Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-15T02:00:19.545Z Has data issue: false hasContentIssue false
  • English
  • Français

Bladder Management and Urinary Tract Infections in Danish Hospitals, Nursing Homes, and Home Care: A National Prevalence Study

Published online by Cambridge University Press:  02 January 2015

Jette Zimakoff ,
David J. Stickler ,
Birgitte Pontoppidan  and
Severin O. Larsen
Jette Zimakoff
Affiliation:
National Centre for Hospital Hygiene, Copenhagen S, Denmark
David J. Stickler*
Affiliation:
School of Pure and Applied Biology, University of Wales College of Cardiff, Cardiff, Wales, United Kingdom
Birgitte Pontoppidan
Affiliation:
National Centre for Hospital Hygiene, Copenhagen S, Denmark
Severin O. Larsen
Affiliation:
Biostatistical Department, Statens Seruminstitut, Copenhagen S, Denmark
*
National Centre for Hospital Hygiene, Statens Seruminstitut, Artillerivej 5, DK 2300, Copenhagen S, Denmark
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To establish the prevalence of urinary tract infection in patients undergoing various forms of bladder management.

Design:

A nationwide descriptive point-prevalence survey with logistic regression analysis of the data relating infection to bladder management.

Setting:

Fifteen hospitals, 21 nursing homes, and 13 home care districts throughout Denmark.

Patients:

Information was collected on 3,665 patients. On the day of the study, 349 patients had indwelling catheters and 1,150 were using external urine drainage systems (condoms or diapers) for bladder management.

Results:

The prevalence of urinary tract infections in catheterized patients and those using external drainage systems was 13.2% and 8.1%, respectively. The prevalence of hospital-acquired urinary tract infection (4.2%) had not changed from that reported in 1978. The proportion of these infections related to the indwelling catheter, however, had reduced from 66% to 30%. Logistic regression analysis confirmed that, when corrected for the patient-related confounders (female gender, age >60 years, incontinence, immobility, and stay in hospital for longer than 15 days), condoms (odds ratio [OR], 5.94; 95% confidence interval [CI95], 2.8 to 12.5), indwelling catheters (OR, 3.3; CI95, 2.3 to 4.8), and diapers (OR, 1.5; CI95, 1.1 to 2.1) were significantly (P<.001, P<.001, and P=.008, respectively) related to infection.

Conclusions:

Prevalence surveys have revealed that over the period 1978 to 1991, during which efforts have been made to restrict the use of indwelling catheters and to encourage the care of catheterized patients according to guidelines recommended by the Danish National Centre for Hospital Hygiene, the percentage of hospital-acquired urinary tract infections associated with indwelling catheters has been halved. External urine drainage systems, however, have emerged as significant risk factors for urinary tract infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 4 , April 1996 , pp. 215 - 221
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Slade, N, Gillespie, WA. The Urinary Tract and the Catheter Infection and Other Problems. Chichester, England: John Wiley & Sons; 1985.Google Scholar
2. Stamm, WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 1991;91;(suppl 3B):65S–71S.CrossRefGoogle Scholar
3. Warren, JW. The catheter and urinary tract infection. Med Clin North Am 1991;75:481–493.CrossRefGoogle ScholarPubMed
4. Ouslander, JG, Greengold, B, Chen, S. Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study. J Urol 1987;138:1191–1195.CrossRefGoogle ScholarPubMed
5. Warren, JW, Damron, D, Tenney, JH, Hoopes, JM, Deforge, B, Muncie, HL. Fever, bacteremia and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis 1987;155:1151–1158.CrossRefGoogle ScholarPubMed
6. Warren, JW, Muncie, HL, Hall-Craggs, M. Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study. J Infect Dis 1988;158:1341–1346.CrossRefGoogle ScholarPubMed
7. Locke, JR, Hill, DE, Walzer, Y. Incidence of squamous cell carcinoma in patients with long-term catheter drainage. J Urol 1985;133:1034–1035.CrossRefGoogle ScholarPubMed
8. Platt, R, Polk, BF, Murdock, B, Rosner, B. Mortality associated with nosocomial urinary tract infection. N Engl J Med 1982;307:637–642.CrossRefGoogle ScholarPubMed
9. Kunin, CM, Douthitt, S, Dancing, J, Anderson, J, Moeschberger, M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 1992;135:291–301.Google ScholarPubMed
10. Jepsen, OB, Mortensen, N. Prevalence of nosocomial infection and infection control in Denmark. J Hosp Infect 1980;1:237–244.CrossRefGoogle ScholarPubMed
11. Jepsen, OB, Larsen, SO, Dankert, J, et al. Urinary tract infection and bacteremia in hospitalized medical patients—a European multicenter prevalence survey on nosocomial infection. J Hosp Infect 1982;3:241–252.CrossRefGoogle Scholar
12. Warren, JW. Urine-collection devices for use in adults with urinary incontinence. J Am Geriatr Soc 1990;38:363–367.CrossRefGoogle ScholarPubMed
13. Zimakoff, J, Pontoppidan, B, Larsen, SO, et al. Management of urinary bladder function in Danish hospitals, nursing homes, and home care. J Hosp Infect 1993;24:183–199.CrossRefGoogle ScholarPubMed
14. Katz, S, Downs, TD, Cash, HR, Grotz, RC. Progress in development of the index of ADL. Gerontologist 1970;10:20–30.CrossRefGoogle ScholarPubMed
15. The International Continence Society Committee on Standardization of Terminology. Scand J Urol Nephrol 1988;(suppl)114:5–19.Google Scholar
16. Centers for Disease Control. Outline for Surveillance and Control of Nosocomial Infections. App.II. Atlanta, GA: US Department of Health, Education and Welfare; 1972.Google Scholar
17. Garner, JS, Jarvis, WR, Emori, T, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
18. Cox, DR, Snell, EJ. Analysis of Binary Data. 2nd ed. London, England: Chapman and Hall; 1989.Google Scholar
19. Magaziner, J, Tenney, JH, Deforge, B, et al. Prevalence and characteristics of nursing home-acquired infections in the aged. J Am Geriatr Soc 1991;39:1071–1078.CrossRefGoogle ScholarPubMed
20. Warren, JW, Steinberg, L, Hebel, JH, et al. The prevalence of urethral catheterization in Maryland nursing homes. Arch Intern Med 1989;149:1535–1537.CrossRefGoogle ScholarPubMed
21. Lewis, SM. The effect of surveillance definitions on nosocomial urinary tract infection rates in a rehabilitation hospital. Infect Control Hosp Epidemiol 1995;16:43–48.CrossRefGoogle Scholar
22. Warren, JW, Palumbo, FB, Fitterman, L, et al. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.CrossRefGoogle ScholarPubMed
23. Zimakoff, J, Pontoppidan, B, Larsen, SO, et al. Quality Assessments of Efforts to Prevent Nosocomial Urinary Tract Infections in Denmark, 1980-1990. Report to the National Board of Health. Statens Serumistitut, Copenhagen, Denmark, 1992:1–59.Google Scholar
24. Hebel, JR, Warren, JW. The use of urethral, condom, and suprapubic catheters in aged nursing home patients. J Am Geriatr Soc 1990;38:777–784.CrossRefGoogle ScholarPubMed
25. Fierer, J, Ekstrom, M. An outbreak of Providencia stuartii urinary tract infections. JAMA 1981;245:1553–1555.CrossRefGoogle ScholarPubMed
26. Hirsh, DD, Fanstein, V, Musher, DM. Do condom catheter collecting systems cause urinary tract infection? JAMA 1979;242:340–341.CrossRefGoogle ScholarPubMed
27. Ouslander, JG, Greengold, B, Chen, S. External catheter use and urinary tract infections among incontinent male nursing home patients. J Am Geriatr Soc 1987;35:1063–1070.CrossRefGoogle ScholarPubMed
28. Brandberg, Å, Seeberg, S, Bergström, G, et al. Reducing the number of nosocomial gram-negative strains by using high absorbing pads as an alternative to indwelling catheters in longterm care—a preliminary study. J Hosp Infect 1980;1:245–250.CrossRefGoogle ScholarPubMed
29. Seeberg, S, Brandberg, Å, Bergström, G, et al. The effect on bacteriuria of removal of indwelling catheters and treatment with co-trimoxazole. J Hosp Infect 1982;3:159–164.CrossRefGoogle ScholarPubMed
30. Nordqvist, P, Ekelund, P, Edouard, L, et al. Catheter-free geriatric care. Routines and consequences for clinical infection, care and economy. J Hosp Infect 1984;5:298–304.CrossRefGoogle ScholarPubMed