thoughts on UTI detection in catheters

Newflash of last week: we're switching to detection of UTIs in catheters! UTIs are the most common sources of nosocomial infections, and they're almost always caused by contaminated catheters: http://www.cdc.gov/ncidod/eid/vol7no2/maki.htm

For patients who have catheters in for multiple days, infection is almost inevitable and can occur through a number of different routes:



There have been some solutions tried in the past, but none have been entirely effective.

Technologic innovation (refs)	Risk reduction in randomized trials
Antiinfective lubricant (2)	Unproven
Sealed catheter-collection tubing junctions (38-40)	Unproven
Antireflux valves (2)	Unproven
Continuous irrigation of bladder with antiinfective solution (2,37)	Unproven
Instillation of antiinfective into collection bag (2)	Unproven
Antiinfective catheter material
Antimicrobial drug-impregnated
Nitrofurazone (20) Minocycline-rifampin (21) Silver oxide (29,30,42) Silver-hydrogel (22-25, 27,42)	0.7 (0.3a) 0.4 Unproven 0.2-0.7

The best so far have been antimicrobial drug-impregnated catheters, but challenges with this solution are:
- higher cost ($5 more/catheter for silver-hydrogels, reduce 26% of infections)
- encourage culturing of drug-resistant strains?
- difficult to target all possible infections (ex. silver hydrogels only do gram+)

Our idea:

We learned SO MUCH just from talking to Nurse Cathy (?name, yes?). Apparently one common way for infection to occur is from bacteria building up (intraluminally) from the drainage or bag, then traveling up the catheter into the bladder. We're thinking it would be possible to put some kind of detection mechanism inside the tube (after the drainage thing) so that nurses know when this buildup starts to occur, and can switch out the catheter as necessary.

Current stage:

looking for chemical tests (see thais' awesome posts below)! have ordered catheters. exciting purchase for DLab health.

- steph