Catheter-associated urinary tract infection in primary and community health care

Introduction: although often a last resort, urinary catheterisation is a relatively common management option for bladder dysfunction in older people and others cared for in community settings. Catheter-associated urinary tract infection (CAUTI) is a well-recognised source of increased morbidity and economic burden in acute care services, but much less is known about the prevalence and impact of CAUTI in primary and community care. Objectives: the aim of this study was to examine the criteria and outcome measures used in reporting CAUTI, to identify sources and quality of data recorded on CAUTI and to determine a base-line prevalence rate for CAUTI in community settings. Methods: (i) a mapping exercise to identify local, national and international sources of data on CAUTI and (ii) a retrospective prevalence survey of CAUTIs, recorded within three Primary Care Trusts in England during 1 month (October 2004). Results: published or other recorded data on CAUTI in community settings were very limited. Criteria and outcome measures were variable and commonly failed to distinguish between symptomatic and asymptomatic CAUTI. A prevalence rate of 8.5% was determined by retrospective survey of patient records. Conclusions: limitations in the quality and consistency of catheter-related information collected by healthcare services present a major obstacle to robust epidemiological analysis of risk and impact of CAUTI in primary and community care. Standardised routine data collection is essential to determine the magnitude of risk associated with CAUTI, to enable the development of a longitudinal database of long-term catheterised patients and to provide base-line data against which infection-control initiatives in primary and community care can be evaluated.