Journal of Hospital Infection 90 (2015) 240e247

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Controlling urinary tract infections associated with
intermittent bladder catheterization in geriatric
R. Girard a, *, S. Gaujard b, V. Pergay a, P. Pornon a, G. Martin Gaujard b,
C. Vieux a, L. Bourguignon c on behalf of the Urinary Tract Infection
Control Group

Unite´ d’hygie`ne et e´pide´miologie, Hoˆpitaux de Ge´riatrie des Hospices Civils de Lyon, Pierre Be´nite, France
Pole d’activite´ me´dicale de Ge´riatrie, Hospices Civils de Lyon, Pierre Be´nite, France
Pharmacie, Hoˆpitaux de Ge´riatrie des Hospices Civils de Lyon, Pierre Be´nite, France



Article history:
Received 22 October 2014
Accepted 9 February 2015
Available online 5 March 2015
Urinary tract infection


Background: Controlling urinary tract infections (UTIs) associated with intermittent
catheterization in geriatric patients.
Aim: After a local epidemiological study identified high rates of UTI, a multi-disciplinary
working group implemented and evaluated corrective measures.
Methods: In 2009, a one-month prospective study measured the incidence of UTI,
controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a selfadministered questionnaire on practices was administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme
to: improve understanding of micturition, measurement of bladder volume and indications
for catheter drainage; limit available medical devices; and improve prescription and
traceability procedures. Detailed training was provided to all personnel on all sites. The
epidemiological study was repeated in 2012 to assess the impact of the programme.
Findings: Over 1500 patients were included in the 2009 study. The incidence of acquired
infection was 4.8%. The infection rate was higher in patients with intermittent catheters
than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P ¼ 0.1013)
which contradicts the literature. In 2010, the 269 responses to the questionnaire showed
that staff did not consider catheterization to place patients at risk of infection, staff had
poor knowledge of the recommended indications and techniques, and the equipment
varied widely between units. Following implementation of the programme, the study was
repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature.
Conclusion: Multi-modal programmes are an effective means to control UTI.
ª 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

* Corresponding author. Address: Unite
´ d’Hygie
`ne et Epide
´miologie, Ba
ˆtiment 3B, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495
Pierre Be
´nite, Cedex, France. Tel.: þ33 04 78 86 12 73; fax: þ33 04 78 86 41 22.
E-mail address: (R. Girard).
0195-6701/ª 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The level of UTI associated with indwelling catheters was similar to the published literature. All the available risk factors established in the literature were included.7 The main result of the study was an abnormally high level of nosocomial UTI associated with intermittent bladder catheterization.6 and at-risk exposures. The UTIC Group consisted of an infection control team (physician and nurses). urodynamics experts. a clinical team (physicians and nurses). They were followed until discharge or until 30th June 2009.. cancer or immunosuppressive treatment).sante-sports. and e positive leukocyturia (104 leukocytes/mL) and urine culture (103 micro-organisms/mL without urinary catheterization and 105 micro-organisms/mL with urinary catheterization) with no more than two micro-organisms. This was a prospective cohort study. UTI antecedents (last six months) and immunodeficiency (leukopenia. subacute care/rehabilitation and long-stay units. a pharmacist and a quality specialist. both on admission and during their stay. / Journal of Hospital Infection 90 (2015) 240e247 Introduction The ‘Geriatric Interclin’ group was created to better coordinate the prevention of infections in six geriatric hospitals of the ‘Hospices Civils de Lyon’. Armonk. Data capture and analysis were undertaken by the infection control team using EpiInfo Version 3. dementia. conducted in other geriatric facilities. Univariate analyses of UTI were performed to compare the risk factors of patients and exposure. and incidence rate per 1000 patient-days attended during the study period. GA. bladder dysfunction. The forms were collected in each unit in a book that included the guidelines. diabetes (treated with insulin/hypoglycaemic drugs or stabilized using hygienic dietary measures). The study focused on clinical UTI. and all the geriatric units in the six hospitals participated.8 and described in the guidelines as follows: 241 e at least one of the following signs: fever (>38 C) or chills. a form was completed by the practitioners and nurses. treatment approval or adjustment according to antibiotic sensitivity. urgency. Intermittent catheterization was only taken into account if it was used before the onset of infection (occasional catheterization for microbiological testing was excluded). cumulative incidence rate per 100 patients followed during the study period. The endpoints were nosocomial UTI. gouv.1 (Centers for Disease Control and Prevention. have shown that urinary tract infections (UTIs) are the most common nosocomial infections.pdf). burning urination. incontinence or recent increase of dysuria or urinary frequency. In 2009. UTIs were considered to be nosocomial if they developed at least 48 h after hospitalization for external patients. The study was advertised on posters in the different geriatric units. Prior epidemiological studies. or to assess the effectiveness of past campaigns concerning indwelling catheters. Compliance was verified by the infection control team. The data collected on exposure were defined based on the literature:7. it was impossible to identify priorities in terms of prevention. A multi-disciplinary working group [Urinary Tract Infection Control Group (UTIC Group)] was created to define prevention priorities and to improve control actions. Girard et al. and use of condoms and nappies. purulent urine in the absence of other causes. An overview of the entire programme is presented in Figure 1.10 type of stay (short and medium stay vs long stay) and dates. and three geriatric units in general Epidemiological studies Similar studies were conducted at the beginning and end of the programme (2009 and 2012). according to the rules of good practice. intermittent or suprapubic) and dates. urinary or suprapubic pain.1e4 In the absence of local data on patient characteristics and the frequency of exposure to at-risk care. present in or admitted to a participating unit from 1st June 2009 to 28th June 2009 were included. adapted from the definition of the US Centers for Disease Control and Prevention. Atlanta. micro-organisms identified and antibiotic sensitivity. controlled for well-established risk factors5. and repeated the epidemiological study in 2012 in order to verify the effectiveness of the programme. The data collected on risk factors were: level of functional dependency measured with a simplified activities of daily living (ADL) score11 (from 0 for independent patients to 6 for fully dependent patients). The UTIC Group conducted practice evaluations and an extensive educational campaign. Population and methods Population Geriatric units at six geographical locations were included in this study. In 2009. The total number of beds was approximately 1200. excluding asymptomatic bacteriuria.12e14 The data collected in the case of a UTI were: date. all hospitalized patients. USA). Z-test for incidence. with the ultimate goal of reducing the rate of UTI. and until discharge or until 30th June 2012. respectively. The following tests were used for comparisons: Mantel-Haenszel c2 test for discontinuous variables (or Yates modified c2 for small numbers). and antibiotics prescribed (initial and adjusted treatments with type of antibiotic and duration). In 2012. USA) and Statistical Package for the Social Sciences Version 17 (IBM Corp. These consisted of three geriatric hospitals with acute care. urinary incontinence. In compliance with French regulations. this type of non-interventional study does not require ethical committee approval if the data are anonymous and if the hospital has been registered previously by a specific research committee. The case definition of UTI used was that proposed by the Ministry of Health in 2007 (http://www. For each patient included. post-voiding residual >300 mL. worsening of dependency or mental condition. presence of nephrostomy. regardless of whether or not they were suffering from an infection. and regardless of the time frame for patients transferred during the study from another geriatric unit taking part in the study. type of urinary catheterization (indwelling. the corresponding dates were from 1st June 2012 to 28th June 2012. and analysis of variance for .9. the Geriatric Interclin group conducted an epidemiological study measuring the incidence of UTI. urinary retention. NY. and was presented at unit meetings.

Girard et al. P < 0. Global schema of the urinary tract infection prevention programme. and (3) to list all available materials. one ‘nurse’ sheet and one ‘pharmacist’ sheet. They were delivered by the infection control team.pdf) and European Given the large number of tests. Three main objectives were identified: (1) to check that local protocols complied with the guidelines.15 Three different forms of collection were prepared and tested: one ‘physician’ sheet. For the second objective. In order to meet the first objective. sf2h. a survey using a self-administered questionnaire was sent personally to every physician and nurse working in the participating geriatric units. Mantel Haenszel c2 test (or c2 test . continuous variables. For the final objective. Data were entered into EpiInfo 2002 and a descriptive analysis was performed. which was associated with a higher risk of UTI in the 2009 study.01 was taken to indicate significance. Multi-variate analysis using a Cox model was performed on nosocomial UTI. the literature and guidelines were reviewed. written according to French recommendations (http://www.242 R. a questionnaire was completed by the hospital pharmacy. / Journal of Hospital Infection 90 (2015) 240e247 First epidemiological study Diagnosis Urinary tract infections are more common with intermittent vs indwelling bladder catheterization Hypothesis 1 Devices not adapted Observation Confirms hypothesis Hypothesis 2 Protocol noncompliant with guidelines Hypothesis 3 Practices not adapted Reviewing Questionnaire study Does not confirm hypothesis Confirms hypothesis Multi-modal programme Second epidemiological study Diagnosis Urinary tract infections are not more common with intermittent vs indwelling bladder catheterization Figure 1. (2) to describe usual practices and knowledge. The references used to check protocol compliance and to describe the stages of intermittent bladder catheterization were defined from a common protocol. considering exposure duration and risk factors that were found to be significant on univariate analysis. Devices and practice evaluation This study focused on intermittent bladder catheterization.

5 days for short. The information was given to each new staff member (physician or nurse) on arrival. between February and May 2011.001 <0. One thousand and fifty women (67.6 52. Girard et al.R.6 56. medical staff. with Yates’ correction when theoretical numbers were <5) was used for comparisons between professions.1 54. At baseline.4). Possibly after indwelling catheters. The difference in distribution compared with 2009 can be explained by the separation of acute care and subacute care/rehabilitation in different hospitals and reduction of long-stay beds. Their mean age was 85.or medium-stay patients and 28. 10. forums etc.9 44. in liaison with the hospital pharmacies.and medium-stay patients. The removal of obsolete equipment and the introduction of new materials were organized at the same time as training. Pre-lubricated catheters were chosen in order to limit pain. risk of urethral stricture and UTI.4 146 84 419 181 40 853 428 9. patient with retention or neurologic bladder (154 patients.16.8%) were included in the 2009 study. and presented at institutional meetings to managers.9 3. regardless of the time course.001 Mantel Haenzel c2 test between 2009 and 2012 data. Concerning the prevalence of risk factors.862 0.17 and e training and awareness-raising meetings for all caregivers concerning aseptic technique (as for indwelling catheters) and new clinical guidelines.6 days for long-stay patients. nurse. and to harmonize the available materials and organization of training sessions. Description of the intervention The aims of the programme were to update and disseminate guidelines for medical prescriptions. The mean duration of follow-up was 10.001 0.5 28. The sessions were held at various times of day and night. new materials and documents) was used.1%) were included in the 2012 study. In June 2009. e improving diagnosis of urinary retention by increasing and improving the use of devices for measuring bladder volume. with no significant difference between males and females. These meetings were held in all geriatric units.9 2. with no significant difference between males and females. A shared training tool (slides.0%). the duration of stay prior to inclusion ranged from 0 days to 10 years. collection of catheter urine samples only if unable to obtain a mid-stream sample. infection control team member) in each hospital.7 11.9 5.836 0. 2012 definition was stricter. the patients included in 2012 did not differ significantly from the patients included in 2009 (see Table I). limited to infections during last six months. and 39. the duration of stay prior to inclusion ranged from 0 days to 10 years. practices and equipment required for intermittent bladder catheterization.710 e 0. with a different training team (physician.7 0. The major difference was in the . Results Epidemiological data For the purposes of brevity.1 63. At baseline.7 7. and 429 for long-stay patients.6 27.and medium-stay patients and 28.420 <0.170 0. 1547 files were completed: 1118 for short. 1510 files were completed: 890 for short. in short sessions.3 292 690 808 892 122 51 153 91 203 182 32 981 336 18.8 2.0 days for long-stay patients. for 2012.681 0.275 <0. Decisions were based on a wide-ranging review of the literature. All other equipment was removed from the units. Comparison includes.9 13. One thousand and thirty women (68.9%) and 497 men (32.2 years (standard deviation 7. e limitation of equipment: either bladder drainage kits (prelubricated catheter pre-connected to sealed bag) or sterile pre-lubricated catheters and sterile bags.2%) and 480 men (31.7 5. In June 2012.1 11. with a median follow-up of 19 days.7 51.4 21. and 35% of patients were enrolled in the study on the day of admission.5 days for short.7 57. and the programme included the following points: e limiting indications: defining specific retention situations.4 10. The mean duration of follow up was 13. so no statistical comparison was made.0).5 years (standard deviation 7. Their mean age was 85. the results of the two studies are presented together.849 0.3 9. so that all professionals could attend.and mediumstay patients and 620 for long-stay patients.2 57.8% of patients were enrolled in the study on the day of admission. / Journal of Hospital Infection 90 (2015) 240e247 243 Table I Presence of confounding factors and exposures to at-risk procedures: prevalence (% patients included) Risk factors Diabetes High dependency (activities of daily living score >4) Dementia Incontinence Retentionb Neurologic bladderb Immunosuppression Post-void residual Infection during previous six monthsc Indwelling catheterization Intermittent bladder catheterizationd Nappy use No exposure a b c d 2009 (1510 patients) Pa 2012 (1547 patients) Patients included Prevalence Patients included Prevalence 268 771 826 866 157 17.

P < 0. but this difference disappeared in 2012 (17.405 859 477 1547 23 9 63 2.38 18.74 2.1 0.9 4. / Journal of Hospital Infection 90 (2015) 240e247 Table II Cumulative incidence of nosocomial urinary tract infection (UTI) by exposure (% patients included) Exposure 2009 Number of patients included Indwelling catheter Intermittent bladder catheterization aloneb Nappy use No exposure All patients a b Pa 2012 UTI N Incidence 181 37 18 11 9. Other UTIs were pyelonephritis (13 cases. In 2009.21 13.4% vs 56. Concerning the difference between intermittent and indwelling catheterization. Escherichia coli remained the most common pathogen. Among the three Morganella spp. No other exposures during the follow-up period.157 0.90 0.349 Mantel Haenzel c2 test between years. Table III Incidence of nosocomial urinary tract infection (UTI) by exposure (& patient days included) Exposure 2009 Follow-up inpatient days Indwelling catheter Intermittent bladder catheterization aloneb Nappy use No exposure All patientsc a b c Pa 2012 UTI Follow-up inpatient days N Incidence 2495 822 18 11 7. patients’ level of dependence. taking into account the duration of follow-up in 2009 and 2012. all these factors.448 17.661 7159 28. As all risk factors included in the study were significantly associated with UTI.1 1.30 1. the difference in terms of UTI observed in 2009 (13.38& vs 7.002). The significant Description of UTI In 2009.6% vs 14. of the 36 E. The microorganisms detected did not differ between 2009 and 2012 (see Table V).305 23 9 63 1.6% of cases of UTI and 1. no resistance was found. 30.8 17. the incidence of UTI associated with intermittent catheterization was much higher than that associated with indwelling catheterization (29. prostatitis (three cases.964). increase in the risk of UTI related to intermittent catheterization found in 2009 was not seen in 2012 (see Table IV). P ¼ 0.244 R.9%. which was generally lower in 2012 (patients with ADL score >4 44. or Yates modified c2 test for small numbers.7 1. cystitis was the most common type of UTI (28 cases. the patients included in the 2012 study did not differ significantly from the patients included in the 2009 study (see Table I).2% of all patients).81&. two were resistant to cefotaxime and sensitive to imipemen.291). and one secreted extendedspectrum beta-lactamase.287 Z-test between years. coli.8%.4% of cases of UTI and 1.21&. P ¼ 0. as well as the type of exposure. Girard et al. Concerning exposure.1%. 4. and the frequency of antibiotic resistance remained low.7% vs 9.170 0. The limited number of patients with nephrostomy (eight in 2009 and seven in 2012) and patients with suprapubic catheters (zero in 2009 and nine in 2012) should also be noted.81 12. The major difference was in the use of nappies. Among the six Klebsiella spp. The sum of all patient data are not the sum of each exposure. and use of closed drainage and sterile pre-lubricated catheters and sterile bags. which was more common in 2012 (63. In 2012.5.8% of all patients).6% vs 51. No other exposures during the follow-up period. In 2012.050) was not seen in 2012 (12.375 6726 29.8% of cases of UTI and 0. the type of UTI was not recorded.255 0. suprapubic catheter data are not presented. one was resistant to cefotaxime and sensitive to imipemen. and one secreted extended-spectrum beta-lactamase. were included in a Cox model.102 0.. .6 0. Result of field studies Protocol conformity The protocol for intermittent catheterization complied with the guidelines with a high level of asepsis.2% of cases of UTI and 1.1%).077 0.45 UTI N Incidence 3064 244 27 3 8..001].2 4. The change in the cumulative incidence of nosocomial UTI between 2009 and 2012 was small and not significant overall or when broken down according to the type of exposure (see Table II).8 Number of patients included UTI N Incidence 182 17 27 3 14. P < 0.381 0.8% of all patients).23 0.2% of all patients). P ¼ 0.30& vs 8.001). 44. 20.9 29. and specific UTIs on indwelling catheters (19 cases.7 853 428 1510 35 5 72 4.358 35 5 72 1.30 0. P ¼ 0. P  0.001). UTI at study inclusion was more common in 2009 than in 2012 [143 cases (9.5%) vs 95 cases (6.26 2. The same was observed for the incidence of UTI according to exposure (see Table III).

435 <0.856e5. The differences in terms of the level of dependency and the use of nappies could be explained by improved understanding of the relationship between nosocomial UTI and these criteria. Enterobacter aerogenes or cloacae Klebsiella (pneumoniae or other) Proteus mirabilis Pseudomonas aeruginosa Morganella spp. Practices and knowledge evaluation concerning intermittent catheterization In total. thanks to the clear messages given during training in compliance with numerous guidelines.298e0. the incidence of UTI associated with intermittent bladder catheterization was higher than the incidence of UTI associated with indwelling catheterization.6 2.22 The results can be considered reliable as: (1) a large population was included.5 1 36 8 1 6 3 4 3 0 1 0 6 1.143 2.R. Only 53 nurses reported their criteria for selecting equipment.5%) preferred urine samples to be taken with a catheter. Aqueous povidone iodine was the main antiseptic used. a Measured with activities of daily living score [numeric data.001]. CI.3%). The protocol was usually consulted to present to students or new members of staff or.055 3.053 1.001 3.286 0.8 4. The frequency of UTI in the present study should be compared with data in the literature.733 0.042 0.960 0. The incidence of UTI in .801 0. For example. (16.4 2.5%). confidence interval. the incidence of UTI has fallen in line with the published literature.001 1.416 1. The devices and equipment available varied widely.8 3. relative risk. The main criterion cited was availability (cited 43 times). in case of doubt regarding the technique.562 0.004 0. more rarely.665e9.5 7. and clamping to stop the drain in the event of a large volume of urine.028e4.458e3. followed by the prevention of infection by the closed system (cited five times). Physicians reported less compliance with rinsing and wiping after genital cleaning. from 0 (not dependent) to 6 (totally dependent)].999 0.681 0.1 10. traceability of actions.659 0.010 RR.2 11.489 0. Discussion The implementation of a preventative programme adapted to the local situation has been associated with the control of UTI associated with intermittent bladder catheterization.3 5.7 6.001 2. / Journal of Hospital Infection 90 (2015) 240e247 Table IV Significant factors for nosocomial urinary tract infection in multivariate analysis using Cox model Factor 2009 Intermittent bladder catheterization alone Post-void residual Indwelling bladder catheterization Level of dependencya Dementia Retention 2012 Indwelling bladder catheterization Infection during the previous six months Intermittent bladder catheterization alone Dementia Incontinence RR 95% CI of RR P 5.252 1. Girard et al. The answers did not differ between physicians and nurses.329e0.295e0. more than 20 different types of catheter were found in one hospital. Staphylococcus aureus Other Gram-positive cocci Candida spp.5 52.21 (2) generalization of closed drainage and lubricated catheters.3 0 1.219 <0. practicality (cited four times) and patient comfort (cited twice). The results showed that oral prescriptions were made occasionally. eight residents (32. especially among physicians [six physicians. and (3) increased availability of bladder scan evaluation equipment and better understanding of its use.035 0.050 6. (2) the population was similar between the two periods. and (5) the medical team did not change between the two periods.924 <0. except for one hospital that recommended the use of a lubricated catheter.2%).18e20 Following the study intervention. Two nurses reported that the bladder drainage kit with integrated bag was awkward because the catheter and hose were too short.501 0. prevention of infection by the closed system (cited once) and availability (cited once). cited by 25 physicians (51.527e9. Available devices Most pharmacies did not provide advice regarding which equipment to use. P < 0.376 1. Not available 2009 2012 N % N % 2 67 12 4 5 11 9 4 8 3 3 15 1.5 0 8. In 2009. Five physicians (13.4%) reported that they always made written prescriptions.3% of physicians) and 230 nurses (63. The effectiveness of this control programme was probably due to: (1) significant improvement in aseptic quality when using intermittent catheterization.005 0. Table V Micro-organisms causing urinary tract infections by year Micro-organism Citrobacter spp.992e3.8 5. (4) the antibiotic resistance patterns were similar for both periods. Few differences were found between the practices of the two groups.849 0. although written prescriptions were the rule: 109/263 professionals (41. (3) the criteria were not modified except for the timeframe for preliminary UTI (only during the last six months in 2012).4 46. and post-void residual was cited by 16 physicians (43. The most commonly mentioned indication was retention.7%). They practised in short-.15. Escherichia coli Enterococcus spp. and more complete data collection.911 1.6 245 The answers regarding the key stages of different practices are reported in Table VI.6 1. contradicting the literature.254 0.173e0.3 2.5 8.8 8.933 0. medium. 269 professionals answered the questionnaire: 31 senior physicians.7 4.2%) vs 135 nurses (58. followed by patient comfort (cited twice).and long-stay units. The questions on prescriptions were the same for both nurses and physicians. Knowledge of the protocol was poor.1 2. and another hospital that recommended the use of a bladder drainage kit.088e1.Eight physicians indicated their selection criteria: the main criterion cited was handy or practical (cited four times).286 0.

Di Stasi SM.1) 163 (70. Int J Antimicrob Agents 2008.117:903e911.26:593e598. Engelhart ST. Ismail NH. Funding sources None. C.7) 191 (83. P. Cochrane Database Syst Rev 2007. Ling ML. Haber N. Kunin CM. J Am Geriatr Soc 2008.8) 3 (8.2) 205 (89. M-E.8) (8. Am J Med 1984.1) (2. Virgili G. Kernig A. Types of indwelling urinary catheters for long-term bladder drainage in adults. Residual urine as a risk factor for lower urinary tract infection: a 1-year follow-up study in nursing homes.4) (18. 1):S68eS78.7) (5.3) 22 (9. 16.2) 25 (10.25. When are indwelling urinary catheters appropriate in elderly patients? Geriatrics 2007.001 9 (24. 8.9) (10. Cracco. 6. The authors also wish to thank the Heads of Units: M. 15. the other two described only prescription practices. Prospective surveillance for healthcare-associated infections in German nursing home residents.31(Suppl. Int J Antimicrob Agents 2006. Seifert-Huhmer A. Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. Paute J.70 <103 0. Colgan R.4) Usually N (%) Nurses (N ¼ 230) Pa Sometimes. a Mantel Haenzel c2 test between nurses and physicians. Enzi G. B.21:179e187.14 0.7) 19 (8. Castel-Kremer. Nosocomial infections in geriatric long-term-care and rehabilitation facilities: exploration in the development of a risk index for epidemiological surveillance.4) 4 (1. Girard et al. N. 13.5) 12 (32.3) 8 (3. Abacioglu H. 9. Kasuga K.96 0. and the data were not analysed separately by type of catheter.74 0. Minami M. Skotnes LH. Bercegol and C. 5. 3. Bacteraemia in the elderly. J Hosp Infect 2005. Bjerklund Johansen TE. Kunin CM. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Kovacs B. Tenke P. Hooton TM. Astagneau P. or Yates modified c2 test for small numbers. prevalence is studied more often.1) 19 (8.2) (29. L.0) 0 (0.46:186e193.9) 183 (81. Uysal U. B.9) 8 (3.7) 61 (26. Hospital-acquired infections in elderly patients: results of a West Anatolian University Hospital surveillance. Bonnefoy. Genitourinary infections in the patient at risk: extrinsic risk factors. Gengler. Mauranne. Michel-Laaengh.22:746e753.7) 99 (43. Ucku R.3) 73 (31.37:259e263. Scholes D. et al. / Journal of Hospital Infection 90 (2015) 240e247 Table VI Intermittent catheterization practices Physicians (N ¼ 37)* Steps and devices Always N (%) Washing with soap Rinsing Wiping Antisepsis Hand disinfection Sterile gloves Sterile closed drainage Lubricationb Clamping if >500 cc in bladder Transmission 22 19 17 19 23 23 11 12 15 (59. coli amongst the pathogens has also been reported in other studies.28(Suppl.6) 14 (6.246 R. Tambyah PA.4) (62. but the improvements need to be sustained. good communication about cases of UTI. Gupta K. Albrand and E. Intermittent catheterization with a prelubricated . Omli R. Naber KG. Nicolle LE.8) 14 (6.82 0. French Prevalence Survey Study Group. Matsumoto T.26 This work indicates that interventions to prevent UTI were acceptable in the group of study hospitals.0) 42 (18. Sergi G. Sato S.24 These comparisons are limited as few studies have investigated incidence. Kuhry E. rarely or never N (%) Always N (%) Usually N (%) Sometimes.40:643e654. 14.04 0. Gouot A.1% of patients and 2. Recent studies in geriatric units have found similar cumulative incidences23 and similar incidence rates. Training of new staff (nurses and physicians).5) (51.5) 5 (13.3) 4 (10. References 1. Inelmen EM. Predictors of urinary tract infection after menopause: a prospective study. Porena M. Scivoletto G. 11. Demura S. rarely or never N (%) (8.9) 0 (0.9% of patients with indwelling catheters.60:46e50. 1):S78eS81. Infect Control Hosp Epidemiol 2001. Andre ´-Foue ¨t. Ellidokuz H. J Physiol Anthropol Appl Human Sci 2002. Ann Acad Med Singapore 1997. Golliot F.9) 105 (45. Kramer MH.23& of patient-days. J Hosp Infect 2000.9) (18.0) 4 (10. Langer G. Conflict of interest statement None declared. Hanses-Derendorf L. including 11. 37 described their practices concerning catheterization.9) (51. Am J Med 2004. 2. Oltra.1) 0 (0. Arch Gerontol Geriatr 2003. Longitudinal assessment of ADL ability of partially dependent elderly people: examining the utility of the index and characteristics of longitudinal change in ADL ability. Schaeffer A. Urinary-catheter-associated infections in the elderly. Mykletun A. Bakke AM. Lieu PK.1) (18.4) 10 (27. Fihn SD.1) (8. G. Boyko EJ. Acknowledgements The authors would like to thank the members of the UTIC Group: E. French Prevalence Survey Study Group. 12.4) (45. B.5) 36 (15. the study population in 2012 was 4. Moindrot. N. [Incidence and clinical characteristics of symptomatic urinary infections in a geriatric hospital]. Krolak-Salmon. Bradley S.5) 24 (10. Okra N.121 0.56:871e874.1) 31 (13.5) <103 3 7 4 3 3 1 2 7 7 *Of the 39 physicians that responded to the study. Rice JC. Abraham L. Depagneux. J. 4. The predominance of E. Lien CT.3) 0.76:131e139.5) 16 (7.0) 2 (5. b Pre-lubricated catheter or lubrication using sterile gel. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Exner M.62:18e22. 10.4) (40.7) (32. Giannantoni A. Jackson SL.2) (62.0) 198 (86. Brucker G. Jahn P. Clin Infect Dis 2005. Dolci S.0) 173 (75.2) 10 (4. Comte.5) 189 (82.7) 8 (3.3) 0 (0. Preuss M. Martignolles.8) 36 (15. 7.3:CD004997.8) 172 (74. Med Mal Infect 2007.0) 5 (13. Rothan-Tondeur M.37:664e672. Cassou B. observation of practice and further epidemiological studies will be prioritized.

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