IntroductionIndwelling urinary catheters are used frequently in various settings such as hospitals, nursing homes, acute care hospitals, and in extended care facilites.

Catheter associated urinary tract infections (CAUTI) are one of the most common nosocomial infections in hospitals and nursing homes (Maki and Tambyah 2001).

In many cases catheter use is found to be unnecessary. On average 16-25% of hospitalized patients have catheters, and in nearly 21% of those patients catheter use was unjustified (Lipsky et al. 2002).

Catheters were often forgot about by as many as 50% of new residents, while 40% of senior residents were also unaware of which of their patients had catheters when asked (Lipsky et al. 2002).

The age and sex of a patient are also thought to play a role in CAUTI incidence rate. Discrepancies exist in current literature when it comes to sex and age. Some say men are more likely to obtain CAUTIs than women, while others say women are more likely to obtain CAUTIs. Some say the older you are the more likely you are to get a CAUTI while others say age does not play a factor in CAUTI incidence.

This study will focus mainly on the nurse to patient ratio between two units. The idea that catheters are often forgotten will be analyzed by comparing the CAUTI incidence rates between two units with a (1:5) and (1:8) nurse to patient ratio.

Identifying Risk Factors Linked to Increased Rates ofCatheter Associated Urinary Tract Infections (CAUTI)

Objective/HypothesesObjective: To identify risk factors linked to increased rates of CAUTI.

Hypotheses:• The incidence of CAUTI will be higher in the 1:8 nurse to

patient ratio unit than the incidences of CAUTI in the 1:5 nurse to patient ratio unit.

• Women will have a higher CAUTI incidence rate than men.

• Individuals over the age of 60 will have a greater chance of developing a CAUTI.

http://clinidirect.co.uk/content/userfiles/images/Indwelling-Foloy%20-%20Urinary%20Catheter.jpg http://what-when-how.com/wp-content/uploads/2012/08/tmp61b6112_thumb222.png

MethodsRegular rounding of patients with catheters was conducted 1-2 times per month at Levindale Hebrew Geriatric Center and Hospital. * Random rounds were also conducted.

Units studied were Miesel 1 (M1) and Burk 2 (B2) * Units were similar in size and had patients with similar health.

* Units had different nurse to patient ratios.M1 (1:5)B2 (1:8)

Results The number of infections varied over the year for both units (Figure 1).

There was not a significant difference between the total number of CAUTI’s in the 1:5 unit and the 1:8 unit (Figure 2).

The mean number of males with CAUTI’s was not significantly different from that of females (Figure 3). * There was not a significant difference between the total number of males and females that obtained CAUTI’s in the 1:5 unit (Figure 4) * There was a significant difference between the mean number of males and females with CAUTI’s in the 1:8 unit (Figure 5).

The total number of CAUTI’s per age range increased to a certain point and then began to decrease after age 80 (Figure 6).

Noelle Bricker, Department of Biology, York College of Pennsylvania

AcknowledgementsI would like to thank Dr. Ronald Kaltreider for being my mentor for senior thesis. I would also like to thank Lucia Smeldly and Virginia Saunders for their assistance in data collection for this project, and Dr. Bridgette Hagerty for her assistance with data analysis. Finally I would like to thank all of the Biology Faculty at York College of Pennsylvania for providing me the opportunity to design and carry out my own research.

Overall Conclusions• The nurse to patient ratio did not affect the incidence

rate of CAUTI.• No determinations could be made about the

relationship of CAUTI in regards to sex and age.

Future Studies• All patients with catheters should be included to do an

overall percentage of patients with CAUTI’s. It can be calculated out of the total number of individuals with catheters with or without CAUTI’s.

• The study should be conducted for a longer period of time in future studies to collect more data, 1 year was not quite sufficient.

• Extend the study to more locations to gain a larger sample size for greater diversity among patients.

Literature CitedLipsky, B., Saint, S., and Goold, S. 2002. Indwelling urinary catheters: a one point restraint? Ann Intern Med 16; 137(2): 125-127. Maki, D. and Tambyah, P. 2001. Engineering out the risk for infection with urinary catheters.Emerging Infectious Diseases 7(2): 342-347.

Methods ContinuedData was collected when rounding and then separated out by unit by an infection control practitioner. Age, sex of patient, and presence of CAUTI were identified.

Repeater CAUTI's were identified, preventing pseudoreplication.

Unpaired t-tests were conducted to test for significance between sex, age, and total number of CAUTI’s observed in the 1:5 nurse to patient ratio compared to the 1:8 nurse to patient ratio (Graphpad Prism 6.0).

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec0

2

4

6

Month

Nu

mb

er

of

CA

UT

I's

Figure 1: Total Numbers of CAUTI's Per Unit Each Month in 2014. Barsrepresent the total number of CAUTI's per month in M1 (n=23, black bars) andB2 (n = 18, gray bars).

M1 B2

0

1

2

3

4

Unit

Nu

mb

er

of

CA

UT

I 's

(p

er

mo

nth

)

Figure 2:Total Number of CAUTI's in M1 and B2. Mean number of CAUTI's inindividuals in M1(n = 23) and B2(n = 18). Means of M1and B2 are not significantlydifferent (ns) as indicated by an unpaired t-test (t(22) = 0.6644, p= 0.5133). Errorbars represent 95% CI.

(ns)

Male Female0

1

2

3

4

Sex

Nu

mb

er

of

CA

UT

I's

Figure 3: Total Number of CAUTI's in Males and Females. Mean numberof males (n = 26) and females (n = 15) that had CAUTI's per month in 2014.Means of the two groups were not significantly different (ns) as indicated byan unpaired t-test (t(22)=1.370, p =0.1846). Error bars represent 95% CI.

(ns)

Males Female0.0

0.5

1.0

1.5

2.0

Sex

Num

ber

of In

divi

dual

s w

ith C

AU

TI's

(per

mon

th)

Figure 4: M1 Sex Comparision. Mean number of males (n = 12) and females(n = 11) that had CAUTI's per month in M1. Means of the two groups were notsignificantly different (ns) as indicated by an unpaired t-test (t(22)=0.2328, p=0.8181). Error bars represent 95% CI.

(ns)

Male Female0.0

0.5

1.0

1.5

2.0

2.5

Sex

Nu

mb

er

of

Ind

ivid

uals

wit

h C

AU

TI's (

per

mo

nth

)

Figure 5: B2 Sex Comparison. Mean number of males (n = 14) andfemales (n = 4) that had CAUTI's per month in B2. Means of the two groupswere found to be significantly different (*) (p <0.05) as indicated by anunpaired t-test (t(22)=2.236, p =0.0358). Error bars represent 95% CI.

(*)

1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-1000

5

10

15

Age Range

Nu

mb

er

of

Ind

ivid

ual

s

Figure 6: Age Range of Indivuduals With CAUTI's During 2014. Barsrepresent the total number of individuals in each age range that experiencedCAUTI's in 2014 at Levindale Hebrew Geriatric Center and Hospital.Figures