Abstract
Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, arising from biofilm-forming bacteria and cause increased morbidity, mortality, length of stay and hospital costs.
The linear model of the microbial theory of disease has failed to solve CAUTI. It was hoped that, knowing the nosological diagnosis (urinary tract infection), the cause (bacteria) and its treatment (antibiotic), the cure would be simple.
However, the prevention and treatment of CAUTI imposes challenges, which can only be addressed, if it is understood that CAUTI is a complex entity where different actors and multiple factors interact, in various settings.
The objective of this article is to review the intervention of different actors and elements in the prevention of CAUTI, focusing on the assessment of the complexity of preventing CAUTI and bacterial biofilm.
The unnecessary use of indwelling urethral catheter is the primary risk factor for CAUTI, so the use of the catheter with appropriate indications, its proper insertion and maintenance, and its rapid removal are recommended.
In selected patients, alternatives to indwelling urethral catheterization, such as the male external catheter and the prostatic stent, may be considered, although they are not without complications.
The health care setting should be considered in the design of prevention strategies. CAUTIs in intensive care units are associated with increased lengths of stay, healthcare costs and antibiotic resistance development.
In the twenty-first century, the proportion of older people tends to increase globally, which adds value to the fact that elder age is a significant risk factor for CAUTI.
Biofilm is the central factor in the pathogenesis of CAUTI. Various antibiofilm strategies have been designed because once biofilms are formed, they are difficult to treat. Biomedical technology continuously introduces new antifouling and antibacterial materials for urethral catheter coating. The efficiency of the different coatings is proven in vitro, in animal models, and clinical trials. However, its application in clinical settings has not been satisfactory.
Education should include both patients and their families and/or caregivers as well as health personnel. Patient and family participation is necessary in the patient’s care. It is important to consider the values, attitudes, and beliefs of health personnel, which will impact clinical practice.
The overload of work of health personnel and inadequate and/or insufficient infrastructure are added as barriers to adherence to prevention recommendations.
Therefore, it is necessary to address and optimize the complexity of CAUTI care, through a multimodal and multidisciplinary intervention, which minimizes its incidence and complication.