Urinary catheters increase the risk of developing a urinary tract infection (UTI). A UTI is an infection within the urinary system, including the kidneys, ureters, bladder, and urethra. Catheters introduce a foreign object into this sterile environment, providing a pathway for bacteria to enter and multiply. Catheter-associated UTIs (CAUTIs) are among the most frequently reported healthcare-associated infections.
How Catheters Lead to UTIs
An indwelling urinary catheter creates opportunities for bacteria to enter the urinary tract. Microorganisms can migrate into the bladder along the external surface of the catheter, moving from the urethral opening. Bacteria can also enter through the inside of the catheter lumen, often from a contaminated drainage bag or connection point.
Once inside, bacteria can adhere to the catheter’s surface and form a protective layer known as biofilm. This biofilm acts as a shield, making the bacteria highly resistant to antibiotics and the body’s natural immune defenses. The catheter itself can also irritate the bladder lining, causing inflammation and making the tissue more susceptible to bacterial invasion and infection.
Bacteria multiply rapidly in the presence of a catheter, potentially reaching high concentrations within 24 to 48 hours. The longer a catheter remains in place, the greater the likelihood of biofilm formation and subsequent infection. This persistent colonization makes eradicating the infection challenging without removing the catheter.
Recognizing Catheter-Associated UTI Symptoms
CAUTI symptoms can differ from those of a UTI in individuals without a catheter, often being less obvious. Patients might experience a general feeling of unwellness, fever, or chills. Pain in the lower abdomen or back can also indicate an infection.
Changes in urine appearance, such as it becoming cloudy, foul-smelling, or bloody, are common indicators. In older adults, altered mental status or confusion might be the sole symptom of a CAUTI. Promptly report any of these symptoms to a healthcare provider.
Reducing the Risk of CAUTI
Preventing CAUTIs involves strict infection control practices. Proper hand hygiene is essential; healthcare providers and caregivers should wash their hands thoroughly before and after touching the catheter or drainage system. Maintaining a sterile, continuously closed drainage system is also important to preventing bacterial entry.
The catheter should be properly secured to the patient’s leg to prevent movement, which can reduce irritation and the risk of bacteria migrating along the urethra. The drainage bag must always be kept below the level of the bladder to ensure continuous, unobstructed urine flow and prevent urine from flowing back into the bladder. Kinks or obstructions in the tubing should be avoided to allow for proper drainage.
Regular cleaning of the area around the urethra and the catheter with an antiseptic solution, such as CHG wipes, can help reduce bacterial colonization. Emptying the collecting bag regularly using a separate, clean container, without touching the drainage spigot, also minimizes contamination. The most effective measure to reduce CAUTI risk is to remove the catheter as soon as it is no longer medically necessary, as the risk of infection increases with the duration of catheterization.