Results of a national survey of infection control experts highlight the shortcomings of the widely used Foley urinary catheter. The new findings may help explain why catheter-associated urinary tract infections (CAUTIs) have become the nation's largest single source of dangerous hospital-acquired infections and remain the most problematic nosocomial infections.
Among results of the survey:
• The great majority (83 percent) said trauma to the bladder wall/lining could increase the risk of CAUTIs.
• A similar number (79 percen) agreed that a Foley catheter -- the current standard of care -- can cause trauma to the wall/lining of the bladder.
• A majority said their hospital's nurses were not adequately complying with recommended protocols to reduce CAUTIs.
• Two-thirds of the infection-control experts said their hospital administration is putting "strong emphasis on CAUTI reduction."
The survey was sent to approximately 860 clinicians across the U.S. and netted 161 complete responses. More than three-quarters of respondents were infection preventionists working in acute-care hospitals, where Foley catheters are widely used.
"This survey demonstrates that in the eyes of the people most responsible for preventing CAUTIs, the status quo is not acceptable," says Kathleen M. Vollman, MSN, RN, CCNS, FCCM, FAAN, a nationally recognized clinical nurse specialist and educator. "When the Foley catheter itself is causing bladder trauma, not even perfect compliance with all preventive protocols can prevent CAUTIs."
The survey results are important because of the profound impact CAUTIs have on the U.S. healthcare system. CAUTIs are considered a preventable condition, yet the CDC estimates that every year more than 560,000 cases of a CAUTI occur in the U.S. alone. The infections lead to an attributable 13,000 deaths.
These infections cost U.S. hospitals between $400 million and $500 million annually according to the CDC. Other reputable estimates put the cost much higher. Under newly implemented provisions of the Affordable Care Act, some hospitals have also already had their Medicare reimbursements cut because their patients suffer high CAUTI rates. These penalties can escalate yearly.
CAUTIs are the focus of a national campaign, founded by an affiliate of the American Hospital Association and other prominent healthcare organizations, called On the CUSP. The campaign focuses on reducing urinary catheter use and removing catheters as soon as possible. Yet in the five years of this national campaign, CAUTI rates have actually increased according to the CDC. The data suggest that simply revising existing protocols does not reduce CAUTI rates.
Human-factors engineering, which uses better technology to supplement healthcare protocols, has often proven to be a better approach than relying on protocols alone.The survey results are consistent with the belief of many infection control experts that Foley catheter design flaws can lead to CAUTIs -- even when the catheter is used as directed.
"For real change to occur, the design of the urinary catheter has to change," says urologist Bruce Wiita, MD, founder and chairman of Poiesis Medical. "Changing protocols but using the same poor Foley design is akin to carrying water in a pail with holes in the bottom."
Recent studies show that design flaws in the Foley catheter can cause the destruction of the bladder's innate immune response to bacteria. The tip of the Foley can come directly into contact with sensitive bladder mucosal tissue. This tissue barrier is the first line of defense against bacteria colonization of the bladder wall. Also, the open eyes of the Foley catheter can aspirate tissue into the drainage system, blocking the removal of fluid that would otherwise carry bacteria out of the body.
"As a result of the problematic design of the Foley catheter, CAUTIs are one obvious threat. Another is septicemia, which has a 10 percent mortality rate in CAUTI patients," says Wiita.
In addition to CAUTIs and septicemia, clinically confirmed complications associated with the Foley catheter include bladder spasms, hematuria, blockage, leakage, and, in some chronic users, even cancer.
The survey was conducted by Dowling & Dennis Public Relations in June 2015, with support from Poiesis Medical, maker of the Duette™ urinary drainage system. The new Duette system is designed to replace the Foley catheter, which has not been fundamentally modified since it was introduced more than 75 years ago. The Duette system has a novel dual-balloon configuration that is designed to protect the mucosal lining and integrity of the bladder wall from trauma.
Source: Poiesis Medical