Catheter-Associated Urinary Tract Infection after C-Section
In the United States, more than one million patients acquire catheter-associated urinary tract infections annually in hospitals and other healthcare facilities. Recently, cesarean delivery is done on one in three expectant mothers making it one of the most common obstetric surgery. Urinary catheters are routinely used during and after cesarean delivery to drain urine from the bladder; they are flexible elastic tubes. The use of catheters helps minimize bladder injury and improve visualization during surgery by maintaining bladder drainage. They also help to reduce the retention of urine after cesarean delivery since the patient is unable to pass urine. The use of indwelling catheters during cesarean delivery has increased the risk of urinary tract infections, which lead to further health complications on women after childbirth. Evidence in recent studies has shown that avoiding the use of catheters on cesarean delivery reduces the instances of urinary tract infections in women after the surgery (Moulton et al., 2018).
Organisms are inoculated into the bladder by urinary catheters, which provide a surface for adhesion, promoting colonization of bacteria. The bacteria enter into the bladder when the catheter is inserted, when it is manipulated to drain urine efficiently, when the catheter drains urine, or when it is removed. Candida is the most common bacterium associated with catheter-associated urinary tract infections. The potentially pathogenic bacteria cause urinary tract infections in patients; hence the use of urinary catheters during cesarean delivery poses a significant problem in healthcare. Forty percent of all acquired infections in hospitals are catheter-associated urinary tract infections. There is a five to ten percent risk of infection when urinary catheters are used (Jackson et al., 2018). There is a three to ten percent daily incidence of bacterium when catheters are used. 10 to 30 percent of patients undergoing short-term catheterization and 90 to 100 percent of those on long-term catheterization are infected with the bacteria.
Various measures can be taken to reduce the risk of getting urinary tract infections due to the use of indwelling catheters during cesarean delivery. Assessment of need before the insertion of indwelling catheters is not done for mothers undergoing cesarean delivery. Before the use of indwelling catheters, an assessment of its necessity in the surgery should be done. The procedure is essential to determine if the use of the equipment is crucial for the given operation or not. If not necessary, surgery should be done without the use of catheters. Previous studies have shown that cesarean delivery done using catheters had 29.3 percent of urinary tract infections, while those done without its use had 4 percent cases (Pandey et al., 2015). Cesarean deliveries done without the use of the catheters had the surgery for a shorter period with lesser pain, and the patients stayed in the hospital for a shorter period. The risks associated with indwelling catheters during cesarean delivery make it necessary to avoid its use during surgery.
In some instances, the use of catheters is essential. Guidelines for their use have to be followed to reduce the risk of urinary tract infections. In 2009 guidelines for the use of catheters to prevent catheter-associated urinary tract infections were provided by the Center for Disease Control and Prevention. The measures were set to reduce the incidences of urinary tract infections, causing an increased hospital stay. Proper sanitation and hygiene practices should be maintained while handling catheters. Urinary catheters coated with silver alloy and other types of catheters that reduce the risk of catheter-related urinary tract infections can be used. The duration of use for the catheters should be reduced, especially for patients with high risks of infection like mothers with existing health complications an impaired immunity. The decreased duration can be reduced by removing the devices as soon as possible because the bacterium in the tubing and bag creates a biofilm against antibiotics within two weeks. Tests should be done for the existence of bacterium after the removal of catheters and patients given treatment immediately based on the results to prevent further complications.
Hospital procedures are done to improve the patient’s outcome. High ethical standards must be maintained and legal issues considered before making any decision regarding the treatment procedure of a patient (Cherry &Jacob, 2016). The best interest of the patient should be considered to avoid harming the patient. The use of catheters is associated with complications such as trauma, urinary tract infections, and other common expensive complications though it is widely used in medicine (Meddings et al., 2014). Physicians insert urinary catheters for various inappropriate reasons making health providers vulnerable to medical liability because of medical malpractice (Awad et al., 2016). The devices are used without physician awareness, which is inappropriate. It is unethical to use catheters without assessment because it is not needed for all cesarean delivery surgeries. Surgeries without catheters pose various health risks to the patient, which could be avoided if not used. Patients can sue medical facilities for using inappropriate procedures on them for treatment resulting in health complications. Healthcare providers should be keen on the decisions of the treatment procedures to be used on a patient.
Indwelling catheters are widely used for cesarean deliveries. The devices pose a health risk because it facilitates bacterial entry in the bladder resulting in urinary tract infections. It results in increased hospital stay, more pain for the patients, increased costs on healthcare, and further health complications. The use of catheters can be avoided by analyzing its need in the surgery to prevent its use if necessary. Failure to use catheters in cesarean delivery has better health outcomes and reduces the risk of urinary tract infections.
References
Awad, M. A., Osterberg, E. C., Chang, H., Gaither, T. W., Alwaal, A., Fox, R., & Breyer, B. N. (2016). Urethral catheters and medical malpractice: a legal database review from 1965 to 2015. Translational andrology and urology, 5(5), 762.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.
Jackson, E., Greene, K. A., Wyman, A. M., Patton, S., Prieto, I., & Bassaly, R. (2018). 44: Risk factors for catheter associated urinary tract infections and catheter associated pain in women with voiding dysfunction following pelvic reconstructive surgery: A retrospective case-control study. American Journal of Obstetrics & Gynecology, 218(2), S921-S922.
Meddings, J., Reichert, H., Dueweke, E., & Rhyner, J. (2014). Issues regarding identification of urinary catheter use from medical records. Advances in the Prevention and Control of HAIs, 223.
Moulton, L., Lachiewicz, M., Liu, X., & Goje, O. (2018). Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution. The Journal of Maternal-Fetal & Neonatal Medicine, 31(3), 395-400.
Pandey, D., Mehta, S., Grover, A., & Goel, N. (2015). Indwelling Catheterization in Caesarean Section: Time To Retire It!. Journal of clinical and diagnostic research: JCDR, 9(9), QC01.