Urinary Tract Infections as One of the Most Common Types of Infection - Research Paper Example

?Does Silver Alloy Coated Foley Catheters Reduce Urinary Catheter Infections The Urinary Track Infections (UTI) is one of the most common types of infection, and it occurs heavily in the anterior and in the interior regions of the reproductive organs in both male and female. In our body, there are preventive mechanisms like the lining of the bladder, antimicrobial properties of urine, etc. Even then the bacterium enters through external mediums or proliferates in the bladder and other regions, leading to acute infection. One of the external mediums, through which or because of which the incidence of UTI increase is Foley Catheters, used to drain urine, when normal urination is not possible due to some medical conditions. The use of catheters causes one of the most common health associated infections and is known as CAUTI or Catheters Associated Urinary Tract Infections. As CAUTI can deteriorate into a serious condition, preventive steps have to be taken to minimize it in the hospital environment as well as in other settings. One of the steps that are being carried out is the use of Foley catheters coated with silver alloy. These catheters, when used as part of indwelling catheterization, are said to reduce CAUTI sizably. Although other studies show that it provides only negligible positive results. So, this paper after analyzing six journal articles, its purpose, its results, strengths and weaknesses, will discuss whether silver alloy coated Foley catheters reduces UTI. The article, Audit of catheter-associated UTI using silver alloy-coated Foley catheters written by Coral Seymour discusses the advantages of using the silver alloy-coated Foley catheter in reducing the threat of CAUTI in an acute general hospital. As part of the study, even before the use of silver alloy coated Foley catheters, the standard catheters were used for 10 weeks on particular patients and the prevalence of CAUTI was audited. Silver alloy-coated Foley catheters there were introduced among 117 newly catheterized patients, and they were monitored for signs of CAUTI for another 10 weeks. Then the results were audited and analyzed, and it clearly emerged that CAUTI incidence rate has decreased by 20%. Although, the period of 10 weeks for monitoring may seem little short to fully analyze the course of UTI, the fact that emerged is “silver alloy-coated Foley catheters proved to be cost-effective given the recognized additional costs of CAUTI and prolonged in-patient stay” (Seymour, 2006). The article, A prospective, controlled, randomized study of the effect of a slow-release silver device on the frequency of urinary tract infection in newly catheterized patients was authored by Reiche et al., and it focuses on the efficacy of silver ions releasing systems including silver alloy coated Foley catheters regarding CAUTI. The study focused on 213 patients as part of a prospective controlled randomized trial. At the end of the trial, the authors state that there were reductions in UTI among subjects, who either used antibacterial devices like the Unometer 400 metering system or PP 2000N closed urine-bag system, as well as coated Foley catheter. However, the limitation with this study is, the difference between infection and non-infection in the subjects were not statistically significant (P < 0.05). In addition, the authors come to the conclusion that modifications to the Foley catheters and the urine-collecting systems in the form of silver coating and silver releasing may yield positive results, care should be taken to block the internal and external pathways of infection. In the article, The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis written by Sanjay Saint et al. discusses about the effectiveness of not only silver alloy coated Foley catheters, but also silver oxide coated ones as well. Instead of conducting trials directly, “published or unpublished articles were sought using MEDLINE, reference review, and correspondence with original authors, catheter manufacturers, and experts.” (Saint et al. 1998). Out of these 117 reports and the various studies conducted in it, eight trials consisting of 2,355 patients fulfilled the inclusion criteria. Although, summary Odd Ratios clearly showed that both type of catheters are effective, a test of heterogeneity, however, provided mixed results, with silver alloy catheter showing better results than the silver oxide one. With results of over 2000 patients being included, this study appears extensive, but as this article maximally depended on other sources, it could be vulnerable to misses. Mark E. Rupp et al. in Effect of silver-coated urinary catheters: Efficacy, cost-effectiveness, and antimicrobial resistance focuses on the role played by silver alloy coated Foley catheters in the reduction of UTIs as well as the costs associated with it. In addition, the article also focused on whether any form of resistance has emerged for the silver alloy. Patients in around 10 patient care units were studied as part of 2-year prospective surveillance study. To figure out the cost reductions or cost-effectiveness, range of cost estimates was conducted. The study is the strength of this article because of its exhaustive and encompassing nature. Although, the silver susceptibility could have been studied in a more in-depth manner, the results were on expected lines, that is, silver alloy coated catheters are effective against CAUTI. The article, A Randomized Crossover Study of Silver-Coated Urinary Catheters in Hospitalized Patients was authored by B Tobi et al, and it focused on beneficial role of silver alloy coated Foley catheters, and the cost savings it gives for hospitals as well as patients. The main strength of this trial is the sizable duration for trial conduction, as 12-month randomized crossover trial was conducted, comparing CAUTI in patients with silver-coated and uncoated catheters. The other strength is as part of the study over 25000 patients using catheters were studied, including the number of infections and also the number of patient days with inflections. The risk of infection got declined sizably, in the ranges of 21% to 32% among all the target groups, which used the silver alloy coated Foley catheters. Although, the cost of this catheter is higher than the standard ones, it helps in the overall reduction of hospital and patients’ costs. Michelle Beattie and Julie Taylor’s article, Silver alloy vs. uncoated urinary catheters: a systematic review of the literature also focuses on the effectiveness of silver alloy coated catheter by doing a literature review. Without going for a direct study in a particular setting, which could be a weakness, the authors collected earlier completed literatures about silver alloy coated urinary catheters, including the studies that were featured in it. Randomized control trials, systematic reviews and meta-analyses were identified by searching relevant databases, and in that process 11 literatures were only retained. Those literature featured eight studies, and basis of the analysis of these studies, it was clearly seen that silver alloy coated catheters are effective. Again there was weakness, owing to the poor quality of some individual studies and that prevented the authors from giving definitive conclusions. Summary Catheters or Foley Catheters are used maximally in post-operative period in hospitals and continuously for other conditions like paraplegia, hemiplegia, etc. Although a UTI can occur in any setting, it was found that the “bacteraemia rate among hospitalized, catheterized patients was three times that of uncatheterized patients.” (Reiche et al., 2008). The other key fact is, “UTI during indwelling bladder catheterization among hospitalized patients was associated with a nearly threefold increase in mortality compared with catheterized patients with no UTI.” (Reiche et al., 2008). As indwelling catheterization can lead to serious complications, effective preventive measures have to be undertaken and one among them is the use of silvery alloy coated Foley catheters. There are types of silver coating, one silver alloy and another silver oxide. Two studies (Saint et al., 1998 and Tobi et al., 2000) covering both these types clearly favors silver alloys over silver oxide for effectively combating CAUTI. “Silver alloy catheters (OR = 0.24; 95% CI, 0.11 to 0.52) were significantly more protective against bacteriuria than silver oxide catheters (OR = 0.79; 95% CI, 0.56 to 1.10).” (Saint et al., 1998). However, the key point that pervades through all the articles is the efficacy of silver alloy coated Foley catheters in arresting infections. Although, certain studies Beattie and Taylor (2011) and Reiche et al. (2008) gave a slightly ambiguous picture, with the silver alloy coated catheters showing only minimal results, other studies seems to fully favor it. For examples, Seymour (2006) provides details of how CAUTI rate was reduced by 20% by this catheter. Tobi et al. (2000) states how “infection declined by 21% among study wards randomized to silver-coated catheters and by 32% among patients in whom silver-coated catheters were used on the wards.” Apart from the reduction in CAUTI incidence, these catheters also help in reducing costs from the hospital perspective as well as the patient perspective. With extended stay due to continual infection, cost will be incurred on both the patient and the hospital. With these catheters minimizing UTIs, patient could be discharged from the hospital quickly, after the treatment for their original illness or heath issue is finished. Tobi et al. (2000) provides these details by stating that “Estimated hospital cost savings with the use of the silver-coated catheters ranged from $14,456 to $573,293”. Though silver alloy coated urinary catheters costs more than the standard urinary catheters, it may be less than the costs that could be incurred, when a patient gets UTI and has to be admitted in the hospital for that, or even has to be given an extended stay in the hospital for that. Another key finding is, there has not been any resistance formed to the silver coated in the catheter, and this may allow the medical personnel to use it without any inhibition. (Rupp et al. 2004). From the above summarization, it is clear that CAUTI is a common problem and could even turn into a serious problem, unless preventive measures including the use of silver alloy impregnated Foley catheters are used. References Beattie, M. and Taylor, J. (2011). Silver alloy vs. uncoated urinary catheters: a systematic review of the literature. Journal of Clinical Nursing, 20 Reiche, T., Lisby, G., Jorgensen, S., Christensen, B and Nordling, J. (2000). A prospective, controlled, randomized study of the effect of a slow-release silver device on the frequency of urinary tract infection in newly catheterized patients. BJU International, 85: 54–59. Rupp, M. E., Fitzgerald, T., Marion, N., Helget, V., Puumala, S., Anderson, J. R. and Fey, P. D. (2004). Effect of silver-coated urinary catheters: Efficacy, cost- effectiveness, and antimicrobial resistance. American Journal of Infection Control, 32 (8): 445-450. Saint, S., Elmore, J. G., Sullivan, S. D., Emerson, S. S. and Koepsell, T. D. (1998). The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis. The American Journal of Medicine, 105 (3): 236-241. Seymour, C. (2006), Audit of catheter-associated UTI using silver alloy-coated Foley catheters. British Journal of Nursing 15 (11): 598 - 603. Tobi, B., Karchmer, M. D., Giannetta, E. T., Muto, C. A., Strain, B. A and Farr, B. M. (2000). A Randomized Crossover Study of Silver-Coated Urinary Catheters in Hospitalized Patients. Archives of Internal Medicine, 160: 3294-3298. Read More