UTIs account for about 40% of all HAIs (62). Instrumentation, particularly indwelling catheterization, is responsible for the majority of nosocomial UTIs (63). Therefore, using these catheters only when indicated, inserting and maintaining them properly, and removing them when they are no longer needed is important.
Urinary catheters are frequently overused and are left in for longer than needed; catheters should never be used for convenience (64). Personnel who insert and maintain catheters should be trained in aseptic technique. Strict adherence to the sterile, continuously closed system of urinary drainage is the standard and has been shown to be superior to open drainage (63). The use of prophylactic antimicrobials in the prevention of catheter-related UTIs is not currently recommended and has been shown to increase resistance in some studies (65,66). Most episodes of catheter-associated UTI appear to be caused by the migration of bacteria from the urethral meatus along the external surface of the catheter into the bladder rather than intraluminally (67). Studies of the efficacy of catheters coated with antimicrobials or silver alloy in reducing bacteriuria and UTIs have had mixed results, but silver alloy/hydrogel-coated catheters have shown promise and may be cost-effective (68). A recent prospective trial of a silicone-based, silver-coated Foley catheter did not demonstrate a reduction in nosocomial UTIs, although there were differences in the study groups (69). The use of antimicrobial coatings may encourage resistance. Newer approaches include the use of catheters impregnated with synergistic combinations of antiseptics or coated with an avirulent strain of E. coli (70,71).
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