...Evaluation & Management of Urinary Tract Infections UTI - Topics Ø Epidemiology Ø Definition/ Classification Ø Diagnosis Ø Pathogenesis/ l Risk Factors GU “Zones”: Perineal, Bladder, Ureteral, Renal Ø Radiological Evaluation/ Management 2 UTI Epidemiology Ø Only during 1st year of life, males have more UTI than females Ø Uncircumcised boys 10X risk than noncircumcised Ø U.S. Healthcare Cost and Utilization Project (HCUP) (Freedman, 2004) l l 51/100,000 children & 174/100,000 infants hospitalized annually with UTI Girls hospitalized 2.5X more than boys 3 UTI Epidemiology Ø UTI = 2.4 – 2.8% of physician visits Ø Cost: (HCUP + National Association of Children’s Hospitals and Related Institutions [NACHRI]) l l l 40,000 admissions for UTI per year Mean cost of $4500 per child for each UTI = $180 million/year without factoring the ambulatory visits 4 Definition of UTI Ø What defines a “significant” clinical UTI controversial Ø Urinary tract normally sterile Ø “Colonization” v. “Infection” is debatable Ø Collection technique is related to the reliability for UTI diagnosis 5 Classification of UTI Ø Many vague classification systems in use: complicated v. uncomplicated, upper v. lower tract, persistent v. reinfections, symptomatic v. aysmptomatic Ø Most useful clinically: first infection v. recurrent or “other” infections 6 UTI - Diagnosis ...
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...URINARY TRACT INFECTION IN PREGNANCY: BACKGROUND The occurrence of acute pyelonephritis within the duration of pregnancy increases lower urinary tract infection that has been closely associated with the upper urinary tract infection. The association of asymptomatic bacteriuria includes risk factors for lower urinary tract infection in pregnancies with multiparity, diabetes mellitus, urinary tract malformations, low socioeconomic status, and preterm labor delivery. The detrimental asymptomatic bacteriuria within the upper urinary tract as well as the lower urinary tract that may cause issues of adverse perinatal outcomes includes preterm delivery and low neonatal birth weight (5-8). The progression of pyelonephritis in nonpregnant women is only 1% to 2% whereas ASB in pregnant women will progress into pyelonephritis in 20-40% cases. This increasing chance of infection in the maternal body is due to immunosuppression normally during pregnancy; Allowing increase growth of Escherichia coli in association to the lower and upper UTIs, the acute pyelonephritis in pregnancy continues to scale significant numbers in maternal and fetal morbidity. Maternal sepsis, renal failure, and respiratory insufficiency are among the associations found between pyelonephritis and maternal-fetal compromise [3]. Due to most pyelonephritis cases presented in the second to third trimester of gestational period, the threat of preterm delivery can result in tocolytic administration, which risks for pulmonary...
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...Urinary tract infections are common infections prevalent in bole males and females around the world. I am going to explain to you what an urinary tract infection (UTI) is, how it relates to the Helene Feld School of Nursing (HFSON) Conceptual Framework, nursing roles that relate to urinary tract infections, a care plan for urinary tract infection and evidence-based practice related to urinary tract infections. The urinary tract is composed of: two kidneys, two ureters, a bladder, a prostate (in men only) and an urethra; therefore an UTI is an infection of any of the foregoing organs, ducts and/or gland. Urinary tract infections vary depending on the location in the urinary tract and can be caused by a variety of mechanisms. The various factors...
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...short-term indwelling urinary catheters” (Nix, Denise, and Ann Marie Pettis. 2012). This expose the patients to the risk of acquiring catheter associated infection. In this paper, the author discuss the trend of CAUTI infection, its impact on patient care outcome, morbidity, mortality and related treatment cost. Different studies reveal that use of a protocol guiding insertion, care and prompt discontinuation of urinary catheter has the ability to reverse the current trends. Catheter Associated Urinary Tract Infection (CAUTI) accounts for 70-80% of all urinary tract infections. The risk of developing a urinary tract infection increase by 3% for each day the urinary catheter is left...
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...u r na l of m e dic i n e Clinical Practice Caren G. Solomon, M.D., M.P.H., Editor Urinary Tract Infections in Older Men Anthony J. Schaeffer, M.D., and Lindsay E. Nicolle, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. From the Feinberg School of Medicine, Northwestern University, Chicago (A.J.S.); and the University of Manitoba, Winnipeg, Canada (L.E.N.). Address reprint requests to Dr. Schaeffer at the Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Tarry Bldg. 16-703, Chicago, IL 60611, or at jschaeffer@ a northwestern.edu. N Engl J Med 2016;374:562-71. DOI: 10.1056/NEJMcp1503950 Copyright © 2016 Massachusetts Medical Society. An audio version of this article is available at NEJM.org 562 A 79-year-old community-dwelling man presents with urinary frequency, dysuria, and fever. Culture reveals extended-spectrum beta-lactamase Escherichia coli. He had a similar infection several months ago, with the same organism isolated, and he had a response to nitrofurantoin treatment. How would you further evaluate and manage this case? U The Cl inic a l Probl em rinary tract infection in men without indwelling catheters is uncommon among men younger than 60 years of age, but the...
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...Urinary Tract Infection in the Geriatric Population Elizabeth Shultz Abstract The geriatric population is very vulnerable to Urinary Tract Infection (UTI) and its negative consequences. If left untreated, UTI in the elderly patient can have negative consequences such as delirium or even death. UTI can also contribute to the onset of acute or chronic kidney infections, which could permanently damage the kidneys and result in renal failure. In view of this, the purpose of this paper is to review related literature to find current evidence or best practices related to UTI in the geriatric population and to objectively critique the evidence. CINAHL and MEDLINE computer databases were mainly searched from January, 2005 to January, 2015 using a combination of manual and computer-based methods. Keywords: elderly, urinary tract, elderly infection management, urinary tract infection prevention, elderly and UTI. Introduction By convention, a Urinary tract infection (UTI) is defined either as a lower tract (acute cystitis) or upper tract (acute pyelonephritis) infection (Nicolle, 2014). Urinary tract infection (UTI) is the most common infectious problem among older adults both in the community and institutional settings (Midthun, Paur, Bruce, & Midthun, 2005). The elderly population is most likely to experience UTI due to many reasons, not the least of which is their overall susceptibility to all infections...
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...scrutinizes an evidence-based adjustment in repetitive urinary amplitude infections (UTI), amid earlier females in her analysis the beat vaguely why appearance shows an cogent affection in females allocating with the contamination. Getting older, bestowing to Nazarko, escalates the crisis of females that gets the illness. Added associated account are apparent in her beat including confiscation of antibiotics if physicians abominably analyze earlier females. Antibacterial analysis has accident factors, allowances and they may aswell accord to alterations in abdomen and close vaginal film that advances preconditions females to UTI (Pg. 407). The biographer mentions that complete females will accept accessible accomplished abundant antibacterial managements in their lifespan, appropriately influencing them to added opportunities of appliance UTI’S. Therefore, the bearings should be handled anxiously if it derives to complete individuals as it needs to be appropriately identified, as to avoid it from axis it a poorer in individuals that is already traveling through antimicrobial resistance. This commodity approaches her analysis through authoritative assorted points. She begins by defining a urinary amplitude infection so that her admirers understands the article’s topic. “Lower UTI is about authentic as ‘evidence of urinary amplitude infection with affection evocative of cystitis” (Pg. 407). She explains that urinary amplitude infections ability be articular as either simple or complex...
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...of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 34(5), 238-245 8p. doi:10.7257/1053-816X.2014.34.5.238 An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infections. Urinary tract infections account for at least 35% of all hospital acquired infections with 80% of them being associated to indwelling catheter. Each day an indwelling catheter is in situ increase pose a 3% tom 10% risk of developing an infection. Early discontinuation of the catheter reduce the risk of acquiring infection and in this study, infection rate drop from 4 cases in second quarter to none in the fourth quarter in the protocol implementation (Carter, N. M., Reitmeier, L., & Goodloe, L. R. 2014). 2...
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...Research Critique Part 1: A Qualitative Study on Preventing Hospital-acquired Urinary Tract Infection in United Sates Medical Facilities Donna Frazier Grand Canyon University Introduction to Nursing Research NRS-433V Chris Thompson-Sanxter February 01, 2013 Research Critique Part 1: A Qualitative Study on Preventing Hospital-acquired Urinary Tract Infection in United Sates Medical Facilities Problem Statement The clinical problem in this research article identified as hospital-acquired urinary tract infections in US hospitals and the research problem focused on how to prevent hospital-acquired urinary tract infections. Though urinary tract infections are the most common hospital-acquired infection, accounting for 40% of all nosocomial infections, there is very little information as to why hospitals do or do not use the available preventative methods. (Sanjay, et al., 2008) Purpose and Research Questions A list of questions were designed using the qualitative method, then used in 38 semi-regulated phone interviews with crucial staff at 14 expressly chosen hospitals and 39 face-to-face interviews at five of those fourteen medical facilities, to identify persistent and integrated ideas that describe in what way healthcare facilities tackled the dilemma of hospital-acquired urinary tract infections. (Sanjay, et al., 2008) The personnel interviewed were able to speak their thoughts freely since the data collection was so accommodating by using open-ended questions...
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...Assessment task 2- Scenario 2 Urinary tract infection is one of the most common infections diagnosed among women in the world. There has been increasing concern for alternative method to treat urinary tract infection over antibiotics since misuse of antibiotics can led to bacterial resistance(Scholes et al., 2004). This essay will establish PICO (population, intervention, comparison and outcome) question in the given scenario where a 22 year old Susan visits the GP with symptoms of urinary frequency, dysuria, lower back pain and shivering. She was diagnosed with Urinary tract infection (hereby referred as UTI) and antibiotics were prescribed. However after developing thrush due to antibiotics for urinary tract infection previously, she is reluctant to take antibiotics. On surfing the internet she read about cranberry juice being used to treat UTI and is considering to stop her antibiotics. PICO question development In order to provide the right pathway to commence our research and ensuring that every questions are suitable and relevant, PICO model will be used which is Population, Intervention, Comparison and Outcome(Bronson and Davis, 2011). In the given scenario, population would be women suffering from UTI. Similarly intervention is using cranberry juice to prevent UTI and comparison is to use antibiotics. Richardson et al., 2014 mentioned that the outcome would analyze the effectiveness of the intervention. Therefore the outcome would be effectiveness of cranberry...
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...Retrospective analysis of catheter-acquired urinary tract infection (CAUTI): Relationship to stroke diagnosis Abstract Background: Eighty percent of hospital-acquired urinary tract infections are associated with urinary catheters (Joint Commission Resources, 2011). Catheter-acquired urinary tract infections (CAUTI) continues to be at the forefront of the fight against hospital-acquired infections (HAI). Despite ongoing efforts to decrease the incidence of catheter-acquired urinary tract infections (CAUTI) in the acute care setting, overall standardized infection rates (SIR) for CAUTI have decreased only 7% since 2009 (Centers for Disease Control and Prevention (CDC), 2013). Purpose: The purpose of this study was to compare patients with a diagnosis of stroke to patients without a primary diagnosis of stroke to determine if patients diagnosed with stroke had a higher incidence of CAUTI infection. A secondary aim was to examine use of antibiotics, steroids, length of hospital stay, catheter days, and ICU length of stay in both stroke and non-stroke patients. Methods: The study method is a retrospective chart review analysis uses data from an 874-bed large teaching hospital located in the Southeastern United States from 2011 and 2012. After approval from both the Nursing Scientific Advisory Committee and the Institutional Review Board of the institution, analysis of data began. Results: 600 patients were potential candidates for analysis. Of the 600 patients...
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...4/26/13 Introduction “Urinary tract infections (UTI’s) are common hospital-acquired infections and account for up to 40% of the 2 million nosocomial infections reported each year” (Yin-Yin, C., Mei-Man, C., Yu-Chih, C., Yu-Jiun, C., Shin-Shang, C., & Fu-Der, W., 2013). Urinary tract infections also happen to be the most common nosocomial infection reported. Of all of the UTI’s reported, 80% of them are caused by the use of indwelling urinary catheters. Improper use and duration of indwelling catheters put patients at unnecessary risk for complications, longer hospital stays, and cause a financial burden on the health care system. Although there are set guidelines for placement and retention of these indwelling catheters that are supposed to be followed, the incidence of these catheter acquired urinary tract infections (CAUTI’s) is still relatively high. This could be because many times catheters are left in for unnecessary reasons whether it’s just an oversight by the physician or nurse or it’s for convenience, either way it puts patients at risk for infection. (Yin-Yin, C., Mei-Man, C., Yu-Chih, C., Yu-Jiun, C., Shin-Shang, C., & Fu-Der, W., 2013). Background of Study There is a direct correlation between the duration of indwelling urinary catheters and the incidence of CAUTI’s. The purpose of the research article being reviewed is to determine if the use of a criteria based reminder system would help reduce the use indwelling urinary catheters and reduce the incidence...
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...problems and issues that the healthcare setting have encountered. Theses guidelines reduce or decrease, “Never Events”, while improving quality care and patient safety. The purpose of this paper is to review the guidelines that has been developed to address the Urinary Tract Infections (UTI) problem, it’s importance and significance to nursing practice, as well as its impact on the patients and community, and the differences in care based on evidence. “Patients with indwelling catheters, even with current standards of care and evidence-based practice, urinary tract infections continue to be a problem”(Kevin J. Ribby, June 2006). Practice setting problem Urinary tract infections continue to be a problem in healthcare. The numbers of patient’s with urinary tract infections are still too high. “A plethora of articles have been written about nosocomial urinary catheter-related infections, management of the catheter, and proper placement of the indwelling catheter in the male patient 4 but little about the impact of nursing education on outcomes related to decreasing UTIs and usage of indwelling urinary catheters” (Doyle B, Zubina M, Horgan M, 2001). There are a various reasons for why nurses continue to see urinary tract infections like incorrect perineal cleaning, a break in aseptic technique when inserting urethral catheters, and the amount of time a urethral catheter remains in a patient. There have been various evidence-based practices that...
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...Melissa Flores Seriousness of Bladder Infections on Infants I. Introduction A. (Attention Getter) UTI (unary tract infection) is the most common serious bacterial infection in childhood, in which is bacteria that travels up to the urethra into the bladder and multiply, resulting in an infection; many affected children, particularly infants, have severe symptoms Approximately 7 to 8% of girls and 2% of boys have a urinary tract infection during the first 8 years of life. B. (Reason to Listen) Antibiotic treatment of children with urinary tract infections has almost eliminated the risk of death, which was approximately 20% among children hospitalized for severe kidney infections in the early 20th century. Some 50 years ago, one study described scarring found in the functional tissue of the kidney in 210 of 597 children treated for recurrent urinary tract infections. Another study in that era reported on an 11-to-27-year follow-up of 72 children hospitalized for urinary tract infections; 18% had died, 8% had progressive kidney damage, and 22% had persistent untreated or recurrent infection. C. (Speaker Credibility) The North American Pediatric Renal Trials and Collaborative Studies21 list primary diagnoses for 9854 children who had received transplants over the previous 20 years. D. (Preview) 1. First, I will discuss what’s the long term consequences a UTI can have if left untreated. 2. Second, I will cover the cause of a UTI. 3. Third, I will...
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...Catheter Associated Urinary Tract Infections (CAUTIs) By: Janelle Davidson & Liz Ellis Picot Question Thesis Preventing catheterization Nursing Initiatives Nursing Initiatives Continued Aseptic Technique Current Practice P: Any catheterized patient in the health care setting. I: Special initiative for prompt catheter removal. C: Versus routine procedure for catheter removal. O: Decrease catheter associated urinary tract infections. T: During the patient's length of hospital stay. Preventing catheterization, aseptic technique, nursing initiatives, and prompt removal are all factors that contribute to the decline of indwelling catheter infections. No clear protocol for catheter placement. Criteria included in the research: -Urinary retention (neurogenic bladder) -Urine Tract Obstruction (blood clots, enlarged prostate, urethral problems) -Close monitoring of urine output of critically ill and immobile patients. -Urinary incontinence that poses a risk for a stage 3 pressure ulcers. -Comfort care for terminally ill patients. Overall reduces the risk for infection Competency Based Training -Wash hands -Don sterile gloves -Maintain sterile technique while cleaning the meatus and upon insertion. Important factors: Keep the tubing unclamped, disinfect the drainage spigot after emptying the bag, and place the bag below the bladder at all times. 1.Concept map for management of urinary retention -Daily checklist was applied to see if the catheter was still needed...
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