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Introduction and Objective: Catheter-associated urinary tract infections are a major cause of patient morbidity and mortality. Despite many attempts to design biomaterials that might reduce the risk, none has had a profound impact on reducing the incidence of this most common nosocomial infection. Recent in vitro work, however, has shown promise for a silver-based biomaterial coating composed of methoxylated polyethylene glycol 3,4-dihydroxyphenylalanine (mPEG-DOPA3) in reducing uropathogen attachment and biofilm formation. The aim of this work was to investigate whether these results translate into a meaningful impact on infection development and bacterial adherence in an in vivo rabbit model. Materials and Methods: New Zealand white rabbits were randomized into groups of 12 and had the following catheters inserted: Group 1—uncoated polyurethane, Group 2—Coating A (mPEG-DOPA3 + 2 mg/mL AgNO3), and Group 3—Coating B (mPEG-DOPA3 + 10 mg/mL AgNO3). Each rabbit was challenged with 108 colony-forming units of Escherichia coli GR-12 instilled directly into the bladder at the time of catheter insertion and urine was monitored over 7 days for bacterial counts. Catheters were retrieved and evaluated for encrustation and attachment analysis, and tissues collected for histopathologic characterization and bacterial invasion. Results: Urinary bacterial colony counts were lower among rabbits in the Coating A group vs controls (4/11 vs 10/12, respectively) (p = 0.029), and there were fewer rabbits with invasive infections (3/12 vs 9/12, p = 0.02). More encrustation was observed among animals in the Coating B group vs controls (7.22 vs 2.69 mg/cm2, p = 0.033). There were no significant differences in tissue effects between groups. Conclusions: The use of a mPEG-DOPA3 urinary catheter coating effectively reduced urinary pathogen counts, while not causing adverse tissue effects in this model. Further clinical evaluation is warranted. [ABSTRACT FROM AUTHOR]

This retrospective study describes inpatient healthcare‐associated bloodstream infections (HABSI) in older adults and explores whether urinary catheters (presence/insertion/removal) were related to HABSI events. One hundred and sixty‐seven HABSI events were identified, predominantly (124, 74%) with Gram‐negative bacteria. HABSI was attributed to a urinary source in 110 patients (66%), with over half (63, 57%) of these associated with urinary catheters. Catheter‐associated HABSI may be avoidable and potential preventative strategies are discussed. [ABSTRACT FROM AUTHOR]

Background: Evidence for the benefits of antiseptic meatal cleaning in reducing catheter-associated urinary tract infection (UTI) is inconclusive. We assessed the efficacy of 0·1% chlorhexidine solution compared with normal saline for meatal cleaning before urinary catheter insertion in reducing the incidence of catheter-associated asymptomatic bacteriuria and UTI.Methods: A cross-sectional, stepped-wedge, open-label, randomised controlled trial was undertaken in Australian hospitals. Eligible hospitals were Australian public and private hospitals, with an intensive care unit and more than 30 000 hospital admissions per year. Hospitals were randomly assigned to an intervention crossover date using a computer-generated randomisation system. Crossover dates occurred every 8 weeks; during the first 8 weeks of the study, no hospitals were exposed to the intervention (control phase), after which each hospital sequentially crossed over from the control to the intervention every 8 weeks. Patients requiring a urinary cathetwer were potentially eligible for inclusion in this hospital-wide study. Participants were excluded if they were younger than 2 years, had a medical reason preventing the use of the chlorhexidine, had the catheter inserted in theatre, did not have the catheter insertion date documented, required in-and-out or suprapubic catheterisation, had symptoms and signs suggestive of UTI at the time of catheter insertion, or were currently undergoing treatment for UTI. The intervention was the use of 0·1% chlorhexidine solution for meatal cleaning before urinary catheterisation with 0·9% normal saline used in the control phase. Masking of hospitals was not possible because it was not feasible to mask staff administering the intervention. The co-primary outcomes were the number of cases of catheter-associated asymptomatic bacteriuria and UTI per 100 catheter-days and were assessed within 7 days of catheter insertion in the intention-to-treat population. This trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12617000373370.Findings: 21 hospitals were assessed for eligibility between Jan 5, 2017, and May 1, 2017; of these, three were successfully enrolled and randomised to one of three intervention crossover dates. 1642 participants in these hospitals were included in the study between Aug 1, 2017, and March 12, 2018, 697 (42%) in the control phase and 945 (58%) in the intervention period. In the control period, 13 catheter-associated UTI and 29 catheter-associated asymptomatic bacteriuria events in 2889 catheter-days (0·45 catheter-associated UTI cases and 1·00 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) were recorded compared with four catheter-associated UTI and 16 catheter-associated asymptomatic bacteriuria events in 2338 catheter-days (0·17 catheter-associated UTI cases and 0·68 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) during the intervention period. The intervention was associated with a 74% reduction in the incidence of catheter-associated asymptomatic bacteriuria (incident rate ratio 0·26, 95% CI 0·08-0·86, p=0·026), and a 94% decrease in the incidence of catheter-associated UTI (0·06, 95% CI 0·01-0·32, p=0·00080). There were no reported adverse events.Interpretation: The use of chlorhexidine solution for meatal cleaning before catheter insertion decreased the incidence of catheter-associated asymptomatic bacteriuria and UTI and has the potential to improve patient safety.Funding: HCF Research Foundation. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the impact of a catheter-associated urinary tract infection (CAUTI) education package on nurses' knowledge of indwelling catheter management. CAUTI is the most common health-care associated infection worldwide. Prolonged catheter use is the major CAUTI risk factor (Mohajer & Darouiche, 2013). Nurses deliver a huge part of daily catheter cares. Nurse- focused education plays a signiicant role in preventing CAUTI (Gould et al, 2009). A multi-phased mixed-method approach, with convenience sampling and using focus groups (n = 13) and pre-test and post-test (n = 14), was conducted at two post-operative wards of a tertiary public hospital. Data were collected from March to June 2014 and had three phases. An evidence-based education package with multi-faceted teaching methods was implemented to address knowledge or care deficits. A paired t-test indicated a significant difference (p < .0001) in the nurses' overall score between the pre- and post-test. There was also a significant difference (p < .05) in nurses' pre- and post-test scores on the four catheter care components. The CAUTI education package had a significant impact on nurses' knowledge gaps. Effective CAUTI prevention needs to address all catheter care components through continuous education, using multi-faceted strategies, of everyone involved in catheter care. [ABSTRACT FROM AUTHOR]