Reducing Urinary Tract Infections


The Agency for Healthcare Research and Quality issued in April its annual quality report including data on rates of healthcare-associated infections (HAI) in adult hospital patients tracked in the report. Five specific HAIs are tracked because of their high incidence and therefore high costs, one of which is postoperative catheter-associated urinary tract infections (UTIs). The five are also targeted because they stem from categories considered “Never Events” because they never should happen in the course of a normal hospital stay when care meets established standards and protocols.

The term Never Event was first introduced in 2001 by the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. The NQF initially defined 28 such events in 2002.  Four years later it revised and expanded the list. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable. The list is grouped into six categorical events: surgical, product or device, patient protection, care management, environmental, and criminal1. In August 2007, the Centers for Medicare and Medicaid announced that beginning in 2008 it would no longer reimburse hospitals for costs associated with certain infections and complications occurring during hospitalization, including catheter-associated UTIs.2 These are also referred to as nosocomial UTIs.

Catheters are associated with colonization of bacteria and increased risks of clinical infection.  While single-use, sterile catheters reduce the risks, they do not prevent UTIs.  While catheters coated with antimicrobial agents such as nitrofurazone have received considerable attention, they come at a sixfold increase in cost and raise questions about how to best select the most appropriate patients for their use.

Despite all of the attention and focus on this and other “Never Events,” the latest quality report reveals postoperative catheter-associated UTIs increased by 3.6 percent in 2009. Such a fact begs the question of whether the attention and focus are where they need to be. Nearly a decade ago, Kunin declared there is no need to wait for a mechanical or chemical answer to the problem of nosocomial UTIs because the culprits are “unnecessary and prolonged use of indwelling urinary catheters when they are no longer needed.”3 This echoed a similar declaration published six years earlier.4

In the end, as with the practice of intermittent catheterization for emptying the bladder of urine, there is no substitute for maintaining proper care, while remaining alert to symptoms of UTI. There’s help for that from NAFC and other online sources.


1Agency for Healthcare Research and Quality, accessed on May 25, 2010 at

2 Pear, R.  Medicare says it won’t cover hospital errors, The New York Times, August 19, 2007, accessed on May 25, 2010 at

3 Kunin, C. M.  (2001).  Nosocomial urinary tract infections and the indwelling catheter:  what is new and what is true? Chest, 120 (1): 10-12.

4 Jain, P., Parada, J. P., David, A. et al. (1995).  Overuse of the indwelling urinary catheter in hospitalized medical patients.  Archives of Internal Medicine, 155: 1425 – 1429.

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12 Responses to Reducing Urinary Tract Infections

  1. June O'Dea RN CCCN says:

    Recurrent UTI can be a problem for women of post-menopausal age due to the effects of loss of estrogen. The urethra no longer provides an effective barrier for bacteria as it does not seal well. Pelvic organ relaxation can obstruct the flow of urine from the bladder increasing the risk of increased post void residual, a reservoir for bacterial growth. Teaching toileting techniques, avoiding straining during voids, managing constipation and drinking enough fluids are important strategies. Encouraging beverages and supplements that alter urine acidity is also helpful. Many physicians order estrogen cream periurethrally to improve the ph of the tissues to discourage bacteria from ascending the urethra and increase the comfort of the tissues. Insruct patients not to use folded paper products or menstrual pads preventively as these do not wick moisture from the skin. Pads can increase skin temperature and promote bacterial growth and should be avoided if not necessary.

  2. I want to voice my appreciation for your kind-heartedness for men and women that have the need for assistance with this one issue. Your very own dedication to passing the solution all through had been really helpful and have continuously encouraged women like me to realize their endeavors. Your new useful tips and hints implies a lot a person like me and still more to my office colleagues. Best wishes; from everyone of us.

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  7. Mulch 47401 says:

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  8. magnificent post, very informative. Im wondering why the other specialists of this sector do not realize this. You must proceed your writing. Im sure, youve a huge readers base already!

    • John says:

      The male urethra pseass through the shaft of the penis and sits away from the rectum. Like most UTIs are caused by bacteria commonly found in the stool, people have extra protection against such because their urethra (the tube that comes from the bladder to the outside) is positioned well away from the anus and the length that the bacteria would have to travel up the urethra is much longer than that of a woman. Also, men are not necessary to wipe every time they urinent.En contrast, female urethra sitting very close to the anus and have a very short urethra. The movement using toilet paper describes one site to another, which is why medical professionals advise wiping from front to arrie8re.Hope That helps.

      • Sasha says:

        UTIs (water infections) are often cueasd more by bacterial infections than a physical problem but it does occur. Depending on size and location of cysts, yes it might be pressing against bladder maybe even irritating thus need to urinate more often. Glad you are getting the scope procedure done. Best to have a good look-see.References :

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