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Unfortunate circumstances prevent my attendance at the upcoming Nursing2012 Symposium. There are many sessions I'd love to attend. I'd like to take this opportunity to express my deep appreciation for this journal. I've been a subscriber for 25+ years and it's always helped me give the best care possible to a very diverse patient population.
Editor's note: We hope your circumstances change and you can join us in Lake Buena Vista, Fla., April 25-28! We encourage nurses to visit http://www.NursingSymposium.com for more information.
In a recent Advice P.R.N. department, you advised a reader that changing a urinary catheter before obtaining a specimen for culture is unnecessary ("Obtaining Urine Specimens: Fresh Catheter Required?" January).* This answer was incomplete. According to the Association of Professionals of Infection Control and Epidemiology (APIC), "...If a CAUTI [catheter-associated urinary tract infection] is suspected, the best practice is removal of the old catheter before obtaining the specimen in order to eliminate the confounding factor of possible catheter biofilm. If an indication for urinary catheterization still exists in a patient suspected of having a CAUTI, obtain the urine specimen after replacing the old one."1 Obtaining a fresh specimen from a newly inserted catheter represents current practice standards and is supported by good evidence.2
-TONYA WARREN, BSN, RN
-GLORIA ESCALONA, MS, RN, PHN
San Francisco, Calif.
-STEVEN J. SCHWEON, MSN, MPH, RN, CIC, HEM
1. Guide to the Elimination of Catheter-associated Urinary Tract Infections (CAUTIs). Washington, DC: Association for Professionals in Infection Control and Epidemiology; 2008:13. http://www.apic.org. [Context Link]
2. Trautner BW. Management of catheter-associated urinary tract infection. Curr Opin Infect Dis. 2010;23(1):76-82. [Context Link]
Your response correctly cited the CDC 2009 guidelines, but the CDC also recommends changing the catheter if infection is suspected, and this was not addressed.1 An additional perspective from infectious disease experts was published after the CDC released its guidelines: "If an indwelling catheter has been in place for >2 weeks at the onset of CAUTI and is still indicated, the catheter should be replaced...The urine culture should be obtained from the freshly placed catheter prior to the initiation of antimicrobial therapy to help guide treatment."2 I believe the nurse manager was correct to direct the nurse to use a fresh catheter.
1. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections; 2009:13. [Context Link]
2. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50(1 March):629. [Context Link]
* Individual subscribers can access articles free online at http://www.nursing2012.com. [Context Link]
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