How catheter use influences UTI risk

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A urinary catheter is a flexible small tube that is inserted into the bladder to allow urine to drain⁽¹⁾. Catheters are used for various reasons and can be used in healthcare facilities, or at home. Long-term catheter usage at home is common for people who experience urinary incontience and urianry retention⁽²⁾. In a hospital settings, catheters may be used for urine testing, or therapeutic purposes to support urine drainage.

UTIs are one of the most common infections acquired in healthcare facilities. The CDC reports that 75% of UTIs in the hospital setting are associated with a urinary catheter⁽³⁾.

Let’s dive into understanding what a catheter is and how they can influence UTI risk.

Catheters can be used when there are complications with the process of urinary drainage. These complications can be long term or short term, and are generally used for therapeutic or diagnostic reasons to support the process of urinary drainage⁽⁴⁾.

Acute or chronic urinary retention

• Urinary retention can be due to an obstruction, meaning something could be restricting or blocking the flow of urine. Urinary retention could also occur during inflammation and infections such as cystitis (inflammation of the badder), prostatitis (disorder of the prostate gland usually associated with inflammation), vulvovaginitis (swelling or infection of the vulva and vagina), and urethritis (inflammation of the urethra). Urinary retention could also occur in certain disease states such as multiple sclerosis, Parkinson’s Disease and dementia as well as injuries to the brain and spinal cord, and cerebrovascular accidents⁽⁴⁾.

Medication

• Some medications can also cause urinary retention – elderly individuals are at higher risk of developing this type due to the existence of co-morbidities like BPH and the use of medications that treat their comorbidities⁽⁵⁾.  

Medical procedures

• Someone may also need a urinary catheter after having a urological and gynecological operation⁽⁴⁾.

Bladder control

• Bladder related conditions such as neurogenic bladder dysfunction (when someone lacks bladder control due to a brain, spinal cord or nerve condition), urinary incontinence, and bladder irrigation⁽⁴⁾.

Diagnostic

• In some cases urine may need to be collected for testing purposes such as urinalysis using a catheter⁽⁴⁾.

Other instances

• Patients who require close urinary output measurements⁽⁴⁾.

Due to the difference in length of the urethra in males and females, there are some differences in catheters. Male catheters are much longer because the male urethra is longer compared to the female urethra length. Males can also use a condom catheter that goes over the penis and has a tube that drains into a bag⁽⁶⁾.

• Intermittent catheter: These single use catheters are typically inserted by the user and help empty their bladder at regular intervals during the day.
• Indwelling catheter: also known as a Foley catheter. This is inserted into the bladder via the urethra, or the abdomen (supra-pubic catheter). There is a balloon at the tip of the catheter that keeps the catheter from slipping out of the bladder. The catheter drains into a collection bag.
• Condom catheter: A condom-like device that goes over the penis and has a tube that drains into a bag⁽⁶⁾.

UTIs attributed to catheter use are one of the most common infections acquired in health care facilities⁽⁸⁾. In fact, approximately 75% of UTIs acquired in hospitals are associated with urinary catheter use⁽¹⁾.

One of the factors that increase UTI risk for catheter users is the duration of time a catheter is in use⁽¹⁾. A catheter-associated UTI occurs when bacteria enter the urinary tract via the catheter and cause infection. The longer a catheter is inserted, the more time bacteria has to travel to the urinary tract and cause an infection. This is why it’s important that catheters only be used for appropriate indications and should be removed when they are no longer needed⁽⁹⁾.

• For long-term catheter, ensure hands are clean before and after touching the catheter.
• Check the position of the urine bag to ensure it’s always placed using proper technique.
• Only use a catheter when appropriately needed.
• Talk to your healthcare provider to understand why a catheter is needed and frequently ask if the catheter is still needed.
• Do not tug, pull, twist, of kink the tubing of the catheter^(9).

While these tips can help reduce the risk of infection, it’s important to remember that every body and situation is different. If you are using a catheter, we recommend talking to your doctor or a healthcare professional to ensure that you are taking the proper precautions to prevent an infection.

1. Catheter-associated urinary tract infections (CAUTI). (2015, October 16). Retrieved from https://www.cdc.gov/hai/ca_uti/uti.html
2. Lachance, C. C., & Grobelna, A. (2019). Management of Patients with Long-Term Indwelling Urinary Catheters: A Review of Guidelines. Canadian Agency for Drugs and Technologies in Health. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31449368/ 
3. Catheter-associated urinary tract infections (CAUTI). (2015, October 16). Retrieved from https://www.cdc.gov/hai/ca_uti/uti.html
4. Haider, M. Z., & Annamaraju, P. (2022). Bladder Catheterization. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK560748/ 
5. Verhamme, K. M., Sturkenboom, M. C., Stricker, B. H., & Bosch, R. (2008). Drug-induced urinary retention: incidence, management and prevention. Drug safety, 31(5), 373–388. https://doi.org/10.2165/00002018-200831050-00002
6. Catheters - Continence Product Advisor. (2022). Retrieved from https://www.continenceproductadvisor.org/catheters
7. Self-catheterization (clean intermittent catheterization). (2020). Retrieved from https://my.clevelandclinic.org/health/treatments/15434-clean-intermittent-catheterization
8. Nicolle, L.E. Catheter associated urinary tract infections. Antimicrob Resist Infect Control 3, 23 (2014). https://doi.org/10.1186/2047-2994-3-23
9. Frequently asked questions about catheter-associated urinary tract infections. (2010, November 24). Retrieved from https://www.cdc.gov/hai/ca_uti/cauti_faqs.html