Catheter-associated Urinary Tract Infection (CAUTI) with Case Studies (Part I).

Catheter-associated Urinary Tract Infection (CAUTI) with Case Studies (Part I).


[ Silence ]>>Good morning everyone and
welcome to our third and final day of the 2014 NHSN Training Course. We want to acknowledge again, all of you here who have given your undivided
attention and great participation. Everyone in the room as well as
everyone watching the live web-stream, we do appreciate your participation. I have multiple updates that I’ll give
throughout the day but I have a couple of important things that you’ll
need to know first thing. We wanted to remind you that the
evaluation forms are in the back on the back table outside of this room. I was told that if you are getting CE’s,
well, when you apply for that you’ll be able to do the evaluation on the computer so you
don’t necessarily have to complete it today. But if you aren’t going to be
applying for CE’s then we ask that you do complete the evaluation form today,
and leave it on the table before you have to go. We really appreciate your feedback and
your input and it is important to us, so we do ask that you complete that
if you are able to give your input. With regards to feedback and input we wanted
to let you know, we know some of the people in the front have a hard
time with the bright lights. We can’t unfortunately dim the lights any more than we already have because
of the live web-streams. So we apologize if they’re a little
bright or hot on the tops of your heads. We also know that the round tables
haven’t been ideal for you in the room. Again, hoping that you’ve been able
to see the presentations with all of the drop-down slide viewing but I know
it’s difficult if you have to have your back or have to turn around to face the front. Just so you know, the reason we chose to
do it this way was because we really wanted to maximize the amount of people we could get in
a room and get here to this in-person training so that you’d be able to actually
be in the room if you wanted to. So many people enroll and register to try to get
on the random list that we felt that we should, you know, try to do this so that we
could maximize to the 300 or over, but we will evaluate for next year to see if there’s any way we can fix
that or get a bigger room. Let’s see, I wanted to remind you that the team
outside the door is in the back to help you with your transport to the airport. So, they can help you with all of that but they
need you to sign up on a sheet and let them know when your flight is so that
they can group people together and make sure everybody gets
to the airport on time. And if you are leaving early, which we
want you to stay today as late as possible to hear all the important information being
presented today, but if you do need to leave and you know that it’s going to be ahead of
schedule, please let them know now or as early as possible so that they can make sure
to set you up front aside to get you out early for the transportation. We ask that — oh, yes this is very important. So, you have met many of the individuals
who answer the NHSN mailbox for you. There is a group of user support
team that you were not able to meet because they were not presenters and they’ve
actually been working behind the scenes to continue to answer the mailbox of questions
that come in over the course of this training and are always the front line
individuals that help you. So there’s a group of those. The individuals, the infection preventionists,
a lot of the data analysts, data analyst methods and analytics team, you’ve met here, so
now you know that there’s not hundreds of people behind the scenes
available to answer your questions and when we give the training we always know
that there’s going to be a hike in the mailbox because of all the important
information that was presented. So over the next few weeks the
mailbox is going to double. Over the next two weeks we’re actually down
one IP because she’ll be away for two weeks, so we ask that you give us a little
bit of leeway and understanding if it takes a little bit longer to
answer questions in the next few weeks and give us your support with that, just
to make sure that we catch everybody back up with all the information
that’s been presented. So we just wanted to bring that
to your attention because I know when you ask questions it’s very important and you need those answers
because you need to do your job. We do recognize that too, so we will do the
best that we can to keep up with the questions that already have begun to
come in in these past two days from viewers watching the live web-streaming. And a reminder for these
presentations, they’ve all been taped. They will be archived and posted. We expect them to be up by mid to late April
and this way for your reviewing pleasure, and anyone that you want to pass the information
on to — individuals who couldn’t come, people who weren’t able to get
onto the live web-streaming. They will be broken up into
sections and sessions by topic so that individuals can watch them when
it fits into schedules and do it even in a little more piecemeal
than three days in a row. Because I know it’s a lot
of information to take in. There’s something you might want to watch
again, it’ll be available for you to watch. So I think with those, I will have
Kathy come up and talk about CAUTI, and we’ll give some more
announcements right before lunch. Thank you. [ Applause ]>>Good morning. Well, today we’re going to talk
about catheter-associated UTI’s, and we’re going to try to have a little bit of
fun today so, since you’ve had two long days. Hopefully you’ll enjoy this
morning’s presentation. So, I’m am going to have to cover a little
bit of information that I’ve already covered, such as HAI definitions, POA’s, because we
have people tuning in for the web-streams that may have not listened to
the [inaudible] definition. So if you want to tune out in those situations
you can, and hopefully you’ll tune back in when it’s something new for you,
but just a little bit of a warning. So, today we’re going to go over
the CAUTI, definitions and key terms that are utilized in CAUTI surveillance. We’re going to talk about how to collect
the urinary catheter and patient data. We’re going to again identify the data
collection forms and then we’re going to apply the definitions to
some patient case studies. So, same general overview
that we’ve done in the past. And we’re going to cover the epidemiology,
the definitions, and the changes for 2014. Talk about denominator collection
and I’ll provide you some resources, we’ll do case studies, and then lastly I
do want to give you an update on, you know, what’s going on with the CAUTI definitions. You probably have heard that we
are reviewing those definitions. We’ve actually been reviewing them since the end
of 2012 and hope to have some changes for 2015. I might not be able to give you a
lot of specifics because I’ve learned that don’t give specifics until it’s
actually totally done because as sure as you know what it’s going to change. So — but I can tell you what, you know,
what is being done and then for those of you that are coming to APIC I’ll also be going
a presentation there and maybe I’ll be able to give a little bit more
details at that time, so. So again, we’re not going to go over in-depth
today requirements for the Centers for Medicare and Medicaid Services Inpatient Quality
Reporting Program or the Oncology, the Cancer Exempt Hospitals Reporting. All that information’s available
on our website or through the QIO’s and I’ve provided you those resources here. Also, we will not be going through step by
step data entry and Maggie’s been covering all of the data analysis for us very
well, so we don’t have to do that. So, CAUTI’s, who cares about CAUTI’s? Right? Who cares? Urinary tract infection is tied, believe
it or not, you probably know this, with pneumonia as the second most common
type of health care associated infection, and it’s really only second
to SSI’s in overall incidents. And we know that the majority of them
are associated with indwelling catheters. I don’t know if you’re aware but a
little over 5% of ICU CAUTI’s result in bloodstream infections and in
non-ICU CAUTI’s that is up to about 7.4. So, interestingly enough, higher
secondary BSI rate outside of the ICU. 13,000 people die every year for UTI’s,
so you know, it does cause some morbidity and mortality, and interestingly, up to
1/3 of asymptomatic bacteriuria is treated with antimicrobials even though this is, you
know, in conflict with published guidelines and results in a lot of unnecessary
antibiotic usage, C. difficile infections, adverse reactions. And so, that’s one of the main reasons that
ASB was removed back in 2009 from our criteria. So, it’s important for us to shine a light, sort
of, on CAUTI and what we can do to prevent that and how we can treat it and
identify it correctly. And a lot of people are saying now that, you
know, CAUTI’s may be a proxy measure for the overall general quality
of care for patients. So, you know, that’s another reason that we might be concerned
about what happens in this area. So again, we just want to make sure that
all of our data that we enter is good data. And so, things to consider
for CAUTI surveillance. So, nice thing is that unlike SSI
surveillance, all CAUTI’s are going to require a positive urine culture. So you can start with your laboratory
as your basis for case finding. So hopefully you’re all able to
get a routinely generated report of your positive urine cultures
and that’s your starting point. But I do want to point out that
it’s really important for you to know your laboratory’s urine
culture reporting policies. Specifically, what are the ranges of
colony-forming units that they’re reporting? Some facilities don’t report down to
10 to the third, which is, you know, part of the definition for UTI’s. Some of them don’t quantify yeasts, and so your
facility’s not able to meet all the criterias that are currently written since we include
yeast as a pathogen for CAUTI’s at this time. Sometimes positive urine cultures are reported
for the unit on which they were collected and not necessarily on the
unit that the patient is on. So you may need to check to make
sure that you’re attributing that CAUTI to the right location. It seems to happen a lot with
patients that are discharged. Sometimes the discharge location — or
location for the culture is not accurate. So just — you need to consider
the transfer rules and how the laboratory report
might be affecting that. And finally, you know, just to take into account
that you need to account for positive cultures from the Emergency Department because those
could really represent CAUTI’s from patients that had recently been discharged
and might be — should be attributed to that
discharging location. So again, what are you going to look at first
and where is it going to be on the record? Those are, you know, things
that you need to think about. You’re going to be looking for your urine
culture results and your laboratory results. And then probably what you want to look
for — unless you’re in Pennsylvania, most facilities — not a lot of
facilities are doing surveillance for non-catheter associated UTI’s,
so you know, you’re going to look — maybe the next thing you look at is whether or not they had a urinary catheter
in place in the time period. You know, and you’re going to be
looking for nursing documentation and graphic sheets for those
types of information. This is a sample worksheet that, you know, that
we put out for your use for data collection. You guys — some facilities create their
own data collection sheet, which is fine, just as long as it collects all of
the information you need for NHSN, but this one is available
on the website for your use. And then, you know, the old spiel about making
sure that we’re all doing things the same way. I went over this pretty well with CLABSI. You know, we need to all be
consistently applying the definitions. Standardizing your chart review will
help you to be consistent over time. So if you get into a routine
of how you collect data and how you identify cases,
that will really help. Maintain the focus on the criteria
and don’t deviate from that. CAUTI is one of those areas sometimes where
people feel that maybe they’re not capturing all of the patients that they
clinically believe have a UTI. We hear this a lot with patients that are on
ventilators or spinal cord injury patients, maybe because, you know, they’re not
able to communicate, for whatever reason, suprapubic tenderness or CVA pain. Surprisingly, though, honestly only —
well, 80% of our patients that are reported as CAUTI’s have fever as their only symptom. That may be surprising to you or it may not be. So, if you think about it that way,
the spinal cord injury patients or the ventilated patients
are maybe not that different. I mean, most patients when we identify
it it’s through the use of a fever. You know, the other thing to think about
with that, I always tell people is that just because a patient is ventilated doesn’t
mean they can’t communicate pain. Especially with these sedation vacations
and depending on the level of sedation, patients can exhibit signs of pain if
their physical assessments are done. So, I don’t — I always hate for people to
just say, “Well they’re on a ventilator, we can’t tell whether or not
they have an suprapublic pain. So that’s not always the case. So again, think about surveillance definitions
versus clinical definitions and the fact that sometimes the two are not going to meet. You know, we’re looking — we’re using
the definitions for surveillance different than clinicians are using to make
determinations about what’s going on with a patient and what they should do. And our data elements are going to be limited. They’re going to be finite
and the clinicians are able to use everything that’s available to them. So, it’s okay if they don’t always match. We obviously try to make our criteria so that
they are as close to clinical definitions as possible, but we have a long way
to go, especially in CAUTI, I know. But we are definitely working on that now. Was that a laugh [laughter]. So, sometimes, you know, sometimes it’s
helpful to remind your staff about surveillance or to educate staff about
surveillance in clinical definitions. How many people here have had to have
this conversation in their — yeah. Yeah, yeah. Yep. And surprisingly, sometimes it’s infectious
disease physicians that you have to have that conversation with, which
is always surprising to me because I would have thought
they understood that. But we always want to make sure obviously
that we’re using the surveillance definitions as a determinant of what we report. And we’re always here at
[email protected], as Dawn told you, to receive your questions
and try to help you out. Oh! So, I want to make a disclaimer. I thought it would be fun if I
shared some of the funny emails that we get from users, because we get some. I didn’t include any identifiers
on these, so if it’s from you and you recognize it don’t
tell anybody [laughter]. And they will not know. So I’m going to share — as we go
along today I’m going to share a couple of funny emails that we have gotten. So, here’s one that I got from a user. She said, “I am looking at a patient that
presented to our facility on 2/15/13. A Foley was placed in the
ER on the admission date. During her stay she was afebrile
and symptom-free with one exception. A temp of 102 was documented at midnight. The nurse manager feels that this is possibly a
misdocumentation and would like some guidance. Do we still call this a CAUTI?” No, you can just discount that [inaudible]. Don’t worry about it. It’s probably a mistake. Yes, you have to still call this a CAUTI. All right, so we’re going to get into
the nuts and bolts of the definitions and we’re not really going to be talking about
non-catheter associated UTI’s here today. As you may or may not know, they
have their own criteria designated as the B criteria’s for SUTI. The A criterias are all catheter-associated, the
B criteria’s are all non catheter-associated. And I want to identify that ABUTI
can also be non-catheter associated or they can be catheter-associated. And if you are determining
whether or not an LCBI, BSI is secondary to a non-catheter
associated UTI, you have to make sure that you use non-catheter associated
definitions and you’ll see as we go along, if you don’t already know, why that’s important. So, there are basically two
specific types of UTI. Symptomatic UTI, or SUTI, or
an asymptomatic bacteremic UTI, or ABUTI, as we like to refer to it. I do want to point out sometimes people are
confused between asymptomatic bacteremic UTI and asymptomatic bacteriuria or
ASB, which we used to have in 2009. Asymptomatic bacteriuria just means
that there are organisms in the urine, but an asymptomatic bacteremic UTI is one
where there’s not only organisms in the urine but there’s also a matching
organism in the blood stream. So the patient has a blood stream infection
as a result or concurrently with the UTI. So that is the difference,
they’re not the same animal, and it’s important that you understand that. Both types of infections, both SUTI’s and
ABUTI’s, if they’re catheter-associated, need to be reported as part of any CMS,
CAUTI surveillance that you’re doing. That’s another thing that’s sometimes
people don’t quite understand. You can’t just report the SUTI’s,
you also have to report the ABUTI’s. So, you know, over the years as
I’ve presented this information, I’ve presented it in different ways
and sometimes it’s hard for people to understand the logic of why
the definitions are as they are. Sometimes they seem like they’re really
complicated, so I’ve tried to present it in different ways and this
time I thought I’d tell you — just present the logic behind
the SUTI definitions. And one of the important points is that the
symptoms of a true UTI are going to vary whether or not the patient has a Foley in place. If the patient has a catheter in place they’re
going to have urgency sometimes, you know. I mean, how many people have had a patient and
they said, “I’ve got to go to the bathroom.” And you say, “You’ve got a
catheter in, just relax.” You know, “You can go.” So, that foreign body causes urgency, it can
cause burning, a burning sensation sometimes. You shouldn’t be having frequency,
so we took those out of patients — you know, they used to be in the
criteria for patients that had Foleys and they didn’t make any sense to be in there. So that’s why we’ve taken
them out of the criteria for patients that are currently catheterized. Infants, we know exhibit different
symptomatology as well for infections and that’s why we provide some infant-specific
criteria, and those additional ones are apnea, bradycardia, lethargy, vomiting, or hypothermia. Because, you know, patients can have instability
in temps when they have an infection. So, these are sort of the two big concepts of
why we have some complexity to our UTI criteria. So this is sort of an overview
of the UTI definitions. So, we can see that I’ve
divided these by age groups. SUTI one and SUTI two are
for patients of any age. SUTI three and SUTI four are for infants. And then we have our ABUTI’s, which
again, are for patients of any age. Now, I told you yesterday that infants not only
can meet these but they can meet any of these. It’s just the patients that are over one
year of age that cannot meet three or four. Okay. Within each of these different
types of UTI’s we have catheter-associated or non-catheter associated UTI’s. Make sense? All right. So now we’re going to look at how the
colony-forming units are applied to these. So, for SUTI one and SUTI three
we’re dealing with patients that have at least 100,000 colony-forming units. And I have an asterisk here, you’ll
notice that it goes down to — they have to have no more than two
organisms in that urine culture. And that’s because we want to make sure that
this is not a contaminated urine culture. If there’s three or more organisms
the chances are pretty high that that’s been just a poorly
collected culture, we don’t want to use it to
say that somebody has a UTI. We don’t want to over-call these UTI’s. ABUTI also requires greater than 100,000. You’ll never have an ABUTI that has less
than 100,000, and that’s for a reason. You know, we — this patient is asymptomatic,
so we want to have a high degree of — as high a degree as we can of
confidence that this is truly a UTI and so that’s why we’re going to require
a high colony-forming unit count. You’ll notice, though, there’s two
stars there and that means that not — we don’t use organisms, we use uropathogens. So there cannot be more than two uropathogens and we provide you a list of
what those uropathogens are. It’s a pretty broad list, but there are a
few organisms that are not on that list. That list is included in
the NHSN CAUTI protocol. I’m trying to remember. I think we have it on our organism
list, too, that’s on the website where we have MBI and we have common commensals. People are nodding, so. So that leaves SUTI two and SUTI four. So you’ll notice that one of the infants,
the SUTI three, has 100,000 or more. One of the infants has greater
than 1,000 or less than 100,000. So we have adult and child, adult and child. Or, I say adult — any age
and child, any age and child. So this group here, SUTI two and four
have a lower colony-forming count, 1,000 or more, but less than 100,000. Again, no more than two organisms
in the culture. Because this is a smaller colony-forming
count, we are going to require some symptoms — I’m sorry, some supportive positive
UA to give more credence to the fact that this is truly a good culture
and indicative of an infection. So that’s why this criteria requires this lower
level colony count and a supportive positive UA, again, within a time period of no more than
a single gap day between adjacent elements. Okay. Is this a good way to present this? Does this make sense? Okay. Good. Thank you for the feedback. Okay, so when we’re looking at a symptoms really
the main question that you have to ask yourself, and I went over this a little bit, was the
catheter in place at the date of the event? If the answer is yes, then you’re going to have
a limited number of symptoms that you can use. You can only use suprapubic tenderness,
costovertebral angle pain or tenderness, or fever greater than 38 degrees Celsius. If it’s a baby you can additionally
use hypothermia, less than 36, apnea, bradycardia, lethargy, or vomiting. Okay? You’ll notice what we’ve taken
out of there when you look at the no. So there was no catheter in
place on the date of the event. You’ll see here I bolded. You now have dysuria, frequency,
or urgency that you can utilize. And then you have all that
you had for the yes answer. You have your suprapubic tenderness, CVA pain or
tenderness, fever, and then the infant criteria. So we simply remove these
three, dysuria, frequency, or urgency if the catheter is in place. As I said, when there’s more than two species
of microorganisms that’s routinely regarded as a contaminated culture and we
don’t want to use it for NHSN. We do get questions about culture
reports that come back as mixed flora, and generally mixed flora represents
more than two organisms, two species, so if you have mixed flora and you
have any additional organism recovered from the same culture that’s going
to have more than two organisms. So, for example, if you have to
report that maybe there’s a greater than 100,000 Pseudomonas
aeruginosa, and there’s mixed flora, clinically we probably would
believe that greater than 100,000, but unfortunately we have mixed flora
in there so we can’t utilize that. This is one of the issues that we’re kind of
talking about with the new definitions also. You know, can we say if there’s
a preponderant organism, can we say that that should be utilized? As it stands right now, in that situation
you would not use that culture report. If the organisms are the same
genus but two different species, they’re considered two different organisms. So if you had a Pseudomonas and aeruginosa — aeruginosa and a Pseudomonas stutzeri
[assumed spelling], that’s two organisms. If you add anything onto that you’re
not going to be able to use the culture. And kind of the flip side of
that, if you have an organism that has just simply the same organism but has
different susceptibility pattern such as MRSA or MSSA, those are considered just
one organism because, you know, we know that how the laboratory works those
up they may just pick different colonies from, you know, that — cultures or colonies
that represent the same organisms and there is some variation
and resistance within those. So, we don’t want to say that those
are different organisms all together. So those will be considered just one organism. Okay. Sometimes, obviously patients will
have a positive urine culture — excuse me — shortly after their catheter is removed. So, for those patients if
the event date, the UTI date, is on the day of device discontinuation or the
following calendar day, just like for CLABSI, these are going to be considered
device-associated. As long as the device had already
been in for greater than two days. And, for this criteria you are
able to utilize urgency, frequency, and dysuria because the catheter
has been taken out. So I’ve given you two examples. First one, the Foley is placed and
it’s there, it’s placed on day one. Day two it’s still there. Day three it’s in place for part
of the day and then only for part of the day and then it’s removed. The next day the patient meets UTI criteria,
this is going to be considered a CAUTI. Unlike here, where the Foley’s placed
on day one, it’s taken out on day two. It was there for part of the day, taken out. The next day they have no Foley
and they meet criteria on day four. That is going to be a health care
associated UTI, but it’s not going to be considered a catheter-associated UTI. Whether or not you clinically agree with that
or not, that’s the definitional interpretation. Okay. So let’s just go over
the criteria as a whole here. So these are the A criteria
for SUTI’s, symptomatic UTI’s. A, meaning that these are going
to be catheter-associated. On the first you’ll see its split,
the first half of this is for patients that have the catheter in
place on the day of event. The second half are for those that
had it in for greater than two days but had it removed the day of
or the day before the event. Okay? So for the first ones, it’s in
place, it’s been in place for greater than two days on the day of event. They can have fever, suprapubic
tenderness, CVA angle pain or tenderness, and they have to have a positive urine
culture of greater than 10 to the fifth, and no more than two species of microorganisms. And again, the gap day for
— single gap day does apply. If the catheter had been in place for greater
than two days and it was removed the day of or the day before the event, then we add in
dysuria, urgency, frequency, and then, again, fever, CVA, suprapubic/SP tenderness, and the
same requirements for the positive urine culture of greater than or equal to 10 to the
5th and no more than two microorganisms. Now, you’ll notice that there is an asterisk
here for with no other recognized cause and for those astute clinicians, you’ll
notice that it’s not there for fever. And this is one of the questions that
we get the most and one that, you know, we are discussing how best to approach this. The reason it’s not there is because, to allow
— and this happens more with CAUTI than it does with CLABSI because, you know, with CLABSI
one you don’t have to have any symptoms. But you know, if the patient has a pneumonia
and they have a positive urine culture because they’ve pan cultured the patient,
if the fever is there the fever has to be utilized to meet the UTI criteria. If you’re doing pneumonia surveillance, you’ll
also have to use it for the pneumonia criteria, and that’s because at this point
we haven’t figured out a good way to operationalize clinical
judgment about where that UTI go — or where that fever is responsible for. And it may be responsible — it
may be due to both infections. If the patient has both infections they
may be running a fever because of both. I mean the body doesn’t —
does the body differentiate? I don’t know. So, the only way I think that we could
get around this would be if we were to identify a hierarchy of infections. Okay, if they have this and they have
this infection and this infection, you apply the fever to this infection. But you see that quickly becomes very complex. And so, that’s what we’re wrestling with. So for now the fever is a non-specific
symptom and you have to apply it to all potential infection types. Criteria in two, again this is in A so these
are catheter-associated infections you’ll see. Two, again, is for those patients that have
less than 100,000 but greater than 1,000. If the catheter is in place the symptoms
are exactly the same as they were for A. You’re going to have those symptoms
minus dysuria, frequency, and urgency. Additionally, however, you’re
going to have to have a positive UA and by positive we mean a dipstick that’s
positive for leukocyte esterase or nitrite. Or pyuria, that means greater than
or equal to 10 WBC’s of unspun urine. How many of you know whether or
not your lab spins your urine? Okay, how many of you don’t know? Yeah, so you need to see if it’s being reported
out to you or if not you need to clarify that with your laboratory because if it’s
spun urine, it’s greater than or equal to 10, if it’s unspun urine they’re going to be
looking at it under a high-powered field and it’s greater than five WBC’s to be positive. Okay? And, you could also
meet this using a gram stain if there’s microorganisms seen on unspun urine. Not many laboratories do this anymore. Questions that we do get
sometimes is what is trace? Is trace positive? Yeah, trace is positive. So if you have a trace leukocyte
esterase, it’s positive. Just like with one A; you know, we have
this top portion that was in place. We have the bottom portion that the catheter
was taken out the day of or the day before, that means that we’ve added back
in urgency, frequency, or dysuria. Just as above, this is the ones that have equal
to or greater than 1,000 but less than 100,000. And they have to have one
of the same positive UA’s. So the only difference between the top and the
bottom is the additional criteria of urgency, frequency, and dysuria, if the
catheter had just been removed. Clear? Yeah? Looks like everybody’s with me. Yay. So I’m not going to go over this diagram, I just want to point out
that it is in the protocol. Some people are very, you
know, they do much better with a flow chart than they do all of the text. So we do have it there. One is for — this one it happens
to be if the Foley is in place. We have one if the Foley is removed. There are similar flow charts
for three and four and for ABUTI. Now the criteria for the infants, one
year of age or less, is very similar. You’ll notice that three is very similar to one in that the colony-forming units is
greater than or equal to 100,000. The only difference between the adults — or
the all-age criteria and one and the three is that we’ve added, again, hypothermia,
apnea, bradycardia, lethargy, and vomiting. Other than that it’s exactly the same. The one difference that I’m going
to say is that you’ll notice that we have two asterisks down here. Rather than splitting this up, we have
simply said between those patients that have the catheter or those that had
it removed, we’ve just asterisked down here that if they had the catheter in place for
greater than two calendar days with the day of device placement being done and the
catheter was placed on the date of event, that they can utilize these symptoms here. Four is very similar to two, it’s the analogy of
two in that the colony-forming count is lower, it’s greater than 1,000 less than 100,000. Because of that you need a positive UA. The positive UA results are no different
for children than they are for adults. And, again, those additional
symptoms that I mentioned above. So, this, just to point out that this
double asterisks is how you’re going to determine whether or not this is a
catheter-associated device — or UTI or not. Asymptomatic bacteremic UTI — I’ll give you
a little bit of background for those of you that don’t know how this definition came about. Back in 2009 when we removed ASB, asymptomatic
bacteriuria, we didn’t anticipate a problem that would occur from that, and that was that
if a patient had a positive urine culture, but they didn’t have any symptoms,
it could no longer be called an ASB. It used to be that that could
be reported as an ASB. If it was recorded as an ASB, then it could be
said that an LCBI that occurred at the same time with a matching organism was secondary to that. Well, when we took away ASB, we now
had these positive blood cultures that matched a urine culture but
they couldn’t be called secondary and so if the central-line was
in place they became CLABSI’s. And that didn’t sit well with
people, it didn’t sit well with us. So, we developed asymptomatic bacteremic UTI. So this is for a patient that has a urinary
catheter in place or doesn’t have one, it could be catheter-associated
or not, and any age patient. So, we don’t have an infant one. They can have none of the symptoms that we’ve
mentioned for any of the other criteria. Okay? So, I’m not going to go through all those. They simply can’t have any
of the earlier UTI symptoms. Additionally, they have to have a positive
urine culture or greater than 10 to the fifth. Again, no more than two species, and a list of
specific uropathogens that have to be involved. And we’ll go over those in just a second. There has to be an accompanying,
matching blood culture with at least one organism to the urine culture. If all that occurs within a time-frame that
doesn’t exceed a gap of one calendar day between two adjacent elements, then this is an
ABUTI, and you would not call it primary BSI. Okay? That list of uropathogens are listed
here, as I told you it’s pretty broad — gram negative bacilli, staph
species, yeast, beta hemolytic strep, enterococcus, gardnerella vaginalis. We took these lists from —
I can’t remember the source, but we didn’t make this list up [laughter]. I can get you the list at
the source if you want it. Aerococcus urinae and choroni bacterium. You know, it’s very seldom that I hear
of an organism that doesn’t fit in here. So, and that complete list is,
you know, listing up the species as well as the genus, is on our website. Okay. So, just to say again, only the events for
ABUTI that had catheters in place for greater than two calendar days prior to the date of onset are catheter-associated
otherwise they are none. And then UTI’s is one of them that we get
a lot of questions about the recurrence. Is it new or is it a recurrence? Do we have to report a whole separate UTI? And the guidance here is no
different than it was for LCBI. We say look to see what evidence
of infection is still occurring, does it appear that the infection
has resolved clinically or are they still being treated
for the first UTI? If either of those is yes, then we would not
assign a UTI, we would say it’s a continuation. And that is irrespective of whether
or not it’s the same organism. So, I always use yeast as an
example because it happens so often. Somebody’s being treated for E. coli UTI and four days later they have a
positive urine culture for yeast. They’re probably still being treated at
four days and in that case, if they are, then you’re just going to add that yeast onto —
if you’ve reported the UTI, you’re going to add that yeast on as a pathogen to that, rather
than calling it a separate infection. Okay, you ready for another email? They get funnier as we go along. So, this is one we got. “Good afternoon. I have a patient who met all the criteria for
CAUTI on 1/21 when she spiked a fever, however, she was declared brain-dead on
1/18 and was only being kept around so her organs could be harvested. Would she be considered a CAUTI.” I thought, that’s a really
strange way to phrase that. She was only being kept around
so her organs could be harvested. The answer is yes, we do include
patients that are in hospital, you know, they’re organ-donation patients, because we
shouldn’t be giving them UTI’s even though, you know, they’re here for organ-donation. So, and we actually have reviewed
that decision with our patient — our organ transplant team and they
were in agreement with it, so yes. That got people talking. Okay, now we’re going to go on to key terms. So, obviously all CAUTI’s have to HAI. So we’re going to talk about POA versus HAI. Here’s where you might want to tune out if
you’ve heard this all more than you want to. A POA infection is one that
all criteria, all criteria, are present during the two calendar
days before the day of admission, the first day of admission,
and/or the day after admission, and are documented in the medical record. If it’s POA, you shouldn’t be reporting
it to NHSN, we are only interested in health care associated infections,
and acceptable documentation, again, does not include that reported by the patient. If the patient says I was
febrile, you can’t utilize that. You can if a report comes from the other
hospital that the patient’s febrile. And something I didn’t mention
is that we really, you know, we’re trying to balance what we
require for you to know and whatnot. We didn’t want you to have to go back
and ask the facility what the fever was. So, as long as it’s documented
that the patient was febrile, you can use that to meet
that part of the criteria. Physician diagnoses is not a
part of the CAUTI definition. So, a patient coming in and a physician says
he has a UTI, that is not sufficient to say that the patient had a UTI on admission. Okay? Patient is going to have to meet
the criteria during that time period. So here’s the unlucky family again. Grandpa Unlucky has been in an inpatient rehab
facility following multiple fractures sustained in a multi-car pileup when Atlanta sustained
the Snowmageddon of 2014 [laughter], otherwise known as a half
an inch of snow [laughter]. Yep. He’s now transferred by the way, to your
hospital with a Foley catheter which has been in place for two weeks and
reported by health care worker of fever the day before transfer
and a change in mental status. He’s afebrile on admission and his urine
cultures collected on admission are positive for greater than 100,000 CFU’s of E. coli. So, we’re going to vote again this morning. Which of the following is most accurate? He does not have a UTI. Has a UTI attributed to the new hospital. Or he has a UTI attributable to the rehab
facility and is POA to the hospital. Okay. Let’s see how you’ve done. Couple more seconds. So, 96% of you think that the patient has
a UTI attributable to the rehab facility and POA to the hospital, and
that is the correct answer. And let’s see why. So, he — on the date that he’s admitted
to your hospital there was a report of fever the day before transfer, which
was reported by a health care professional. And he had a urine culture collected,
which was greater than 100,000 of E. coli. So he meets SUTI one A, present on admission. Actually, attributable to the other hospital
and we do encourage you to communicate with other facilities to let them know when
you identify an infection that is attributable to them and if I was you I certainly would,
because I don’t want to be compared to somebody that was not collecting all of their data. Definition of a health care associated
infection, again, it’s considered HAI if all of the infection’s specific criteria were not
present during the POA definition time period. So, not POA, but they were all present on or
after the third calendar day of admission. Again, they have to occur within a
time period that does not exceed a gap of a single calendar day between
any two adjacent elements. And, did we define a gap day
as a calendar day in which none of the infection criteria are present. The transfer rule, as you all know, is if
the patient meets the criteria on the day of transfer or the next day,
we’re going to attribute that back to the transferring location. If it occurs after that time period,
after the day of transfer, the next day, it’s going to be attributable
to the receiving facility. And, you know, this applies also
to patients that are discharged. If they go home and then you find out
the next day, they come back and you find out that they have — even if they
don’t come back, if you find out, maybe you have communications
with your medical offices. But if you’re aware of it you’re going
to attribute that back to your facility if it occurs on the day of
transfer, the next day. I’m sorry, I said transfer, I meant discharge. Okay, warning. The next slide is very important. Does this work? [Ambulance sound] All right, here’s an example. And I say it’s really important because we
actually get this question all the time. I know that people don’t understand
this as well as they should. So this is an example that is not
present on admission, it is an HAI. Day one, the patient’s admitted. They’re asymptomatic. They have, however, a urine culture that’s
collected for 10,000 CFU’s of E. coli in the urine, but they’re asymptomatic,
as I said, and there’s no documentation in the two days prior that
they were symptomatic either. Second day they’re asymptomatic. The third day they run a fever. And the fourth day they have a culture, again, and they’re now 100,000 colony-forming
units of E. coli in the urine. This meets the symptomatic UTI criteria. They didn’t meet it in the POA. They had a positive culture but
they didn’t have any symptoms. You left that catheter in,
you know, for four days. It doesn’t say they had one
here, but you’re only going to report it if they did, probably, so. So, this is a UTI that’s got to
be reported for your facility. Okay? This is one of those examples
where it’s neither POA nor HAI and you’re not going to report anything. Patient came in and they were asymptomatic. They had a fever on the second day. The third day they’re asymptomatic again. The next day, I don’t know why, but
they do a culture on the patient. It happens. And it’s positive for 100,000 of E. coli. Asymptomatic five and six. So, we didn’t meet the criteria in the first
two days, and we didn’t meet them after that and we only had a positive
culture on day three or later. Day seven would be too long because there
would be a gap day here — two gap days here. So, this is one of those cases where
they don’t meet either criteria and it’s not going to be reported. Although, you and I believe they
have — may believe they have a UTI. Okay. Good news is we probably also would
think that they probably came in with it. Okay, I’ve covered this, the gap
day rule or the gap day definition. So, I’ll give you an example
of the gap day again. Patient is admitted on April 1st to the ICU. They put in the Foley Six
days later they had a temp. On 4/8 they’re asymptomatic, they’re afebrile. This is a gap day. They don’t have any suprapubic tenderness,
they have no CVA pain, they have no fever. It’s a gap day. The next day they have a positive urine culture. So, because there’s a single gap day here
and the Foley’s been in longer than two days, this is going to be a catheter-associated UTI. Again, if 4/9 had been asymptomatic, and 4/10 the urine culture had been
collected it would not be considered a UTI. Because there would have been two gap days. Okay. Our definition of an
indwelling catheter has not changed. That’s good to hear, hey? So it’s simply a tube that’s inserted into
the urinary bladder through the urethra, that’s left in place and is
connected to a collection system. It includes those patients
that are getting irrigations. Those patients are probably at higher risk of
UTI’s, so we include those patients as well. It doesn’t include straight, in and out
catheters, nor suprapubic catheters, no nephrostomy tubes, but if a patient has
suprapubic catheter or nephrostomy tubes, which happens sometimes, and a Foley, they are included in your
catheter-associated UTI surveillance. If the Foley’s there, they’re included. I got a question this week from
somebody that they had a patient, I think it was a spinal cord injury
patient, that they were doing — he was doing intermittent self-caths and
then at night the nursing staff was putting in a Foley catheter, and they
were taking it out every day. Is this something that you guys see? No? Okay, so she wanted to know if they were
eligible for CAUTI and my answer is yes, because the catheter was
in place each day for — an indwelling catheter was in
place some point of each day. So on the third night, they now
become eligible for a CAUTI. We get all sorts of crazy questions. Okay. And I think we’ve pretty much covered what
is the definition of a catheter-associated UTI. So, the only thing I want to highlight is it
is the date of the event that you’re looking at to determine whether or not
the catheter had been in two days. The date of the event, the date of the
last element used to meet the criteria. Discontinuation and reinsertion. We get this all the time, and as I said, we’re coming out within the
newsletter with guidance for this. But if the Foley catheter is discontinued and a full catheter day passes before a
Foley is reinserted then the day count for determining catheter-associated
UTI begins anew. Otherwise, it continues from
the previous catheter. So, I have two examples. Patient has a Foley, day three, day four. They took it out on day five. They put it back in on day six. And — I’m sorry, they took it out
on April 2nd, and they put it back in on April 3rd, this becomes day six. Continues from day five for Foley because there
was not a full calendar day without a Foley As opposed to this example down here where
they took the Foley out on April 2nd. There was no Foley for the whole day on
April 3rd and they replaced it on April 4th, this becomes new Foley day one, Foley day
two, and Foley day three on April 6th. On this date they’re eligible for another CAUTI. Okay? Again, somewhat arbitrary
but just trying to make a rule so that we all do it all the same. We just pretty much covered this; the date
of the event is the date of the last symptom. So if you have a temp on one day and a
urine culture the next day, this is — you’ve now met criteria,
this is your date of event. So, quick examples of a device-associated. Patient has a Foley inserted on
day one, they’re asymptomatic. The Foley remains in place and
they spike a fever on day two. They still have a fever on day three and they
have a positive urine culture on day four. That meets criteria, E. coli. Because they didn’t meet the
criteria in the first two days, even though they had a fever here, this
is a device-associated, this is a CAUTI. Okay? They would have had to have their culture
in the first two days for this to be a UTI but not a catheter-associated UTI. You’re just going to ignore this fever
then and utilize day three or day four. I’m sorry, I want to correct that. You can count the fever in here because what we
tell you to do is to look at the date of event. So scratch what I just said
because I don’t want to confuse you. It’s easy to do. It’s easy for me to get confused,
so just look at your date of event. Your date of event is day four here. It’s the date of the last element, because
that day is not in the first two days of the catheter, this is considered
a catheter-associated UTI. That’s really the easiest way to do it, and
it’ll get you into the least amount of trouble. And I can get in trouble sometimes,
in case you hadn’t guessed that. All right. This is not a CAUTI. Foley is inserted on day four. They have a temp of 100.6 the next day. They send the urine culture and it’s positive
for 100,000, they meet the SUTI criteria on this date, day five, but the Foley
hadn’t been in place for greater than two calendar days on
the date of event here. It had only been in, it was on its second day. So this is not catheter-associated UTI. This is also not a catheter-associated UTI. Foley inserted on day four, removed. They’re asymptomatic four days later, day eight. On day nine there’s still
no Foley, they have a fever. And on day 10 they have a
fever and they have candida. The date of event in this case
is day 10 and it was not the day of removal nor the next day, it was after that. So, it’s not considered CAUTI. Last example, I think. Patient comes into the ICU,
has a Foley put in on day four, removed on day eight, reinserted on day nine. And on day 10 they meet criteria. This is one of those reinsertion ones. This is going to be considered
a catheter-associated — oh wait, this patient has a Foley in place
for some part of each calendar day for greater than two days, and there was not a full
calendar day without a Foley in place. So this is a CAUTI. Is that clear? Location of attribution for CAUTI
is the same as it was for LCBI, it’s the location where the patient was
assigned on the day of the UTI event. And, again, the date of the
last element for the criteria, with the only exception being the transfer
rule which, I think, we’ve pretty much covered. If it occurs on the day of transfer
or discharge and the next day, it goes back to the attributing location. I’m just going to go over one example
here that we get a lot of questions about and that’s the small tie transfer rule. So in this case, patient is
in the ICU on day one of admit and on day two they’re also in the ICU. On day three they start in the ICU, then
they go to five west, then they go to CCU. And the next day they have
an HAI, in this case a UTI. This HAI is going to be attributable to the ICU since that was the first
location the day before the event. So this is, you know, your transfer rule time
period here, the day of transfer, the next day. And so this is the ICU here. Trying to expand that incubation
period, you know, to the longest time we can in those two days. Okay. Oh, this came through [inaudible]. I wanted — this was supposed to
come through in two different pieces. So we send out an email to people that said,
“It appears a user from your organization with user name XXX is in the process of
updating their SDN digital certificate. CDC is in the process of reviewing their status and will notify the user via email
when the process is complete. At that time the user will be able to log in.” So we get an email back from this person
that says, “I’ve already installed it on two computers a couple of weeks ago. You better make sure it works right
because it is a hassle to get this done and I did it all myself and it worked fine. Please do not screw it up.” [ Laughter ] Apparently, she’s worked
with us before [laughter]. Aren’t you glad those digital
certificates are going away? Has anyone here been Sammified
[assumed spelling]? Okay. Do you like it?>>Yes.>>All right, cool. All right. Sammified is a new system that you
guys will all be moving over to. Instead of digital certificates they
give you these cool little Bingo cards that they’ll have you put in codes
for and they’re good forever. So, I like this. Okay, now we’re just going to
very, very quickly, like I said, I’m not going to spend a
lot of time on data entry. I do just want to highlight three
fields here on this section. Urinary catheter — we’re going
to ask you to identify whether or not there is a urinary catheter in place
greater than two calendar days on date of event or if it had been removed but was in
place for greater than two calendar days. Or neither. There was not urinary catheter in place on
the day of event or not in place greater than two days on the date of event. Okay? This is going to drive
the system to identify this as either catheter-associated
or non-catheter associated. The location for device insertion
is optional, if you want it. Sometimes we get questions from facilities that
say, “Well, they put one in and they took it out then they put another one in. And there are different units
what do we put in?” We say, “You can make your own determination,
your own policy about what you want to do with that because we don’t
utilize that field right now. So, you know, you get to make your decision. And the date of device-insertion
is also optional at this point. I did get a question this week from somebody. It looks like on the form — I don’t see
it on here, maybe it’s on the screen. It actually says urinary catheter at time
of specimen collection and that’s an error. We missed pulling that off when we
changed the definition, so this is correct and it’s been there for a year
and a half and nobody noticed it until a user emailed me yesterday. So, just know that it’s at the date of event, is what we’re concerned about
with a catheter presence. Not the date of specimen collection. Okay, your summary data is collected pretty much
the same way it’s on the same forms as for LCBI. Again, you’re going to collect the number
of patients that are present at the time of the count, each day on the unit,
and enter that in this field here. And then the number of patients that have a
urinary catheter that are there at that time on that unit and enter it here for each
day, and then you’ll sum the numbers at the bottom at the end of the month. For NICU, I do want to point out that there
is no in-plan CAUTI surveillance for NICU’s. We no longer allow that because
they’re just used so infrequently in that patient population the
data’s not really that meaningful. But some facilities are opting
to continue to do this off-plan. So if you’re doing that,
those will be entered here. URC days and you’ll be stratifying
it by the different birth weights. And again, birth weight, not weight at that
time, but the weight of the baby at birth. Special care areas, there’s no difference
in how the data is collected here between a special care area
and an ICU or a ward. Unlike, you know, CLABSI’s you have permanent
or temporary central lines for LCBI’s, here it’s just a urinary catheter and it’s
enter — I do again, for all of these events or all of these location types you are going
to have to tell us if you’ve had no events for this month and that’s where you’re
going to check it here — CAUTI. If you don’t check that and you don’t enter any
CAUTI events you’ll get an alert and it’ll say, you know, we don’t know, do
you really not have any UTI’s or have you just forgotten to enter them? You’ll also get an alert if you
don’t enter your patient days or your urinary catheter days for that month. And so, this is the example of the alert. In-plan denominators are reported for
these locations with no associated events. So in this case the ICU, you entered summary
data, you told us how many patient days you had and how many urinary tract days you
had but you didn’t enter any CAUTI’s and you didn’t tell us that
there were no events. So you can — handy-dandy little thing here. You can just go down here
and check these if that’s so. A smart person might wait and do that. Probably not a good idea,
but you could do that, so. Again, if you want to collect your data
electronically, we’re happy to have you do that. We just ask that you concurrently
collect your data manually. You go on the unit or have whoever does
it on the unit collect it manually, do the patient count and the catheter day count at the same time each day and
collect it electronically. Also, compare those two for three months. As long as there’s no difference more than 5%
in either direction, you can then do that for that location, just use your electronic methods. If there is a deviation of greater than
5% than you got to start all over again and try to figure out where the problem
is, get it right, until you, you know — make changes until you are able to
get an accurate count electronically and then you can move ahead with that. So, you need to do it in location
for three months, minimum. Just another sign. I do want to say that oncology hospitals have to
report separately for all locations and units. Anybody from an oncology hospital here? Nobody. Okay. And to remind you that you’re
CMS reportable data has to be included in your monthly reporting plans. If you don’t put it in your monthly
reporting plan it will not be sent to CMS and you won’t be happy, they won’t be happy. Here’s your resources. This is the training site for
urinary tract infection information. We have Lectora, which is a self-paced
software program and does have self-testing, and there’s questions in there and
you have to score greater than 80%. We do expect that people will do the training
at least once before they utilize the system. And then we have — these webinars will be
on there as people have told you in April. I believe, I hope this one is down,
I think it is because it’s outdated. These are just the forms that you’ll use to
report your data, and more resources for you. This is a summary online listing of
all the training that’s available that would be pertinent to
you doing CAUTI training. Okay, so another funny email. So we sent this out, you know, we sent
— this is what we call blast email, to everybody that’s a participant, you know. We said, “We will be restarting NHS application
in a few minutes, please plan accordingly.” You know, because if people have
got data on there we want them to save it so it doesn’t get lost. And somebody reported back, “I haven’t started
baking yet, I don’t know if I’ll get to it.” [ Laughter ] I’m not sure what that meant, but [laughter]. I don’t know what she was referring
to, like baking the data, you know, like she didn’t get it in or if she was thought
she was talking to somebody else or what, but we weren’t really sure how to respond, so. Okay, so we have finished about 15 minutes
early and I’m going to look to Courtney to see before we get into the case studies. Do you want to take a break now or do
you want me to start for 15 minutes. [ Inaudible Speaker ] What’s that? [ Inaudible Speaker ] I’m sorry? Keep going? [ Inaudible Speaker ] For 15 minutes? Okay. We’ll keep going for 15 minutes.>>[Inaudible] questions.>>I can, but I would rather wait because
we might cover the question in the — you’re going to be extra special, you’re the only person that’s
going to get to ask a question. How do you like that? Go ahead. Go ahead [laughter]. [ Inaudible Speaker ] Page 23. Okay. Gap day. Page 23, oh my page is different
— my page is different than your page.>>I’m trying to resolve your three-day Foley
rule plus the gap day example of symptomatology. So you said that you have to
have the Foley in for three days by the last day of symptomatology. So in your gap day example you have a
temperature on 4/7, like Monday, whatever, and then you have a gap day, day two. And then you have a culture
on day three, Wednesday. You’re saying that if the
Foley was inserted on Monday?>>This one?>>This would count?>>No I didn’t [laughter].>>On the same day that they
had the first element or some –>>Thank you, is it this one?>>Yes.>>Okay, so –>>So, if instead of the
Foley being placed on 4/1 –>>Yes.>>The Foley was placed on 4/7.>>Okay.>>Because I’m trying to determine if the
Foley has to be in place for three days on the first day of symptoms, or on the
last day, and you just said the last day. Okay. So that means in this example,
this Foley can be placed on 4/7, the day of the temperature,
and then there’s a gap day, and then the day of the urine is the
third day, that’s three or more days.>>That is correct.>>So this would be counted as a CAUTI. Foley placed on the day of the
first symptom, that makes no sense.>>Well, hopefully, if the patient has
the fever they’re going to be looking to find out why the patient has a fever. Okay?>>Correct, but they placed the Foley on the
same day so it shouldn’t be related to that.>>And, clinically, I’m going to agree with you. And the hope is that most of the time if they
have a fever they’re probably going to try to figure out why they have
the fever and they’re going to collect that culture sometime sooner. There will be rare instances — we can sit
here and try to come up with situations that don’t work and those
situations do happen rarely. Okay?>>This is not an uncommon
situation, where they place a Foley because a patient is having problems. Not having problems due to
having the presence of a device.>>It’s a surveillance definition
and we made these rules because people asked for
them, users asked for them. Because before we had no minimum time period. Right? So, in that case it
still would’ve been a CAUTI.>>Without the ability to have some clinical
correlation, we can’t use these numbers to be able to drive performance improvement. I’ll just –>>I understand.>>Okay.>>I understand. Okay, so let’s — we’ll keep going. No, I don’t think so. Well — [ Applause ] [ Silence ] Okay, let’s start with our case study. Oh. So actually we’ll — so before we start
the case studies I wanted to share something that on the web that highlights the
importance of making good methodology when performing HAI surveillance. So, here we go. Escape — oops, that’s right. That’s not right, here. Here. Okay.>>Hi, I’m [inaudible] and my
CEO says I should talk to you because you’re hospital has zero health
care associated infections for three years.>>Yes, as the infection
preventionist I can say that’s true.>>Wow, that’s amazing. I mean, I have my organization [inaudible]
zero infections and we have had some ruts but we had a month here or there where we
have had none, but zero for three years. That’s incredible.>>Yes. We did it. I have zero infections, for three years.>>How? I mean, don’t you ever
have bacterial trans-location where the patient has no infection but the pathogen escapes the GI
tract and appears in a blood culture?>>We have those cases but my ID
doctor throws those out [laughter].>>Your ID doctor? What is he doing surveillance for?>>He always does surveillance after I
find the cases that meet the definition.>>Has he done any online training
on how to use the definitions or done any [inaudible] trainings on the NHSN
definition or gone to a [inaudible] training?>>No he is an ID doctor.>>So, despite the fact that you have
cases that meet the NHSN CLABSI definition, you don’t count them because your ID physician,
who has no training on epidemiologic definitions or NHSN training doesn’t
think they are NHSN cases?>>Yes. He is an ID doctor [laughter].>>Does he say they don’t meet
the NHSN CLABSI definition?>>He is an ID doctor [laughter].>>You already said they met the
definition why even have them look at them?>>He is an ID doctor [laughter].>>We established that. Have you been to training
on the NHSN definition?>>Yes, I have done many classes and do the
[inaudible] training on the definitions.>>So, you are having someone who is incompetent at using the definition override your
judgment as a trained epidemiologist.>>He is an ID doctor [laughter].>>Yes, and if I had a central
line infection I would want him to give advice on how to manage that infection. Why does he even want to
look at the CLABSI cases?>>He is very interested in CLABSI. As Chair of the Infection
Control Committee he gets a bonus for lowering the hospital’s
infections [laughter].>>Don’t you see that is a conflict of interest. Why would you allow that surveillance
to potentially be compromised like that?>>He is an ID doctor.>>Let’s talk about CAUTI. No CAUTI?>>We have zero HAIs. My ID doctor reviews them.>>Is your ID doctor’s name Dr. No? Let’s talk about SSIs. No small bowel infections? No colon surgery infections?>>I have had no HAIs for three years.>>How do you do surveillance for SSIs?>>I look at the microbiology results
and if there are none they are cleared.>>What about radiology results?>>I look at the microbiology results
and if there are none they are cleared.>>Why would a surgeon culture a gut leak, they
use the x-rays to find abscesses and then treat. How about MD notes, do you
read them on the cases?>>Doctors at my hospital write a lot.>>Yes, how do you assure yourself they
aren’t diagnosing a surgical site infection in their notes or describing a wound
infection if you don’t read the notes?>>Doctors at my hospital write a lot.>>Do you do a search for antibiotic therapy
post- surgery or returns to the O.R.?>>I have no HAIs for three years.>>I will take that as a no. So you never had a failed anastomosis
that resulted in an infection?>>We have those cases but my ID
doctor throws those out [laughter].>>Doesn’t he know that the definition
does not exclude them from being cases?>>Yes, but he disagrees with the definition.>>I can disagree with gravity but it
doesn’t mean that it no longer applies to me.>>He is an ID doctor. I have had no HAIs for three years.>>Liar. Oh, I feel an HAI coming on.>>I also have 100% hand hygiene compliance,
do you want to know how [laughter]? [ Applause ] [ Inaudible Speaker ] All right [laughter]. So, I don’t think I want to take
comments after that [laughter]. [ Inaudible Speaker ] Oh, the author’s here? Oh! [ Applause ] Oh, Bravo! Bravo. Who is the author? [ Inaudible Speaker ] Greg Meyers [assumed spelling]. Okay. Nice job. So that was just a little light-hearted. I thought you guys would enjoy that. I enjoyed it. Somebody sent it to me and, you know, I think
it’s really — it does drive home, you know, that we all need to do what we’re supposed
to do and I understand that there are — that the definitions are not perfect. Believe me, we get emails all the time
and we understand it and we are — I hope that you heard in the last two days
that we do listen to you and that we are trying to improve them, you know, where we can. So, we can go ahead and start one case
study and we’re going to just look at these, we’re not going to get into
surveillance versus clinical. We’re just going to learn, make sure that
we’re accurately reporting the definitions or applying the definitions and
we’ll try to optimize the consistency and that application and improve data quality. So, as I said yesterday, when you’re looking
through these case studies you might want to consider looking at them in this order. Is it a POA? If it’s a POA and they haven’t been
discharged in the last two days you can stop, we don’t need to have it reported at
NHSN, we’re only interested in HAI’s. Is it an HAI if it’s not POA? If it’s not an HAI — remember
we talked about there’s some that are not POA, that are not HAI — then stop. Finally — next you’re going to ask
yourself is it catheter-associated UTI. And then you’re going to need to look at where
to attribute it if it is a CAUTI So case one. Mama Unlucky is admitted unconscious
after she fell when three deer ran out in front of her while skiing. She has a broken femur. A Foley and a peripheral IV are inserted. On day three her Foley is removed, she’s
awake and making good recovery progress. On the fourth day she’s up with assistance
but she complains of pain on voiding, has a UA collected and it has
slight leukocyte esterase, negative nitrites, and 15 WBC’s on spun urine. The next day they collect a urine
culture which has 10 the fourth, or 10,000 CFU’s per ml of E. coli. So, questions for you is does this
patient have a CAUTI and if so what type? Choose yes, a SUTI one A. Yes,
a SUTI two A. Yes, an ABUTI. Or, no CAUTI at all. You can vote. A couple more seconds. Okay, so let’s see what you all say. Oh, we have some difference of opinions here. We have 50% say it’s a CAUTI two A,
and some people, 38% say no CAUTI. This is no CAUTI. Okay, so criteria were not met in the POA time
period and the patient does not meet criteria for UTI with dysuria and positive urine culture
and a UA — I’m sorry that do meet that, but the date of event was later
than the day after removal. Right? So, the Foley was removed on day three. The patient didn’t meet criteria
the date of event, until day five. Okay? So, it’s a UTI but it’s
not a catheter-associated UTI. Okay?

How do you get a UTI (urinary tract infection)?

How do you get a UTI (urinary tract infection)?


Urinary tract infections are one very troublesome
complication of an obstructing benign prostatic hyperplasia that can cause patients significant
symptoms. There are two main ways in which BPH cause urinary infections. Firstly, the
obstructing urine may inhibit complete emptying of the bladder such that a post void residual
urine is left within the bladder. This urine can become stagnant and undergo secondary
and bacterial infection leading to urinary tract infection with symptoms of cystitis.
The second mechanism by which benign prostatic hyperplasia can predispose to urinary tract
infections is that to overcome the obstructing prostate, a bladder needs to increase its
pressure: the force with which it exerts to pass urine. This increased pressure against
an obstructing prostate can force urine into the prostatic ducts. This urine sitting within
prosthetic ducts can cause a chemical inflammation which again can predispose to bacterial infection
leading to symptoms of a urinary tract infection such as cystitis and indeed prostatitis.

Urinary Tract Infections – 5

Urinary Tract Infections – 5


Op. Gotta pee. (door closing) (zipper unzipping) There are three things I wanna tell you about urine. (intro: slam and discreet cough) Lesson one, there is a system responsible for discharging urine. It does not include the vagina. Urine is produced in the kidneys, it comes
down two tubes called the ureters, it’s held in the bladder and then exits through
the urethra in a hole called the meatus. Most meatuses are located here in the vulva
in between the vagina and the clitoris and here on the penis at the glans or head. And then because no body is the same, we’ve got meatuses that are sometimes located here and here and here and here. Note, none of these holes are the vagina. Many people think that vaginas are the
exit point for urine, but they’re not. Not typically anyway. So why do people think that urine leaves the body via the vag? Perhaps they weren’t taught, or didn’t learn. Perhaps they think that the vagina is
the opposite of the penis and therefore since urine comes out of the penis then
it must come out of the vagina. Or maybe because they sit down on the toilet, urinate, and it feels like it’s coming out of their vagina. Lesson two, there aren’t usually germs in the urinary tract. Germs do attack the urinary tract by going
through the meatus up the urethra. This is commonly referred to as a urinary tract infection, or a UTI. Some people call it the “Honeymoon Disease”. Why do they call it that? Because when a newlywed couple is getting
sloppy, there are bodily fluids everywhere that transmit the bacteria from the anus to the vagina. Now you’ve just been told. Ok. It’s incredibly painful. You’ll feel the urge to pee, you’ll go to the bathroom
and nothing will come out except maybe a trickle. This sensation will persist,
minutes later the same process again. Then you add feeling feverish, nauseous, achy…. If you finally do get anything out of your
system, it’s cloudy and pungent smelling. Oh, and it burns. So you’re ready to get help. When you do, the doctor might say something like “You’ve got a urinary tract infection,
here’s a prescription for antibiotics. Take these and you’ll feel better soon”. And you might reply, “Oh no, I don’t want to put
antibiotics in my system, no unnecessary things here. I don’t want to create a giant superbug
that’s going to be drug resistant”. And the doctor might say, “If you don’t do
what I recommend, you’ll probably be crawling back in here tomorrow much worse.” And you might take the prescription, surrendering to the excruciating, inflamed irritation between your legs. Okay, so a few hours later,
you go to the bathroom again, and you think it’s going to be this agonizing pain but it’s not, so even though the physical issue isn’t there you’re still scrambling to figure out how
to prevent it from ever happening again. I can help some of you with this, and for others, hopefully prevent it from ever happening, because most of the bacteria is getting into
your urethra from your body’s own system, the anus, wiping back to front, poor hygiene,
and sloppy sex. Let’s go back to anatomy. This body…. Here you have the meatus. This is the anus. On this body, the meatus is here. the anus is some place back here, so if bacteria were to travel, it’d have to go
around the scrotum and then the length of the shaft, whereas here you’ve got about an inch. Making this body much more susceptible to infection
because the distance is shorter and easier to travel. Lesson three: wipe front to back,
pee before and after having sex, practice good hygiene by washing your genitals
and wearing breathable clothing. Where’s my dildo? When it comes to having sex, make
sure that if you’re the receptive partner, you’re the one putting the penetrative
object inside your body, so take it like this and make sure that it
finds the right orifice, because otherwise this person could be boinking around and accidentally hit your perineum or the anus
that’s covered in E. Coli or other bacteria. Bring that right up the vagina, which you
already know is so close to the meatus that we think we pee out of it. If you do wanna play anally, make sure
that you wash with soap and water whatever object you’ve put inside the anus
before you carry it over to the vagina. All clean! (outro music)

FTM “DOWN THERE” HEALTH (UTIs, YEAST INFECTIONS, ECT…)

FTM “DOWN THERE” HEALTH (UTIs, YEAST INFECTIONS, ECT…)


*intro music plays* hey there! my name is chase and this is a video for my sex education stuff uhhhh… video. series. *whispers* yeahhhhh… before i even start with the TITLE of this video, although you’ve probably seen it… DIS-CLAIMER. Trigger warning! Literally. like, DISClAIMER. this video is about the health of an area. that trans men are usually dysphoric about and dont want to talk about, and dont want to look at it and anything like that dont want to use it- whereas some people they like it, and doesnt matter no dysphoria *MMPH noise* but, a lot of people are like do not talk about this. but, today I am going to talk about the health of your- and im going to call it, your who-ha. its either that or using the- well like im not gonn use the word front-hole cuz for me i associate that mostly with sex, and im not gonna use the v-word becasue that would w- that- no. im not doing that cuz no. so. im talking about the health of your who-ha and um.. having a healthy who-ah *adorably awkward laugh* i cant take tis seriously but for real. ummm being like- you know why? you know why im doing this? because there’s absolutely NO information that i have found with all my research that i have done on UTIs, on yeast infections, and on- and i have to use the word right now and im sorry because its part on the word- on bacterial vagiosis. vaginosis? i said it that time. just making sure thats how you say it sorry. there- theres like basically no information. sure, sure, if you google it you’ll get like one or two sources, but um, i thought that i would talk about some things that i have found. now, when trans people- trans men specifically, have infections, STIs, anything like that, its very hard for us to look at some of the symptoms because its like what do you look at? the men, the women, i dont know. so i made a videos about STIs for FTMs, which i will link. um… right there. kay, just for you, put it right there. we’re talking about STIs, gonorrhea and all that stuff. fun… but I made that video to provide information. even though you could google this information, i think its cool to have it in a video form so we can like interact together. so, today im going to be talking about three main infections. that effect the who-ha that we need to talk about. so im going to start with UTIs, and please remember because theres not real- lots of information for trans guys on this, um.. that it- i do have to look at the symptoms for women more, but i have searched a lot like, women high testosterone UTI and stuff like that just to see. or like hormonal balance an stuff lik- just to see if its anything related to hormones, and to see if we are more susceptible to it. alright so what is a uti? so a UTI is a urinary tract infection and its when bacteria um is introduced into the urethra, usually goes all the way up to the bladder and can lead to bladder infections, and if untreated can also lead to kidney infections. so the most common bacteria that is actually inroduced into the urethra is e coli and its very- like the percentage of infections from that is very high and that bacteria usually comes from the bowels i know, all of this is just so like- oh great chase, thank you for this information. but you know what? lets just- we need this information im gonna use words if you watched my STI video, oh my god i cant believe i said all those words out loud like if the neighbours were listening- i mean, they leared a lot of stuff. bless. but i was just like ANUS! and *hella studdering* fun. alright so people with who-has are at greater risk of getting urinary tract infections because our urethra is shorter, so that means when a bacteria is introduced into the area, theres a shorter length of time to the actual bladder um, then people with penises. that urethra is a lot longer, and its a lot more complicated to go all the way into that urethra and find the bladder for the infection. so, with peope with who-has since its a lot shorter, the second that bacteria is introduced into the area, its very likely that it will travel up the urethra and hit the bladder right away. so when that happens, thats when the urethra um, has a lot of issues and and you have issues with urinating, and you have a lot of pain, and soreness, and stuff like that. another reason people with who-has are a greater risk of getting urinary tract infections is because of the anus and the urethra…. is very close together whereas people the anus and the urethra is like *whoosh noise* like its its far, its like a- its far away. like it doesn’t usually connect. right? like on your own self. so another casue of a UTI uh for people with who-has is uh, sexual activity. and that could be multiple sex partners, or it could be one sex partner that goes into um, the anus and then switches over right and goes into the front-hole. now, with or without a condom it doesnt matter, that bacteria that is from that area is now entering the front, and the urethra is very close- its right there, its gonna touch it no matter what. so when that usually happens, thats when the UTI is caused. and its very painful to happen. so if you are planning on having anal sex and then going to the front, just change condoms or add a condom if you didnt have one before. um just so that the likelihood of that is not gonna happen and just a side note thats also a cause of UTIs for people with penises because if you’re doing anal unprotected theres a high chance that the bacteria from that area will enter the urethra. like i said, um people who-has *laughs* are more likely to get it because the urethra is shorter, so with people with penises its gonna a bit longer- like, to go so its- its rare but it happens. so the symptoms are really important for this, um especially because people with who-has are about- its- the statistic is like one out of two. so like fifty percent of people with who-has are gonna get a UTI at least once in their life. so, the common symptoms are uh feeling full and going to pee and- going to urinate if i use proper words, and just a little but comes out, but you really need to go all the time, very painful urination, um some discoloration, blood, um, some odd smell to your urine, um and you can also get some pains in the lower back and abdomen. so the reason why you could have pains in the lower back and in the abdomen area is because if the UTI goes untreated it goes to the bladder, causes a bladder infection, if thats still untreated its gonna move up to the kidneys which will cause a kidney infection, and thats why the back usually hurts. so when this happens its like a very serious infection and you could have a fever, you have chills, theres a lot more symptoms that come around to that because you have a kidney infection now. and this actually happened to Aaron, so if you watch any of the vlogs that i made couple of months, i was at the hospital with Aaron a couple of times because he had a kidney infection and the reason was because he had an untreated UTI that he didn’t realize that he had because- whatever, painful urination is- it wasn’t painful, he had a very high pain tolerance. whatever. anyways, so he was very sick before we went to the hospital i dragged him up to the hospital, got him to the- got him to talk to doctors and i told him i think its his kidneys, and it was his kidneys. so in order to test for this you just have to go to a doctor and they’re gonna do a urine sample and theyre gonna and they’re gonna test for the type of bacteria that could be in a- in a UTI that could categorize it as a UTI. once they do that and you are- they tell you that a UTI, you test positive for that, they’re gonna give you some medication you just have to take it the whole time and then youre good a lot of people think cranberry juice works, and not like the cranberry juice cocktail because like, lets be serious. um but the cranberry juice works um, but according to the Internets it is a very mix because some people say that it doesn’t work, and some people say that it only works through the strand of UTI that comes from e coli which is the most common one so who knows? when i have a UTI which i have had many. *laughs* i drank a lot of cranberry juice and a lot of water to flush it out. alright so you can help prevent UTIs the number one thing that you could to, okay? is to empty your bladder when you are full. now this is where the trans aspect comes in, alright? because sometimes, we dont feel comfortable going to the bathroom. alright? let me tell you a lil quickie. lil story. i was not comfortable going to the bathroom in 2011. 2010. turning 2011, right? that entire year, i just- i could not use the bathroom, i held it in, when i would go to school i would not use the bathroom i was terrified becasue i looked ike i was in the middle i didnt know if i like- women would like scream if i went to the bath- it was just a very confusing time. so i held my pee in for about twelve hours a day. not recommended to do that. anyways, i ended up with a very intense UTI that i was like not wanting to deal with, which turned into a very intense bladder infection, and then which turn into me not being able to pee for 16 hours. and this wasn’t me actively trying to hold it in, this was me i am in so much pain my bladder is about to explode. i go to the hospital, they tell me its not that bad, and then they realize their machine is broken, and they look again and theyre like your bladder it about to explode. so they had to catheterize me and i ended up with a catheter for two months. actually it was like five catheters, sorry. because they had to keep taking it out and putting one back in. you know how comfortable that was? six months on T it was fantastic. thats right when the growth is like at its peak pain. fantastic. so, the moral of this story: DO NOT HOLD YOUR PEE IN. the moral of this story is also that people who are forbidding trans people from using the bathroom, go and do something else with your life. because this is serious! this is serious. i know trans people who refuse to go to the doctor. can you imagine? you cant go pee, you get a urinary tract infection, you get a kidney infection, a bladder infection, you refuse to go to the doctor. you have an infection, youre gonna have a fever, this is dangerous. so, as much as youre just gonna say well now you pass, obviously you’re telling me to go to the bathroom. if i know, if i wouldve known what i knew back then now…. you know what im trying to say, i would have gone to the bathroom, i dont care i would’ve done whatever i could. knowing what i went through it was the horr- the- that two months hurt more than me getting hit by a car. like it was ridiculous. anyways, once again, moral of the story, dont hold your pee in, try to find a bathroom, look for bathrooms where youre going, and like try to find somewhere. go with someone, try to get a friend to go to the bathroom with you. scope it out, just see some stuff. its so to pee. trust me you do not want to end up with a catheter. you dont want to end up with a bladder or kidney infection. its very uncomfortable. and its also very emotionally uncomfortable to talk to the doctors about this stuff. so anyway to prevent it would be great. other ways to prevent it is to drink a lot of water, um, when you have like um, um.. just make sure like underwear you wear makes your junk junk, who-ha dry at all times so that theres no like moisture and potential bacteria than can go i there. obviously like i said, um if youre gonna go from anal to the front, change condoms, or ad- or like put a new condom on, or- whatever. um, those are just little things that you could do to make sure that you dont end up with a UTI. but if you do end up with a UTI, please go to the doctor, because its not as bad as if it turns into a bladder or a kidney infection. becasue they dont have to check your junk at all if you UTI. okay? you just have to do a urine sample and you’re done. um, bladder and kidney infections, they dont have to go inside you but but like i said- not inside you, sorry. jesuse christ they dont have to look at your area, but if you end up being not able to pee because your infection is so intense, then they will have to look at the area and trust me you dont want to- i have trauma related like- its crazy. anyways lets move on alright now lets talk about yeast infections. so about 70% of people with who-has get one yeast infection at least one time in their life. uh yeast infections just like urinary tract infections can be recurring. and i do have a statistic. one, about trans people with this that i found on one website so who knows if its true? but i might as well just tell you you may be more prone to yeast infections at the beginning of HRT. so when you first start using horemones because your hormone balance is going up and down, and yeast infections are very closely related to hormonal imbalance. so what is a yeast infection? well basically, um everyone who has a who-ha has a very small number of yeast in their who-ha. uh, a yeast infection is when there is a abnormal amount of yeast that has been growing in the who-ha. so the symptoms of this are really not fun, its like burning and pain urination, soreness, itchiness, burning an pain when having sex um you also can get some discharge from the area um that has a very weird thick colour and uh- thick colour… okay. um but theres no odor to it so for people who are pre T UTIs are actually really common the week before your monthly cycle thing um because of the hormone imbalance once again. it can also it can also occur if you have like, lack of sleep, or like a weak immune system, and like you eat a lot of sugary foods, which i tried to look up and i was just very confused thats very interesting, sugary foods causes yeast infections. so that was interesting. and also stress. alright so how do you treat a yeast infection? well you could go to a doctor and get some um, superscription medication or usually you could actually just get cream or suppository- suppository? i think im saying that right, at the pharmacy and use it but if you get chronic um yeast infections, so more than three a year, you should go see a doctor because there might be something going on that you need to check out. so if i take a trans angle right here, if i had a yeast infection i would go to a doctor now. just because im too scared that theres something going on that i need to know about and um as bad as it is cause im pretty sure that they sometimes have to look in that area, the who-ha area. i would rather know one hundered percent that its a yeast infection, instead of knowing that its something else. and they give- and i like take medication thats wrong for me like it could be bacterial vagis- vaginosis, sorry it could be an STI or something like that, so id much rather go to a doctor if im not one hundred percent but like i said you dont have to. alright, so number three is bacterial vaginosis. so im gonna stop saying that word and say bacterial whahahaha. so what is it? um, it is an infection caused by too much of a certain bacteria that is in the who-ha which disrupts the balance of the bacteria that you already have in there. so if you look at UTIs and then you look at yeast infections, theyre very like theyre different, but its almost like youre putting like those two symptoms and the way that its done together and basically bacterial vaginosis- i just said it again im sorry is very close to a yeast infection, but theyre different. so you can get bacterial whohaosis from douching too much because youre disrupting the balance of the bacteria in the who-ha and also having multiple sex partners. so sometimes there are no symptoms when you have bacterial whahahaha. but when you do have symptoms you get some white-grayish um discharge odor, um itchiness, and uh irritation, it smells like a fish odor after sex, if youre using that area, and it burns when you urinate. so its not fun but what you can do is go to a doctor. now, this is the part, i know, it is very triggering for a lot of people, but in order to one hundred percent know if you have bacterial whahahaha the doctor needs to take a swab of the fluids from the mehehaha. from the um the who-ha. as i call it. so this can actually go away on its own without any medication, but um if you do have symptoms, you should go to a doctor. and when you do and to a doctor and they test posi- you test positive for that, theyre gonna give you medication. now, as i said in my STI video. for FTMs, STIs for FTMs, um you once you take the medication and get rid of the infection that is happening, it does not mean that youre immune to the infection ever again. this mean that you will potentially, maybe in the future, maybe never, but maybe get it, bacterial bwahermerha again. now while cis men can not transmit it to you, or people with who-has, people with who-has, with other people with who-has can to them selves. to thems- to each other? yeah, there you go. and unfortunatley if you do have bacterial whaherherhah you are at greater risk at transmitting or contracting um HVI or STIs. so that is something to um, understand if you think that you might have it, go to a doctor, and dont have sex just in case. or if you are, just- you know protection and stuff like that but i- you know. just watch the STI for FTMs video, it’ll give you a lot of information about the different type of STIs there and i do talk some specific trans things in there as well. so hopefully this video was in-informational a little bit, i just talked about the three main ones, um i didnt talk about atrophy or anything like that, cause this is more about like the health and things that you can actually do to the area, right? um, going to see a doctor is a very goo idea when you have these infections, um, yes, some of them can go away on their own but honest;y just to make sure that it is that and instead of something else, i would go to a doctor, if you have access to that. um but what is really important is that i know that a lot of people dont think about.. um about these things they dont think about that area because you know, theyre on T, and they never wanna think about it, theyre planning bottom surgery in the future, they have no idea what theyre doing. and youre maybe not thinking about it that often but it is very important to think about these areas, i dont like thinking about them, but i have had yeast infections, pre T and on T, i have also had UTIs pre T and post T, i had a UTI three months ago. theyre not fun, it hurts. and its embarrassing going to the doctor and being like oh by the way im trans too so its not like- like in case they had specific tests for “men” which they dont, by the way, it just a urine test. but i dont know, it was just- hmm. and also, just to mention this as well because i know that i lot of trans men use prosthetic penises and stuff like that make sure that you- if you are- uh, penetrating someone else, or if someone else is penetrating you with it, and you are going from anal to the front or anything like that, even on your partner, make sure you change the condom. or you add a c- like you put a condom on if you didnt have one before, very important, or if you wash your toy, use a different toy, very important. um you dont want to have a potential UTI, or anything like that, you dont want your partner to have a UTI, its just not fun. and also because we use STPs and packers, that are sometimes kinda dirty cause we dont wanna wash them, or we use the same type of packing underwear that is dangerous because it does mean that the area is dirty and becasue the was shorter urethras, the bacteria can go up the urethra like i was talking about before. so we need to be careful with that and wash our STPs becasue that is a cause for a lot of UTIs from a lot of trans guys that ive seen especially holding in your pee. but, we were talking about toys, holding in your pee, those are the two main ones for trans guys. so hopefully that helped. i am like so thirsty right now *eah nosie followed by whoogh* um, let me know what you think, if you have any suggesions on any sex related videos you’d like me to talk about, and of course if you have any questions, let me know. alright, have a great day, bye. *outro music*

3 Simple Home Remedies To TREAT URINARY TRACT INFECTION (UTI) In Women

3 Simple Home Remedies To TREAT URINARY TRACT INFECTION (UTI) In Women


Hello and welcome, In this video we are going
to talk about urinary tract infection. UTI is a painful infection that often is accompanied
by a burning sensation during urination and an urge to urinate often. This occurs most commonly in women.
Lets take a look at some simple remedies that you can try at home. Take a glass of water. And add about one tea spoon of baking soda to this Stir this well, and drink this first thing in the morning.
This helps in reducing the acidic nature of your urine. Take some water, and add one table spoon parsley to this.
Boil this solution for about 6 to 10 minutes. Strain this and let it cool down and store it in your refrigerator.Drink this every day till the bacteria is washed out from your system. Take a glass of water and add a tea spoon of celery seeds also known as ajwain. Boil this solution for about 10 minutes and let it cool down and drink it. This will give you instant relief alternatively you can have 3 glass of cranberry juice everyday preferably without sugar.
Hope these remedies have helped you, for more such amazing video do not forget to like the
video and subscribe to Stlyecraze.

Urinary Tract Infection (UTI) – Home Remedies


Among the few infections that do not surface in the initial stages… is urinary tract infection. It is caused by germs, particularly bacteria. Women are more susceptible to it because they have a shorter urinary tract. UTIs are usually not serious, especially when treated in time. However, they could be a source of great discomfort
and embarrassment because of severe symptoms like: burning sensation during urination Cloudy and smelly urine The urge to urinate even when after the bladder is emptied and pressure in the lower abdomen and back. Though poor hygiene and sexual intercourse top the list of UTI causes, Some other factors that could increase the chances of this malady are kidney stones, menopause and enlarged prostate. While drinking 3-4 glasses of unsweetened cranberry juice
can be beneficial in treating this infection,
there are some other home remedies that you need to look. Take a glass of water. And mix 2 tablespoon of apple cider vinegar in it and drink this solution. You can also add lemon juice and sweeten it with a little honey. Apple cider vinegar inhibits the growth of bacteria that cause UTIs. Another home remedy that you can try. Take a cup of water. Add 1 teaspoon of Indian gooseberry or amla powder to it and 1 teaspoon of turmeric powder. Boil the solution until half the water evaporates And drink the residue 3 times a day for up to 3-5 days. Tips to help you deal with UTI. Include vitamin C rich foods in your diet, and avoid sugary foods and beverages. Increase your water intake. And you may also drink tender coconut water
to relieve burning sensation during urination. To prevent UTIs, make sure you urinate before and after the intercourse. And do not neglect the urge to go to the bathroom.

Febrile Baby: Urinary Tract Infection (UTI) – Pediatrics | Lecturio

Febrile Baby: Urinary Tract Infection (UTI) – Pediatrics | Lecturio


Okay, let’s get away from HSV because I really want to focus on bacterial causes of children being sick in the hospital with a fever. The most common by far risk is urinary tract infection and this typically happens between 5 and 10% of the time, perhaps 10% in the first month and 5% after that. Bacteremia is relatively rare, about only 1% of the time, and meningitis is even rarer than that. So, the bacteria that cause these illnesses are very much the same, they’re bacteria that the child is exposed to during the delivery process. Delivery is not a sterile phenomenon as you probably seen if you’ve been at one. So there are risks for mostly fecal organism such asE. colior vaginal organisms such as group B strep especially in GBS positive mothers who are undertreated or untreated.Strep pneumoniaeis not a typical bacteria that kids are _____ at the time of birth but it absolutely can cause sepsis in these children, although it’s much less likely than in an older child. Likewise,Neisseria meningitidisis incredibly rare to get as a result of the birthing process but can rarely happen.Enterococcusis more of a fecal as isKlebsiellaand we’re seeing more and moreStaph aureusin these newborns as we’re seeing more aggressiveStaph aureustypes like MRSA or resistantStaph aureus, we are seeing it now and then and there can sometimes be outbreaks in newborn nurseries. Okay, I’m worried about urinary tract infection because that’s the most common cause of bacterial illness in these children. What do I do? Whenever we get a test, we want to ask “Is it sensitive or specific?” In the case of this, we have 2 ways we can check labs in these kids. We can get a bag or we can get a urine. If a child has a urinary tract infection, the bag is more sensitive. It’s more likely to be positive. If a child does not have a urinary tract infection, the cath is more likely to be negative. It’s more specific. In general, in the United States, we’ve decided that the cath specimen is superior. Now there are some ways you can work around this. If you have time you might bag the child and if the bag is negative then you’re done and then proceed the catheterization if it’s positive but most centers just go straight to catheterization or alternatively if you’re incapable of getting urine any other way, you might do a suprapubic tap. That’s where we insert a needle directly into the bladder through the abdominal wall to get the urine. It’s actually a fairly safe procedure, although how successful it is depends on the experience of the practitioner but in general in the United States we prefer to go to cath or suprapubic tap as opposed to what they recommend in England. The reason we went that way is because there is more and more a feeling that these urinary tract infections are not as serious as we’ve previously suspected. Kids tend to get better and many times it’s not truly a UTI but it’s bacteriuria, a benign shedding of bacteria in the urine. Okay, if we get that urine we’re going to send it for a urinalysis and the urinalysis has several aspects on it that tell us whether the child is likely to have the disease. Remember, the more tests you get you improve your sensitivity and you lose your specificity. So if we look at the individual elements you can see that these all have different amounts of sensitivity and specificity. The one I would call your attention to is nitrites. It’s 98% specific. That means if you have a positive nitrite on your urine dip, it’s very likely that child has a UTI. Overall, the UA is a very sensitive test. It’s 97% sensitive and has a high false positive rate, 30% false positive rate. So if a patient has UTI, it’s almost always positive but it can be positive in normal individuals. Remember those 3 numbers. How do we approach bacteremia? Very ill children may have overwhelming bacteremia or bacterial sepsis and this is more common in infants than it is in older children. Untreated sepsis can lead to shock and death. So we do worry about bacteremia. What’s the likelihood of bacteremia in a very well-appearing patient? It’s very unlikely. True bacteremia is rare and when real may even resolve untreated. Remember, you are probably bacteremic transiently yesterday when you brushed your teeth. Okay, so we need test that can tell us quickly whether a child is at risk for bacteremia so we can distinguish well-appearing children who we should worry about versus those who we shouldn’t and there are several tests out there. There seems to be early evidence that procalcitonin and CRP may in fact be better than the CBC in terms of screening for this but right now most people are still using a high white count. If the white count is above 15 or below 5, we worry a little bit about bacteremia. Coming soon to a theater near you is blood PCR. I suspect this may 1 day replace what we currently use as the goal standard test, which is culture. So right now we’ll get these preliminary tests, a procalcitonin or a CRP or a CBC looking specifically at the white count and if those are normal we feel comfortable saying it’s very unlikely this is a positive blood culture but if they’re abnormal it might be. Hopefully with advent of blood PCR we don’t need to wait for a definitive thing and we can get that blood PCR relatively quickly, typically takes about an hour and a half to get the test done. Okay, what about meningitis? You should send an LP in a baby if they have suspicion for meningitis. This is typically in children under 4 weeks of age and maybe in that 4 to 8-week range depending on whether you use the Philadelphia and Boston criteria as opposed to the Rochester criteria, we only do it if the white cell count is abnormal. So what labs should we send that cerebrospinal fluid for after we’ve obtained it? Well, the first is a cell count. In a patient with meningitis under a month of age, that cell count would be over 21. In a patient with meningitis who’s between 1 and 2 months, it will be over 11. We should send that CSF for glucose and generally the glucose is about 2/3 of the blood glucose. So if it’s less than that, it’s more likely to be meningitis. If you want to think about it, this is not the pathophysiology but you can think about it as if the bacteria are eating glucose and making protein. So if there’s bacterial meningitis, these patients will have a less than 2/3 of their serum glucose in their spinal fluid. Likewise, the protein will be high so if they have meningitis they should have a high protein above about 90. Gram stain is important and if the gram stain is positive, it’s very likely this is bacterial meningitis but remember the false negative rate is high. So it’s one of these things where if you see it you worry but if you don’t see it you don’t necessarily know. Culture is the goal standard and that’s what we’ll wait for but that takes couple of days and so these infants may be hospitalized for a period of time waiting for that culture to come back. However, if you send an enterovirus PCR in that test and it comes back positive which typically happens in the fall and winter months, you’re done. It’s a very accurate test and we will typically discontinue antibiotics and if the child is well send them home but keep in mind enterovirus meningitis can be very severe and sometimes these kids can get quite sick.

Urinary Tract Infection In Women | Causes & Treatment

Urinary Tract Infection In Women | Causes & Treatment


Feminine health and hygiene issues are often considered uncomfortable to talk about but we at Glamrs want to open up the conversation. One of the topics being, Urinary Tract Infections or UTI’s. Have you heard about UTI’s, but aren’t sure exactly what they are and how to prevent them? We’re here to help you understand how they occur and how they can be easily avoided, to make sure you’re informed, healthy and confident! A UTI is a type of infection that can affect any part of your urinary system. Including your kidneys, ureters, bladder or urethra. A UTI occurs when fecal bacteria from your large intestine enters your urethra, the tube that carries urine from your bladder to outside your body. Once it enters your urethra, it can travel up to your bladder and cause an infection. If left untreated this infection could travel even further up to your kidneys and result in more severe symptoms. Unfortunately, women are more prone to UTI’s than men because of our anatomy. Our urethras are much shorter than men which makes it easy for bacteria to travel up to our bladder easily. UTI’s can also be caused by sexual activity, improper hygiene or menopause. We are also more prone to the infection while pregnant. A UTI is accompanied by symptoms like a strong and frequent urge to urinate without actually being able to pass much. And an extreme burning pain when you urinate as well. Another symptom is urine that is cloudy or contains blood. If you experience these symptoms, see a doctor immediately! You will be made to give a urine sample to test and then can be easily cured in just 2-3 days with antibiotics. Although it’s frustrating that women are so easily prone to UTI’s, it’s also very simple to prevent them by incorporating these quick tips into your daily life. Drink lots of water and liquids throughout the day to stay hydrated and cleanse your urinary system. Urinate before and after sex as it will flush out any bacteria that may have entered your system. Make sure you’re pushing bacteria away from your urethra by wiping yourself from front to back in the bathroom. Scented feminine hygiene products like washes and wipes might make you feel like you’re fresher down there but they might irritate you instead. Cranberry juice doesn’t cure UTI’s but prevents it by stopping bacteria from traveling in your system, so drink up! Above all make sure to maintain proper hygiene and keep yourself clean. UTI’s often recur so if you have experienced one in the past be extra cautious! Urinary Tract Infections are a pain, literally! But they are also extremely easy to avoid. So we hope you find these tips helpful and that this information arms you with the knowledge you need to feel comfortable, safe and to openly talk about female health issues. Until next time, stay tuned and stay Glamrs.

Catheter-Associated Urinary Tract Infection (CAUTI) Case Studies

Catheter-Associated Urinary Tract Infection (CAUTI) Case Studies


>>Alright. Well let’s first
just real quick go over the purpose of
our case studies. First of all, it just gives
you good training on the use of the definitions, and these
are all based on the new, January 13 definitions. Try to learn to accurately
apply these definitions and to realize these are
surveillance definitions. And can be very consistent
in our application and improve our data quality. And I was just speaking with
someone during the break, and I think when we roll out
all these new definitions and we’ve been talking
a lot about validation of denominator data, I
think it’s really good when you move this many
kind of new definitions, it’s good to get
with someone when — with your numerator as well. And when you’re starting to
write up these [inaudible], you know, based on
new definitions, just have someone you can sit
with and validate, say, “Mike, have I got this right?” [Chuckles], you know. But hopefully going
through this will help you. Alright, let’s start
with case one. Day 1, we have a
50-year-old patient with end-stage pancreatic
cancer, with liver and bone meds admitted to the
hospital with advanced directive for comfort care and antibiotics
only, a Foley catheter, a peripheral IV and
nasal canula inserted. On day four now, the
Foley is still in place. The patient is febrile
to 38.0 centigrade. Has suprapubic tenderness. IV ampicillin was started after a urine was
obtained for culture. Day five the patient’s
having difficulty breathing. The chest x-ray shows
an infiltrate in the left lung base. On day six those urine culture
results are back that were taken on the fourth, and it shows
10 to the 5th of e coli. Day seven, you’ve got WBC’s
of 3,400, patchy infiltrates in both lung bases, continued
episodes of dyspnea [inaudible] in the left lower lobe. And on day 11 the
patient expired [pause]. Does this patient have a UTI? And if so, what type? Yes, a SUTI Criterion 1A. You can get your definitions
there, kind of in front of you. There was a — the SUTI page
was cut and pasted on there. Yes, SUTI, Criterion 2A. Yes, and ABUTI, or no UTI. Go ahead and use your clickers. This is to vote. [ Background conversations ]>>All of mine are voting
questions except the last two I think [pause]. Alright. [ Background conversations ]>>We’re getting there. I need a few more
responses we’re waiting for. [ Background conversations ]>>I can see there’s some group
consensus going on at tables; good discussion [pause]. Alright. I’m going to give
you about 10 more seconds. I don’t use the little
timer, but I’m going to close the poling
in about 10 seconds. So go ahead and get
those responses in. [ Background conversations ]>>See I can see how
many of you have voted. I have a little magic
screen here. [ Background conversations ]>>Alrighty. [ Background conversations ]>>And the answer is
yes, they have a SUTI 1a. Okay? And we’re going
to go through and show you the rationale. You all did great on that
[background conversations]. So I have that page right
in front of me there. The catheter had been in
place in place for greater than two calendar days. Suprapubic tenderness,
and greater than 10 to the 5th colony-forming units. See, that wasn’t so hard, right? But that fever that she had? That was only 38. It was not greater than 38. So you had to use that
suprapubic tenderness. [ Pause ]>>Alright. Case 2. On 8/2 a
66-year-old went to the OR for an exploratory lab and
Foley was inserted in the OR, and they were transferred
to ICU post-op. On 8/3 the patient was
stable; Foley’s still in place. On 8/4 the patient was
noted to be febrile to 38.9 and complained of
diffuse abdominal pain. The WBC’s were increased
to 19,000. He had cloudy, foul-smelling
urine, and the urinalysis showed
2+ protein, 1+ nitrites, 2+ leukocyte esterase, WBC’s
of 10,000 and 3+ bacteria. And the culture was 10 to the 4th colony-forming
units of e coli. The abdominal pain seemed to be
localized to the surgical area. Is this a UTI? And if so, what type? Was there no UTI? Yes, it was a SUTI criterion 1b. Yes, a SUTI criterion
2a, or yes, an ABUTI. [ Pause ]>>Place your votes. [ Background conversations ]>>Alright I’m going to give
you about 10 more seconds. Make a decision;
place your vote. [ Background conversations ]>>Okay. [ Background conversations ]>>Yes. Look how well
you all are doing; 90% of you got that one right. Yes. This is a SUTI,
criterion 2a. And we’ll go over that. So remember, 2a is where you
have the little bit lower colony-forming counts, but
the patient has had a Foley in for two days, had the fever
that was greater than 38. Had the leukocyte esterase
and the nitrite positive. Remember the leukocyte
esterase points to the fact that there may be some
WBC’s in the urine. And the nitrite points to the fact there may be
some bacteria in the urine. If you — that’s fallen off
your radar of what that means. Pyuria was present and also
we then had a urine culture that was 10 to the 4th,
so that’s why we went to the criterion 2a and why we
needed a little more evidence that was found there in
that urinalysis, okay? Alright. Case 3. Day 1 you have a 58-year-old
patient who’s admitted to the ED with GI bleed and a
Foley is inserted. Day two the patient
spikes a temp of 38.6, the indwelling catheter
remains in place and a urine specimen is sent. On day 3 the culture results
are back and it’s 10 to the 5th of pseudomonas aeruginosa
in that urine culture. Is this an HAI? And if so, what type? Yes it’s a UTI but not a CAUTI because the catheter had not
been in for two calendar days. No, it meets the definition
for present on admission. Or yes, it’s a SUTI,
criterion 1a. Go ahead and place your votes. [ Background conversations ]>>This first table’s
having lots of discussion. I’m enjoying this over here. Alright, I’m going to give
you about 10 more seconds. It looks like almost everybody
has voted except this one trouble-making table over here. [ Background conversations ]>>Okay, closing it off here. [ Background conversations ]>>No. This meets the definition
for POA or Present on Admission. Very good. Let’s go over that
[background conversations]. An infection is considered
present on admission if it occurs on the day of hospital admission
or the next day. The infection must fully
meet a CDC/NHSN criterion on the third hospital
day to be — prior to the third
hospital day to be POA. And this one definitely
occurred. They’d only been in house
just that second day and they had the symptoms. Okay? Alright. Case 4 — you guys
are doing great. Day 1, an 84-year-old
patient is admitted to an LTAC with a diabetic foot ulcer and
a indwelling catheter in place. On day 8 — so now
we’re 8 days later — indwelling catheter is still
in place and there are no signs and symptoms of infection. Day 9, the patient
becomes hypotensive. The CBC shows a WBC of
15,000, a temp of 38.0. The foot ulcer is
draining moderate amount of purulent drainage, and
the patient is pan cultured. The blood culture and the
urine culture both grow strep pyogenes, and the urine
is showing greater than 10 to the 5th colony-forming
units in that result. The foot culture is positive for
pseudomonas aeruginosa [pause]. Is this a UTI? And if so, what type? 1) No because the
blood’s C to the urine and therefore there is no UTI. Yes, it’s an ABUTI. Or yes, it’s SUTI criterion
1a with a secondary BSI. [ Background conversations ]>>Alright I’m going to
give you 10 more seconds. Maybe I should have had
the “unsure” question 4. Yeah [chuckles]. [Background conversations]
10 more seconds. Give it your best guess. [ Background conversations ]>>Alrighty [pause]. Very good. Yes, this is an Asymptomatic
Bacteremic UTI. Alright. And we’ll go over
the rationale for that. There were no signs
and symptoms. Remember that temperature
was not greater than 38. It was 38 on the nose. And the positive blood
culture has to have at least one uropathogen
matching to the urine culture, which the patient had. What if — this is part 2 —
the organism in both cultures — both the blood and urine
— had been micrococcus? Is this a UTI? Yes, this is an ABUTI? Or No, this is not an ABUTI. Go ahead and vote on that one. [ Background conversations ]>>Okay, listen we’re
almost there. I’m going to go ahead, give
you about 10 more seconds. Finish up your poling. [ Background conversations ]>>Very good. No, this is not an ABUTI. And your rationale here, micrococcus is not
a uropathogen, and therefore this
is not an ABUTI. Remember you need to have — the organisms have to be
on that uropathogen list, and here it is again. And remember, that list is
going to be able to be found in the NHSN manual in your
ABUTI criterion section. It will be right there listed. So that’s helpful for
you to remember, okay? Let’s go on to Case 5. On 8/5 we have a 76-year-old
woman’s admitted from the LTAC at 8:00 am for surgical
debridement of a sacral decub. The medical history’s notable
for severe rheumatoid arthritis and congestive heart failure. A routine admission
UA is performed. It’s positive for leukocyte
esterase and 3 WBC’s by high-powered field
of spun urine. The patient’s afebrile. Denies urinary urgency,
frequency, or pain. And there’s no suprapubic
or CVA pain. And a Foley and a peripheral
IV are inserted in the OR. The next day, 8/6, the wound
care specialist documents that the wound is clean. Temp of 37.4 and the Foley is
draining some cloudy urine. On 8/7 the temp is 38.2
degrees centigrade. The Foley is removed. Encouraged to push PO fluids
and a urine specimen is sent to the lab for culture
and sensitivity. On 8/8 the temp is still 38.6
and the patient’s complaining of dysuria and pain with
palpation to the suprapubic area and bactrim is started. On 8/9 that urine specimen
that was sent on 8/7, the results are back and
are positive for e coli, 100,000 colony-forming units
and the patient is afebrile and preparing for
discharge back to the LTAC. Does this patient have a UTI? And is a CAUTI? 1) No, the UTI was
present on admission. 2) Yes, the patient has a
SUTI 1a and it is a CAUTI. 3) The patient has a SUTI
1b, but it is not a CAUTI. [ Background conversations ]>>Okay I’m going to give
you about 10 more seconds. We’re looking close here, but about 10 more seconds
finish your voting. [ Background conversations ]>>Alrighty. [ Background conversations ]>>Yes. You guys
are doing great. This patient has a SUTI
1a and it is a CAUTI. And we’ll go over the rationale. This all occurred
on hospital Day 3. So it’s been — so greater
than 2 calendar days. And then she had fever
and suprapubic tenderness and the urine culture was
greater than 10 to the 5th of colony-forming units. Now the trick question
there may have been that positive UA on admission. But remember, UA’s
may be positive for non-infectious
reasons, and since symptoms of UTI were definitely
not present on admission and only developed
following Foley insertion, this would meet our
definition for a CAUTI [pause]. Alright? Let’s go on to Case 6. This is a 48-year-old
male who was involved in a motorcycle accident. Has a closed-head injury;
multiple fractures. Taken to the OR for ORIF’s and
evacuation of subdural hematoma. A Foley catheter and left
subclavian catheter placed in the ED and the patient
remains on the ventilator that was placed in the OR. The lungs are clear bilaterally. Now 6 days post-op — we’ve moved on here —
and the temp is 99.8. You have some rhonchi
in the left lung base. The chest x-ray shows a
possible infiltrate atelectasis in this area. The Foley remains in place
draining clear, yellow urine. The patient remains ventilated and has increased
sputum production. Post-op Day 7, you
have a temp of 100.3. The vent settings are
stable and there’s no change to the sputum production. Post-op Day 8 the temp
is now 101.9 Fahrenheit. The lung sounds are
clear; chest x-ray clear. Patient still remains on
the vent, and the Foley and central line
still remain in place. Pan cultures are sent. An empiric antibiotic
treatment was begun. Post-op Day 9, the urine
culture shows 100,000 CFU’s of pseudomonas aeruginosa. The sputum has — shows
pseudomonas aeruginosa. And the blood culture
was no growth. The physical assessment
is normal and the patient has no
response to suprapubic or costovertebral
angle palpation. Does this person have a UTI? And if so — patient rather,
have a UTI and if so, what type? Is there 1) No UTI. Yes, it’s an ABUTI. Yes, it’s a SUTI 2a. Or yes, a SUTI 1a? [ Silence ] [ Background conversations ]>>Okay, I’m going to give
you about 10 more seconds. [ Background conversations ]>>Couple more seconds and [ Background conversations ] . Okay. [ Background conversations ]>>Yes. This patient has
a SUTI 1a, 87% of you. That’s great. [ Background conversations ]>>The Foley was in place for
greater than 2 calendar days. You had that fever. Had a positive urine
culture with greater than 10 to the 5th colony-forming units with just the one,
single pathogen. Now let’s put a little
tweak to this. What if the patient
had been afebrile — you didn’t have that temp —
but you had an elevated WBC and the urine was really cloudy. But the culture results
were the same too. Would the patient have a UTI? No UTI. Yes, still a SUTI 1a. Or yes, an ABUTI. [ Background conversations ]>>Yeah. [Background
conversations] . This one? [Background
conversations]. Yes. [ Background conversations ]>>Someone asked if the elevated
WBC’s and the cloudy urine — the WBC’s were in the urine,
and the answer is yes. That was urine WBC’s
were elevated. [Background conversations] but
the patient doesn’t have a temp. [Background conversations] not that I’m giving you
a hint, but — [ Background conversations ]>>Alright 10 seconds. [ Background conversations ]>>Oh. Very good. No UTI. And the rationale
on that, remember this was a
patient without symptoms. At this point we
took the fever away. Remember they don’t have
a matching blood culture, so it can’t be an ABUTI. And the elevated BC and
cloudy urine are not part of our NHSN UTI surveillance
criteria. But I can tell you, I know —
I can’t tell you how many times when I’m investigating a urinary
tract infection and you try to figure out why they
spent this urine specimen, cloudy urine. Man, lots and lots of
times you see that — seems that that’s why they’re
sending the culture was because they saw cloudy urine. But that is not part of
the definition [pause]. Remember your surveillance
definition tends to work better in some patient populations
than others — which we’ve already talked
about a little bit in terms of how they can respond
to being able to express about different symptoms. And the patient should
be thoroughly assessed for UTI symptoms including that suprapubic tenderness
and the CVA pain. And this is where we can — it
can be really helpful in terms of educating your
nurses in terms of good physical assessments
or any of your clinicians. And again, that that
clinical diagnosis may differ from surveillance determination. You know, and you may
see often these 10 to the 5th being treated
by physicians and called, but it doesn’t meet our
surveillance definition, because that to us is a —
would have been when you take that fever away, that would
have been an asymptomatic UTI, which we don’t document
unless it’s ABUTI. Alright, let’s do Case 7. It’s 8/25 and a 73-year-old
patient in a neurosurgical ICU was
admitted following a cerebral vascular accident. Ventilated. Has a subclavian catheter and
a Foley in place on admit, and the patient reacts
only to painful stimuli. A 9 to the WBC is slightly
elevated at 12,000. Temp of 37.4. The urine is cloudy and the
lungs are clear to auscultation. On 9/3 the WBC’s are at
15,800 per cubic millimeter. Temperature of 37.6. Breath sounds slightly course. Minimal clear sputum. Urine unchanged. The blood and endotracheal and
urine specimens are collected and there’s no suprapubic
or CVA pain noted. On 9/4 blood and endotracheal
cultures are no growth and the urine is 10 to the
5th colony-forming units of enterococcus faecium. Does this patient have a UTI? And if so, what type? Yes they have an ABUTI. They have a SUTI criterion 1a. A SUTI criterion 1b. Or no UTI. [ Background conversations ]>>Okay. We just have 10 minutes
left for our case studies, so I want to give you —
get through all these, so let’s wrap this
voting up in 10 seconds. [ Background conversations ]>>Alright. Here we go. [Inaudible] [pause]. Really good. 88% of you correct answer. There is no UTI. Because there were
no urinary symptoms, and there wasn’t a
fever greater than 38 and no matching cultures, the urine surveillance
for UTI are not met. But let’s give it a
little tweak here. What if the patient’s
temp had been 38.1 and the patient also
met the criteria. You saw that pulmonary
stuff going on. Had met criteria
for probable VAP. Including a bronchioalveolar
lavage with — oop — I’ll have to change
the organism here. With our VAE criteria, we
wouldn’t have enterococcus — I just noticed that —
but we’ll just say we did. Enterococcus faecium. So you have the same
organism now from the BAL as you do in the urine. So here’s the new question. Does this patient have a UTI? No. The patient’s fever
is due to pneumonia. Therefore the patient
is symptomless. Yes, it’s a SUTI 1a. Fever is nonspecific
and may be due to more than one infection at a time. [ Background conversations ]>>What? I know. [ Background conversations ]>>Alright. 10 seconds because we’re getting
close to the end of the day. [ Background conversations ]>>Alright. Here we go. [ Background conversations ]>>Yes. Because fever’s
nonspecific and definitely may
be due to more than one infection at a time. They had — the patient
had a SUTI 1a. The indwelling catheter
was present. The fever and the urine culture,
and greater than 10 to the 5th of a colony-forming units. Alright. We have 4-year-old
admitted following an MVA. Taken to the OR for ORIF
and internal fixation of a left upper and right
lower extremity fractures. Admitted to the Pediatric
Surgical Care Unit with a Foley catheter
draining yellow urine and a right femur attraction. IV in the right antecubital
vein. 8/18 afebrile, taking
clear, liquid diet and beginning oral pain med
using incentive spirometer. The Foley’s draining
yellow urine. 8/19 next day tolerating
a solid diet. The IV is converted
to a saline lock. Foley draining yellow urine. 8/20 the Foley is
removed at 0800 and the patient is
voiding without problems. And the patient has a slight
cough of clear phlegm. 8:21 in the morning, the
patient is requesting a bedpan frequently. Crying with urination. Temp of 37.9. The cough is unchanged and a straight cath urine
specimen’s collected. The urine’s cloudy and the UA is
positive for leukocyte esterase. Nitrite’s negative. A WBC of 10 for high-powered
field. Later that evening
the gram stain of the urine shows
many gram negative rods and empiric Bactrim is started. On 8/23 that culture comes back and it’s 50,000 colony-forming
units of e coli. Does this patient have a UTI? No. Or yes, a SUTI 1b. Yes a SUTI 2a. Or yes, a SUTI 2b. [ Background conversations ]>>Alright. Place your votes. 10 more seconds. [ Background conversations ]>>Alright. [ Background conversations ]>>Yes, this is a SUTI 2a. If you look at that lower
part of the definition, the patient had an indwelling
catheter in place for two days. It had just been removed. And we had frequency and dysuria
that she was complaining of. Leukocyte esterase positive. You had that 10 WBC’s
for high-powered field, and they saw microorganisms. And the organism result was
between that greater than 10 to the 3rd but less than
10 to the 5th [pause]. Well, we only have — we — [ Background conversations ]>>Okay. We’re going to
go to the last couple that lets you practice counting
those denominators we were talking about. So let me get to those. [ Background conversations ]>>All these cases
are in your packet, and you’ll have the
answer sheets as well. Alright. Let’s talk
about counting Foley days for your denominators
we were discussing. So I want you to look
at this, alright? And tell me how many indwelling
catheter days you think you have. Look at the status. This — everything was
counted at 12 noon, okay? In this unit. And do you have 6, 5, 4,
3, 2 or 1 catheter days for that day on the unit? [ Silence ]>>And this one is not a —
this is not one you can vote on, so I’m just going to show you. But just, you know, make
your decision in your head, what you think your
answer is, okay? I’m going to give you
a couple more minutes, but count was done at noon. [ Background conversations ]>>Alright? [ Background conversations ]>>I see most people look
like they — there’s two. And I’m going to show
you where they are here. You have this one,
patient 101, Mr. Black. Had an indwelling
catheter that whole day. And at that — at noon, and 106
had an indwelling Foley at noon. Now you might have
thought there were three, but look at the patient
[inaudible]. They weren’t admitted until
2:00 in the afternoon. So at noon that — they
would not have been there with a Foley. So those are the
only two patients that at noon would
have had a Foley. Okay, let’s try one
more [pause]. Okay. Let’s — same thing. Now this is again, another unit. How many indwelling catheter
days do you see here? And this is a unit where they’re
doing their catheter counting at 11:00 pm. [ Silence ]>>Think you got it? Okay, here we go [pause]. See if you guessed
right on this one. One. [Background conversations]. It looks like people are happy. It’s this patient — Miss
Dallas — is the only one. We don’t count condom caths
and suprapubics don’t count. And that other indwelling,
they’d already been discharged. So we have one Foley
catheter day that day. Great. Well thank
you very much —

Septic Shock: Treating Blood Infections, Pneumonia, Urinary Tract Infections

Septic Shock: Treating Blood Infections, Pneumonia, Urinary Tract Infections


Septic shock is the result of an infection
that’s in the blood stream. These can be infections that come from different
sorts of areas. So, in the lungs, it would be called a pneumonia,
or in the urine, a urinary tract infection. And often times, when we get these infections,
our bodies are able to fight them off, and especially if we can get antibiotics and other
therapies, it can kind of turn the course. But sometimes the infection gets worse, and
the shock happens when the body has an abnormal, exaggerated response to the infection. And this can lead to a host of downstream
complications that are primarily related to the inability of the body to deliver oxygenated
blood to your vital organs, and when that happens, the organs can start to shut down,
or go into organ failure. And the key to treating this is to give antibiotics
early, effective antibiotics, to give intravenous fluids to help support blood flow to the organs,
and try to support all the organ function that the patient needs.