Infection Control

Executive Summary

Catheter-Associated Urinary Tract Infections (CAUTI) is one of the most common causes of infections in hospitals in Hong Kong. Foley Catheter is commonly used invasive device and is widely associated with urinary tract infections. Escherichia coli are common bacteria that are easily transmitted through the invasive devices used to assist patients with serious complications. STEC produces two bacteriophage-encoded Shiga toxins, Stx2 and Stx 1. The two bacteriophages are of AB5 –Type toxins. Binding occurs between the B-pentema of holotoxin and the host’s globotriaosylceramide (Gb3) present in the microvascular endothelial cell surface such as intestines, brain and kidney. Shiga toxin-producing E. coli was first reported as a human pathogen when the first outbreak occurred nearly 30 years ago in Wong Sin Tai District. STEC O 157:H7 was then labeled as rear until 1993 when undercooked hamburgers resulted into a multistate outbreak. I would recommend the government to totally implement the policy guidelines put in place by the World Health Organization to minimize the cases of STEC infections which are associated with invasive devices.

Introduction

Healthcare associated infections are on the rise and troubling the healthcare Industry. Hospitals have become breeding grounds for the organism associated infections. Patient safety networks and organizations which are more concerned with the quality of service delivery, are looking for appropriate ways to improve infection control and reduce the number of patients who get infected. Some of the bacteria that are widely liked to Healthcare-associated infections are Clostridium difficile, Staphylococcus aureus, norovirus and Escherichi coli. Catheter-Associated Urinary Tract Infections (CAUTI) is one of the most common causes of infections in hospitals in Hong Kong. Foley Catheter exposes the patients to a greater risk of getting urinary tract infection (UTI). The infection which is mainly in the form of bacteria such as the Shiga Toxin-Producing E. coli, can gain access to the urinary system through the urethra. It can then spread to the kidney causing serious failure of the organ and damage to the body. This paper aims to discuss Catheter-Associated Urinary Tract Infections in details including the risks to the patients.

Invasive Devices Associated with CAUTI

Invasive devices are commonly used in the hospital in handling infectious complications such as the ones caused by STEC. Immediately the patient is taken to the hospital, they are evaluated for venous access needs. The patients who have serious conditions and those with urinary retention may require a urinary catheter. A Foley catheter which is a thin flexible tube is a commonly used CAUTI to drain urine out of the patient’s body. The tube is normally attached to the bladder of the patient. The patient is at a huge risk of getting infected by bacteria such as STEC which is a common urinary tract infection (UTI). The bacteria can gain access through the urethra and ladder spread to other parts such as the kidney causing serious complications such damage of the entire organ. The medical providers can always prevent CAUTI. The nurse attending to the patient should ensure high level of hygiene around the patient whole using the devices. The devices should never be put on the floor or other surfaces that they can get exposed to infections.

Local Practice in the Hong Kong on CAUTI

Cases of Catheter urinary associated infection (CAUTI) which are related to Shiga Toxin-Producing E. coli (STEC O157:H7) is estimated to 3,200 infections and 96,000 cases of diarrhea, reported in hospitals in Hong Kong each year. Human infections have been reported to occur three to four days after the bacteria have been ingested. The patients were reported to exhibit vomiting, diarrhea, low-grade fever that continues for 5 to 7 days and stomach cramps. Cases urinary associated infections, that may cause permanent or transient kidney damage has also been reported though in rare occasions. A case was reported on October 24, 2011, by Wong Tai Sin District Department of Health where a cluster of STEC O 157:H7 infections. Following this development, the Center for Disease Control and Prevention (CDC) rolled out a multistate investigation and the outcome was that there were cases within Districts in the Hong Kong. The local and State Public Health Officials in Wong Tai Sin District identified Laboratory confirmed cases of STEC O157. An overall 58 cases of STEC infection were reported in 10 states. The median age of cases was 28 years. The female population was at 61% and 39% were male. 34 of the cases which contribute to 68% were hospitalized and there were 3 documented cases of who developed hemolytic uremic syndrome (HUS). In all the cases, there were no deaths reported.

Comparison of Statics

In 2009, Center of Disease Control and Prevention came up guidelines that required that all the stools submitted to the clinical laboratories for the diagnosis of acute community diarrhea be tested for Shiga toxin. The guideline was put in place after STEC was associated with most cases of CAUTI. The routine consisted of the use of selective differential agar technique to detect Shiga Toxin-Producing E. coli (STEC). The reports of this publication found out about 96, 534 STEC O157 infections occur annually in the Hong Kong. The infections are linked to 3,600 hospitalization cases and 30 deaths each year. According to the report by Center of Disease Control and Prevention Annual Summary, there were 0.72 per 100,000 population national isolation rate of STEC O157:H7 related CAUTI in 2009 alone. Overall cases of STEC are detected in 0% to 4% of stools submitted to testing in the clinical laboratories. These figures are approximated because the signs and symptoms associated with CAUTI vary from one individual to the other before it riches a stage deemed as life threating. Thus the main of the Center of Disease Control and Prevention current recommendation was to ensure that cases of outbreaks are diagnosed at an early stage. This allows the patients to receive the appropriate care and the additional cases of CAUTI can also be identified and documented. According to CDC, the beginning of 2008, most clinical microbiology laboratories put in place protocols to minimize CAUTI complications.

How Effective is Local Practice

Due to the persistent cases of CAUTI infection, the local government in the Hong Kong has put a lot of effort to try to combat the increasing cases associated with the bacteria, STEC. This involves establishing a control measure at all the stages of the chain of spread of infection by the bacteria. It is confirmed that good hygiene can reduce the CAUTI cases but does not totally eliminate the presence of CAUTI. The guidelines require that all the surfaces which are touched frequently in the hospital are disinfected. This helps to reduce the chances of spread of CAUTI to the patient and the staff in the hospital. Disinfecting the surfaces kills the bacteria and viruses that are not visible with the baked eye. This ensures that when the next person touches the surfaces and will not carry the microorganisms on their hands to the next place or infect themselves in the process. The commonly touched surfaces in the hospital are door handles, telephone, tray table, bedside table, bed rails and call buttons among many other surfaces.

The hospital stuff are also provided with training module to help them handle the equipment that are used in the hospital to minimize the risks of CAUTI. At the end of the training module the staff is expected to identify the chain of infection and use appropriate strategies to break the chain. They should be able to explain the role a clean environment plays in preventing CAUTI complications. They should understand the importance of maintain and taking care of catheters in terms of the cleanliness of the environment. This will help the hospital residence from acquiring catheter-associated urinary tract infections (CAUTI). The staff should also be able to use important steps when using environmental disinfected to clean the surfaces that are commonly infected with CAUTI. Proper indwelling catheter care by the staff is very important in breaking the chain in which CAUTI takes place. Foley Catheter for instance requires high level of care and maintenance especially if they are not maintained appropriately. The staff assists the patients with good personal hygiene, proper waste disposal and dresses the open wounds to help prevent the spread of the CAUTI through person to person contact.

Conclusion

A Foley catheter which is a thin flexible tube is a commonly used CAUTI to drain urine out of the patient’s body. The patient is at a huge risk of getting infected by bacteria such as STEC which is a common urinary tract infection (UTI). Shiga toxin-producing E.coli have several biological adaptabilities that will enable them to survive in the environment and in the body of the host organism for long. STEC can survive up to very high temperatures of 500C and low water content surfaces. It can also live in acidic environment with pH as low as 4.4. The ability to survive in surfaces with low water content enables it to stick on the surfaces of walls before it is spread. These biological properties of STEC make it very difficult to eliminate. Researchers have made an observation that paying attention to high levels of hygiene will lower the rate of spread of infection but can’t totally eliminate STEC. Cases of outbreak of the CAUTI by STEC have been reported in the Hong Kong as well as England. In both countries, the modes of contamination are almost similar to the vulnerable population being the young children and adults of 60 years and above. The local government in Hong Kong has come up with several mitigation procedures to minimize CAUTUI some of which are working but a slow rate. I would recommend the government to totally implement the policies guidelines put in place by the World Health Organization to minimize the incidences of CAUTI.