surveillance system. J Hosp Infect 2011; 78: 41-44
    CrossrefSearch in Google Scholar
  • 25 Mariglano A, Barbadoro P, Pennacchietti L et al. Active training and surveillance: 2 good friends to reduce urinary catheterization rate. Am J Infect Contr 2012; 40: 692-695
    CrossrefSearch in Google Scholar
  • 26 Schneevoigt BS, Stief C. Blasenkatheterisierung. Dtsch Med Wochenschr 2011; 136: 145-147
    Thieme ConnectSearch in Google Scholar
  • 27 Kommission für Krankenhaushygiene und Infektionsprävention am Robert-Koch-Institut. Empfehlungen zur Prävention und Kontrolle katheterassoziierter Harnwegsinfektionen. Bundesgesundheitsblatt 1999; 42: 806-809
    Search in Google Scholar
  • 28 Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents 2001; 17: 299-303
    CrossrefSearch in Google Scholar
  • 29 Kunin CM, McCormack RC. Prevention of catheter-induced urinary tract infections by sterile closed drainage. N Engl J Med 1966; 274: 1155-1161
    CrossrefSearch in Google Scholar
  • 30 Davies AJ, Desai HN, Turton S et al. Does instillation of chlorhexidine into the bladder of catheterized geriatric patients help reduce bacteriuria?. J Hosp Infect 1987; 9: 72-75
    CrossrefSearch in Google Scholar
  • 31 Thompson RL, Haley CE, Searcy MA et al. Catheter-associated bacteriuria: failure to reduce attack rates using periodic instillations of a disinfectant into urinary drainage systems. J Am Med Assoc 1984; 251: 747-751
    CrossrefSearch in Google Scholar
  • 32 Siddiq DM, Darouiche RO. New strategies to prevent catheter-associated urinary tract infections. Nat Rev Urol 2012; 9: 305-314
    CrossrefSearch in Google Scholar
  • 33 Schumm K, Lam TB. Types of urethral catheters for management of short-term voiding problems in hospitalized adults. Cochrane Database Syst Rev 2008; CD004013
    Search in Google Scholar
  • 34 Srinivasan A, Karchmer T, Richards A et al. A prospective trial of a novel, silicone-based, silver-coated foley catheter for the prevention of nosocomial urinary tract infections. Infect Control Hosp Epidemiol 2006; 27: 38-43
    CrossrefSearch in Google Scholar
  • 35 Pickard R, Lam T, MacLennan G et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterization in hospital: a multicentre randomized controlled trial. Lancet 2012; 380: 1927-1935
    CrossrefSearch in Google Scholar
  • 36 Mathers MJ, von Rundstedt F, Brandt AS et al. Mythos oder Wahrheit? Cranberry-Saft in der Prophylaxe und Behandlung von rezidivierenden Harnwegsinfekten. Urologe 2009; 48: 1203-1209
    CrossrefSearch in Google Scholar
  • 37 Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2012; CD001321
    Search in Google Scholar
  • 38 Schulze-Röbbecke R. Bündel zur Prävention nosokomialer Infektionen. Krankenh hyg up2date 2011; 6: 9-23
    Thieme ConnectSearch in Google Scholar
  • 39 Marra AR, Camargo TZS, Goncalves P et al. Preventing catheter-associated urinary tract infection in the zero-tolerance era. Am J Infect Control 2011; 39: 817-822
    CrossrefSearch in Google Scholar
  • 40 Hull RA. Virulence properties of Escherichia coli 83972, a prototype strain associated with asymptomatic bacteriuria. Infect Immun 1999; 67: 429-432
    Search in Google Scholar