Prevention of Nosocomial Urinary Tract Infection in ICU Patients

Study objectives To determine whether the rate ofacquisition of bacteriuria differs between the use of a complex closeddrainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and atwo-chamber open drainage system (TCOS) in ICU patients. Design Prospective, nonrandomized, controlled trial. Setting Medical/surgical/trauma ICU in a universityhospital. Patients Two hundred twenty-four ICUpatients requiring an indwelling urinary catheter. Intervention We compared the rate of acquisition ofbacteriuria in two groups of consecutive patients (n = 113 andn = 111, respectively) who underwent bladder catheterization with a TCOS during the first 6 months and with a CCDS during the next 6months. Urinary catheters were managed by a team of trained nursesfollowing the same written protocol. No prophylactic antibiotics wereadministered, either during management of catheter placements orcatheter withdrawal, but 75% of patients received one or moreantimicrobial medications for treatment of infected sites other thanthe urinary tract. Urine samples were obtained weekly for the durationof catheterization and within 24 h after catheter removal, andeach time symptoms of urinary infection were suspected. Only patientswho required an indwelling catheter for > 48 h were evaluated. Measurements and results There was no statisticaldifference in the rate of bacteriuria between the two groups. Bacteriuria occurred in 11.5% and 13.5% of patients, and wasdiagnosed on day 14 ± 8 and 13 ± 9 of catheterization(mean ± SD) for the TCOS and the CCDS, respectively. A CCDS cost $3(US dollars) more than the TCOS. Conclusions To ourknowledge, this is the first study to compare the effectiveness of a TCOS and a CCDS in ICU patients. No differences were noted between thetwo systems (α = 0.05). The higher cost of a CCDS is not justifiedfor ICU patients.