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NUR 311: IPC > Week 10 - Topic 1: UTIs > Flashcards

Week 10 - Topic 1: UTIs Flashcards

1
Q

Why are women at a higher risk of fecal flora colonization in the urinary tract?

A

Women’s urethra is a lot shorter (4 cm vs 20 cm for men)

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2
Q

What are the normal flora of the vagina?

A

Candida spp*
Gardnerella vaginalis*

Lactobacillus
Streptococcus
Staphylococcus
Bacteriodes
Klebsiella
Proteus
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3
Q

Why are elderly women more at risk for an UTI?

A

Women at menopause or with lower estrogen have vaginal cells that produce less glycogen, converted into lactic acid by lactobacillus, which creates an acidic environment and inhibits the growth of pathogens.

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4
Q

What are opportunistic urinary pathogens?

A 
E coli*
Klebsiella spp*
Porteus spp*
Pseudomonas
Staph saprophyticus

*common

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5
Q

What is candiduria?

A

The amount of yeast (fungi) in the urinary tract that reaches a certain threshold

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6
Q

What are two things that increase the chance of having candiduria?

A

1) Use of broad-spectrum Abx

2) Long term indwelling urinary catheters

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7
Q

What are 3 factors that inhibit bacterial growth in the urine?

A

1) Low pH (acidic)
2) High urea concentration
3) High osmolality

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8
Q

What are virulence factors of bacteria that cause UTIs?

A
  • Pili (fimbriae) for adhesion –> E coli, Proteus, Pseudomonas
  • Flagella to move upstream –> E coli, N gonorrheae
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9
Q

Name some host risk factors for UTI

A

Change in urine pH (diet, medication, disease)

pH changes in vagina (pregnancy, menopause, douches)

Increase in fecal flora around the urethra

Illnesses (diabetes, polycystic kidneys, renal transplants)

Obstruction/non functional urinary system

Inadequate fluid intake

Device in place (Foley)

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10
Q

To have an UTI, you must have a significant + urine culture and what other sx?

A

Urgency/frequency
Dysuria
Suprapubic pain or flank pain in the kidney area
Pyuria

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11
Q

What are some non-specific sx for an UTI?

A

Fever
Lethargy or changes in mental status
Nausea, vomiting

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12
Q

What are some signs that not indicative of a UTI?

A

Strong smelling urine
Cloudy urine
Incontinence
Retention

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13
Q

True or False: Your PT has cloudy urine. Do you send a urine culture?

A

False

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14
Q

What are causes for cloudy urine?

A
  • Dehydration
  • Food dyes
  • Drugs/vitamines (Vit B, C)
  • Blood (from kidney stones)
  • Mucus
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15
Q

What is ABUTI?

A

Asymptomatic bacteriuria –> bacteria in urine with no sx

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16
Q

Who is more likely to have ABUTI?

A
  • Elderly PT
  • PT with spinal cord injury
  • PT with indwelling urinary catheters
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17
Q

We don’t usually treat cases of ABUTI. Name 2 exceptions

A

1) Prior to urological procedures

2) Pregnant women

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18
Q

What are some sequelae (consequences) with UTI?

A

Secondary bacteremia
Damage to the urinary tract –> urethritis
Relapse (from same pathogen)

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19
Q

How do you prevent UTIs in people with no foley?

A
  • Clean perineum (F: wipe front to back after pooping, M: clean foreskin)
  • Refrain from vaginal douches
  • Use birth control other than diaphragms
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20
Q

True or False: Peeing after sex, drinking 2-4L of fluid/day and drinking cranberry juice can prevent UTIs

A

Neither, it is controversial advice

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21
Q

When are the 2 instances to culture urine?

A

1) When there is an order

2) Before starting Abx

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22
Q

What urine tests are performed?

A

1) Microscopic urine analysis
2) Dipstick (at the bedside)
3) Culture ‘n’ sensitivity

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23
Q

How do we minimize contamination during urine culture/sample?

A

1) Use a sterile leak proof container
(clean catch midstream, aseptic NTT for in and out catheterization or disinfect sampling port for foley)

2) Transport immediately or refrigerate

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24
Q

How do you collect a urine sample from a foley?

A
  • Drain the urine from tubing
  • Clamp
  • Wait for fresh urine
  • Disinfect sampling port prior to sample
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25
Q

How do we do a lab microscopic analysis of urine?

A

Centrifuge urine and assess the sediments under a high power field (HPF) while looking for:

casts, cells, crystals, bacteria/yeast

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26
Q

How do we assess for pyuria in urine culture?

A

Assess for the presence leukocyte esterase (enzyme in WBC), possible infection if there is more than 10 WBC/HPF

27
Q

True or False: Having pyuria makes it likely you have an infection.

A

True, but pyuria alone is not a signal to give Abx

28
Q

What can give false negatives for leukocyte esterase?

A
  • Neutropenic PT

- Urine elevated with protein (> 500 mg/dL), glucose (> 3g/dL) or high specific gravity

29
Q

Why do we assess for urinary nitrite?

A

It can indicate a presence of bacteria because they convert nitrates in the urine

30
Q

What type of bacteria produces urinary nitrites?

31
Q

What causes false negatives for the nitrite test?

A
  • Some organisms can’t produce nitrites (gram +, yeast)
  • PT is on Abx
  • PT has recently voided or has diluted urine (pee must be in bladder for at least 1h)
  • PT does not eat enough nitrate
32
Q

What does the urine dipstick check for?

A 
Acidity
Urine concentration
Protein
Sugar
Ketones
Bilirubin
Nitrites or leukocyte esterase
Blood
33
Q

What must you check before doing a dipstick test (2)?

A
  • Expiry date

- If container was properly closed

34
Q

What must you do during a dipstick test (3)?

A

1) Mix urine well so cells do not settle at bottom
2) Expose the urine for recommended time (check brand)
3) Ensure there is not excess urine on the strip that can cause regents to leak out and distort the colours

35
Q

What is the criteria for sending a urine culture?

A

Onset of fever/hypothermia/chills/altered mental status/nausea-vomiting

AND at least one of:
Suprapubic pain
Acute hematuria
Urgency
Frequency
Dysuria
36
Q

What are the 3 types of urine cultures?

A

1) Bladder tap (sterile normally)
2) Voided urine (some contamination from periurethral area)
3) Catheterized urine (some contamination)

37
Q

What could indicate that a catheterized urine sample was contaminated?

A

3+ organisms

38
Q

What concentration do we need for significant results of in/out - midsteam - catheter urine?

A

≥ 10^8 CFU/L or

≥ 10^5 CFU/mL

39
Q

What is the most common healthcare associated infection?

40
Q

What causes UTIs in the healthcare setting?

A

Indwelling urinary catheter (15-25% of all HAI)

41
Q

What is so dangerous about the drainage bag?

A

It is a reservoir for MDROs

42
Q

True or False: Half of all UTIs are not true UTIs

A

False, it is 1/3

43
Q

What is CAUTI?

A

Catheter-associated UTI

44
Q

What are the 3 main ways for bacteria to enter when using a catheter?

A

1) Contamination of the tip during insertion
2) Residual contaminated urine ascends the outside walls of the catheter
3) Residual contaminated urine ascends the inside walls of the catheter

45
Q

What are the 2 extraluminal routes of entry for bacteria in CAUTIs?

A

Early, at insertion

Late, by capillary action

46
Q

What are the 2 intraluminal routes of entry for bacteria in CAUTIs?

A

Break in closed drainage

Contamination of collection bag

47
Q

True or False: Your PT has a foley. It is not recommended to start him on antibiotic prophylaxis.

A

True, prophylaxis can slow progression of biofilms on foley, but not stop it

48
Q

What are the 3 stages of a biofilm formation?

A

1) Microbe attaches to device surface
2) Cells grow and aggregate (microcolonies)
3) They mature and new cells disseminate for new colonies

49
Q

What is the 3 main sites of biofilm infection?

A

1) Mouth/teeth
2) Subvenous catheter
3) Artificial hip implant

50
Q

How do you handle a Foley properly?

A

Make sure it is secured
Disinfect the junctions
Position the bag below the bladder
Maintain a closed system

51
Q

How do you prevent cross contamination when manipulating Foleys?

A

Wash hands before

Do not share urinary measuring container (to avoid contamination spigot)

52
Q

What is CHORUS (indications for urinary catheter use)?

A 
C omfort
H emodynamic monitoring
O bstruction
R etention
U rologic
S surgery
53
Q

What does the C in CHORUS signify?

A

Comfort
Comfort measures for terminally ill
Open sacral/perineal wounds in incontinent PT

54
Q

What does the H in CHORUS signify?

A

Hemodynamic monitoring
Close monitoring of urine output
Aggressive tx with diuretics or fluids

55
Q

What does the O in CHORUS signify?

A

Obstruction

Enlarged prostate, blood clots, etc.

56
Q

What does the R in CHORUS signify?

A

Retention

Urinary retention not manageable by other means

57
Q

What does the U in CHORUS signify?

A

Urologic

Urologist placed urinary catheter, urologic studies, neurogenic bladder

58
Q

What does the S in CHORUS signify?

A

Surgery
Urologic, gynecological or perineal surgery
Epidural catheter in place
Orthopedic fracture prior to repair

59
Q

What is HOUDINI (assesses the need for the catheter daily)?

A 
Does PT have...
H ematuria
O bstruction
U rological surgery
D ecubitus ulcer 
I &O for hourly management or hemodynamic instability
N o code/comfort care
I mmobility due to physical constraints

If not, remove catheter

60
Q

What are 2 alternative uses to a Foley?

A

1) External condom catheters

2) Bladder ultrasound with intermittent catheterization

61
Q

How long should you have a catheter for high risk of infection?

62
Q

What should you document wrt the catheter (3)?

A

1) Why it was inserted
2) When it was inserted
3) When it was removed

63
Q

How do you prevent UTIs when inserting the Foley?

A
  • Hand hygiene
  • Aseptic clean no touch technique (sterile equipment + 1 sterile glove)
  • Antiseptics to clean the urethral meatus
  • Single use packet of sterile lubricant jelly
  • Smallest catheter size possible
  • Stabilize catheter
64
Q

Why shouldn’t you give a catheter to a PT who is continuously incontinent?

A

Chronic catheterization inevitably leads bacteriuria

NUR 311: IPC (17 decks)

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