**7. Conclusion**

**6.10. Prevention of CAUTIs in elderly with long-term catheter**

34 Recent Advances in the Field of Urinary Tract Infections

ment modification.

Elderly are prone to long-term catheterization for many reasons and many of them are either surgically correctable e.g. a large symptomatic cystocele in women can easily be corrected with pelvic floor reconstruction or medically associated e.g. due to antihistamines, anticholinergics or tricyclic antidepressants and may be managed with medication discontinuation or treat‐

Long-term catheters are almost always associated with bacteriuria [107]. Strategy for preven‐ tion in these cases includes [108]: Hydration in order to promote washout of bacteria and maintain proper function of catheter. Routine catheter exchange e.g. every 4-6 weeks, depend‐ ing on each patient. Patients with tendency to catheter encrustation require more frequent catheter exchange. Routine antibiotic prophylaxis is not required as it has already mentioned

Development of a local strategy from hospitals may contribute in reduction in the incidence

Implement a system for documenting: indications for catheter insertion, date and time of catheter insertion, individual

Most of them have been evaluated in a number of studies and have shown their effectiveness in reduction of CAUTIs. For example, the utility of various reminder systems, physical or virtual, has been examined in a number studies with encouraging results [110-116]. In one study paper based prewritten 'stop orders' or protocols and stickers to encourage clinicians to insert catheters only when absolutely necessary and remove as soon as no longer proved useful in reduction of CAUTIs [110]. Bruminhent et al. [111] found that placing reminder stickers on patient medical records significantly reduced the rate of CAUTIs (7.02 vs. 2.08, P<0.001) after 3 months. This study was also associated with lower antibiotics costs and no impact on overall mortality. Another study by Loeb et al. [114] randomized 692 patients with indwelling catheters to usual care vs. prewritten orders for catheter removal if specified criteria are not present. This study reported a significant reduction of duration of inappropriate urinary catheterization in hospitalized patients but did not reduce urinary tract infections. Virtual

above it inevitably leads to development of drug resistant bacteria [87, 88, 89].

of CAUTIs. The components of this policy are presented on table 3 [109].

who performed insertion, date and time of catheter insertion, date and time of catheter removal

**6.11. Local policy development for reduction of CAUTIs**

Periodic training in aseptic technique, maintenance and removal Education about CAUTIs and alternatives to indwelling catheter

Use of standardized methodology for performing CAUTI surveillance

**Table 3.** Components of a local policy in reduction of CAUTIs [109].

Family and caregiver teaching, discharge instructions

Use of removal triggers

Early catheter removal program

Prevention is the main step against CAUTI. Priorities with proven value are the appropriate use and early removal of catheters, aseptic insertion, the maintenance of a closed urinary drainage system and implement of a structured local policy. However, there are still many challenges that need more clarification from research and well designed randomized control trials.
