Monthly Archives: August 2013

Is there benefit to routinely screening for urinary tract infection (bacteruria) in hospitalized patients without urinary catheters?

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The information below pertains to asymptomatic bacteruria because the assumption is if the patient were symptomatic, diagnostic testing would be administered as standard care for the patient.

Here are guidelines for diagnosing and managing asymptomatic bacteruria.

  • Infectious Diseases Society of America (IDSA) guideline on diagnosis and treatment of asymptomatic bacteriuria in adults.  Clin Infect Dis 2005 Mar 1;40(5):643.
    • Based on evidence from at least 1 quality RCT in each case, IDSA recommends AGAINST screening premenopausal, nonpregnant women, women with diabetes, elderly institutionalized persons, older persons living in community, patients with spinal cord injury, patients with indwelling urethral catheter.  Also recommends screening pregnant women.
    • IDSA does recommend screening prior to transurethral resection of prostate (based on at least 1 RCT) and before other urologic procedures (based on descriptive studies and expert opinion)
    • IDSA does not make any recommendation about screening renal or other solid organ transplant recipients
  • United States Preventive Services Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria in adults.  National Guideline Clearinghouse 2008 Aug 4:12619 or Ann Intern Med 2008 Jul 1;149(1):43.
    • Only recommends routine screening for pregnant women.

Guidelines suggest further research is needed to address management of asymptomatic bacteruria in these populations:  chronic kidney disease, indwelling urinary devices other than catheters (eg, urinary stents, nephrostomy tubes), selected immunocompromised patients (eg, neutropenia, transplant recipients), and patients undergoing prosthetic implantation (orthopedic or vascular procedures).

Evidence from the guidelines includes hospitalized and non-hospitalized patients.  Details of the evidence are provided in the guidelines.

Searches of Medline and CINAHL using combinations of these terms did not identify any papers on routine testing of hospitalized patients.

Urine analysis
Routine, screening
Hospitalized, inpatients
Transplant, immunocompromised

Nursing care for a patient with externalized shunt

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Hill, Michelle A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit. Journal of Neuroscience Nursing, 2012 Aug; 44 (4): 188-93.

Henman, Lita Checklists and Bundles-Not Just for Central Lines Anymore: Using a Standardized Insertion and Maintenance Approach to Eliminate External Ventricular Drain Infections. American Journal of Infection Control, 2011 Jun; 39 (5): E195.

Orsi GB Hospital-acquired infection surveillance in a neurosurgical intensive care unit. Journal of Hospital Infection, 2006 Sep; 64 (1): 23-9.

Cummings R Understanding external ventricular drainage. Journal of Neuroscience Nursing (J NEUROSCI NURS), 1992 Apr; 24 (2): 84-7.

Lwin, Sein, et al. “External ventricular drain infections: successful implementation of strategies to reduce infection rate.” Singapore medical journal 53.4 (2012):255-259.

Littlejohns, Linda R, and BrettTrimble. “Our policy on external ventricular drainage systems includes the procedure for priming the system. Does it really have to be primed?.” Critical care nurse 25.3 (2005):57-59.

Criddle, Laura M. “Is it an expected practice for critical care nurses to irrigate an external ventriculostomy drainage (EVD) system with tissue plasminogen activator (tPA) to break up blood clots in the tubing to facilitate drainage, thereby preventing increased intracranial pressure?.” Critical care nurse 27.3 (2007):78-78, 81.

Searched PubMed & CINAHL. Keywords: external shunt, externalized shunt, (nursing or nurse)