EPIDEMIOLOGY OF SARS-COV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread globally since December 2019. A first wave was visible up to the end of June 2020 in many regions (Salzberger et al., 2021).
The SARS-CoV2 predominantly replicates in the upper and lower respiratory tracts in contrast to MERS-CoV which replicates predominantly in the lower respiratory tract and is particularly transmitted by droplets and aerosols. The estimate for the basic reproduction number (R0) is between 2 and 3 and the median incubation period is 6 days (range 2-14 days). A high proportion of infections are uncomplicated, but moderate or severe courses develop in 5-10% of infected persons. Pneumonia, cardiac involvement and thromboembolisms are the most frequent manifestations leading to hospitalization (Salzberger et al., 2021). The estimation for the infection fatality rate (IFR) is between 0.5% and 1% across all age groups (Salzberger et al., 2021). Risk factors for a complicated course are advanced age, hypertension, diabetes mellitus and chronic cardiovascular and pulmonary diseases as well as immunodeficiency (Salzberger et al., 2021).

(Sariol and Perlman, 2020)

SIGNS AND SYMPTOMS OF PATIENTS WITH SARS-COV-2

Introduction

A comprehensive review and meta-analysis were undertaken by Al Maqbali et al. to determine the frequency of COVID-19 patient's clinical symptoms. The inclusion criteria were satisfied by a total of 215 studies involving 132,647 COVID-19 participants. The four most prevalent symptoms' combined prevalence was as follows: fever 76.2% (n = 214; 95% CI 73.9-78.5); coughing 60.4% (n = 215; 95% CI 58.6-62.1); fatigue 33.6% (n = 175; 95% CI 31.2-36.1); and dyspnea 26.2% (n = 195; 95% CI 24.1-28.5). Other signs and symptoms range in prevalence from highest to lowest, including expectorant (22.2%), anorexia (21.6%), myalgias (17.5%), chills (15%), sore throat (14.1%), headache (11.7%), nausea or vomiting (8.7%), rhinorrhea (8.2%), and hemoptysis (3.3%). (Al Maqbali et al., 2022). It is important to note that the omicron variant of SARS-CoV-2 which emerged in 2021 produces milder symptoms including runny nose, headache, fatigue, sneezing and sore throat. This is a sharp contrast to the initial list of symptoms associated with SARS-CoV-2 which included high temperature, a new continuous cough or loss of charge in sense of smell or taste (Rae, 2022).

ASSOCIATION BETWEEN SARS-COV-2 AND HEALTHCARE ASSOCIATED INFECTIONS IN USA
The most common healthcare associated infection (HAI) in intensive care units (ICUs) are catheter-associated urinary tract infections (CAUTI), ventilator-associated events (VAE), and central line-associated bloodstream infections (CLABSI) (Dudeck et al., 2011a, Dudeck et al., 2011b, Dudeck et al., 2013, Edwards et al., 2008, Edwards et al., 2007, Edwards et al., 2009, Klevens et al., 2008, Nguyen et al., 2017).
The purpose of this publication is to update, clarify, and emphasize the need of implementing those interventions as the rate of those three types of HAIs increased during the COVID pandemic.
Prior to the emergence and global spread of the coronavirus disease 2019 pandemic, hospitals in the United States had seen a significant decline in the prevalence of HAIs (Weiner-Lastinger et al., 2021b) .
As COVID-19 spread across the US in waves throughout 2020, several areas saw substantial increases in the number of cases and hospitalizations. In certain investigations, secondary infections were particularly mentioned as occurring in COVID-19 patients (Ripa et al., 2021).
Single-site studies observed signs of increases in select HAIs in the US as early as the spring of 2020 (Fakih et al., 2021, LeRose et al., 2021, McMullen et al., 2020).
As US hospitals across the country responded to the inflow of COVID-19 patients in the second quarter of 2020, rising standardized infection ratios (SIRs) were found. Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, CLABSIs, and VAE all showed initial elevations in the SIRs (Weiner-Lastinger et al., 2021b).
The third and fourth quarters of 2020 were remarkable for considerable increases in SIRs linked to CLABSIs, VAEs, MRSA bacteremia, and CAUTI compared to the pre-pandemic rates seen throughout 2019. The increase in SIRs for all HAI categories was most significant for CLABSIs when comparing 2020, the first year of COVID-19 hospitalizations throughout the US, to the pre-pandemic experience of 2019 (Weiner-Lastinger et al., 2021b).
According to the CDC- National Healthcare Safety Network (NHSN), increasing rates for CLABSIs were noted in the earliest months of the pandemic (Patel et al., 2021).
Longer patient stays, more comorbidities, higher patient acuity levels, and prolonged device usage are all factors that might contribute to increased risks for device-associated healthcare associated infections (DA-HAI) during the COVID-19 pandemic in 2020 (Weiner-Lastinger et al., 2021b).
Elevated dependence on acute-care hospitals (ACHs) during the pandemic may have further expanded HAI risks in a number of ways, including modified employment of personal protective equipment, changing staffing patterns and procedures, and increased critical care capacity (Rebmann et al., 2021, Weiner-Lastinger et al., 2021a).

ASSOCIATION BETWEEN SARS-COV-2 AND HEALTHCARE ASSOCIATED INFECTIONS IN EUROPE
Bardi et al conducted a study in Spain including 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. Fifty-seven patients (40.7%) developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission and was significantly associated with the APACHE II score (p = 0.02). There were 91 episodes of infection: primary (31%) and CLABSI (25%) were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%), and urinary tract infection (8%) that were produced by a wide spectrum of Gram-positive (55%) and Gram-negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p = 0.015) and a longer ICU stay (p < 0.001) (Bardi et al., 2021).
Falcone et al conducted a prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. A multivariate analysis was performed to identify factors independently associated with superinfections. Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11-29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5-39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4-13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2-11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7-7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1-7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections compared with those who did not (30 versus 11 days, P < 0.001). The risk of bacterial and fungal superinfections in COVID-19 is consistent (Falcone et al., 2021).

ASSOCIATION BETWEEN SARS-COV-2 AND HEALTHCARE ASSOCIATED INFECTIONS IN LIMITED RESOURCES COUNTRIES
A global HAI monitoring network is the International Nosocomial Infection Control Consortium (INICC). Hospitals in several Low-to-Middle-Income Countries employ INICC surveillance online system (LMICs) (Rosenthal, 2016, Rosenthal et al., 2021c, Rosenthal et al., 2008a, Rosenthal et al., 2013b). The incidence of CLABSI, VAE, and CAUTI have significantly decreased for over 20 years, from 2002 to 2019, among the LMIC members of the INICC, as a result of their adoption and use of INICC online platform and preventative techniques (Rosenthal et al., 2013a, Rosenthal et al., 2010b, Rosenthal et al., 2014b, Rosenthal et al., 2012c, Rosenthal et al., 2012d, Rosenthal et al., 2012e, Rosenthal et al., 2012f, Rosenthal et al., 2012h, Rosenthal et al., 2012i).
A research by INICC looked at how the COVID-19 pandemic affected the occurrence of HAI in LMICs. Patients from 7 LMICs (India, Mongolia, Jordan, Lebanon, Palestine, Egypt, and Turkey) were followed during hospital ICU stays throughout January 2019 to May 2020. HAI rates were calculated using the INICC Surveillance Online System applying CDC-NHSN criteria. Pre-COVID-19 rates for 2019 were compared to COVID-19 era rates for 2020 for CLABSI, CAUTI, VAE, mortality and lengths of stay (LOS). 7,775 patients were followed for 49,506 bed-days. 2019 to 2020 rate comparisons: 2.54 and 4.73 CLABSIs per 1,000 central line days (RR=1.85, p = 0.0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR=1.29, p = 0.10), 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR=1.14; p = 0.69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR=1.42; p < 0.0001). Mean LOS were 6.02 and 7.54 days (RR=1.21, p < 0.0001). This report documents a rise in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices (Rosenthal et al., 2022).

EPIDEMIOLOGY AND CLINICAL OUTCOMES OF NOSOCOMIAL PNEUMONIA

• The most prevalent HAI is pneumonia. One percent of hospitalized patients and up to 10% patients undergoing invasive mechanical ventilation develop VAE (Magill et al., 2018, Walter et al., 2018).
• However, it is challenging to determine the real occurrence of nosocomial pneumonia because to the vast variation in diagnostic criteria, poor correlation with histology, frequent subjectivity, and inconsistent application by various surveyors (Ego et al., 2015, Kerlin et al., 2017, Stevens J. P. et al., 2014, Tejerina et al., 2010).
• International Nosocomial Infection Control Consortium (INICC) surveillance data from January 2013 through December 2018 (664 ICUs in 45 countries) reported a VAE rate of 11.4 per 1000 mechanical ventilator days (Rosenthal et al., 2016, Rosenthal et al., 2020b, Rosenthal et al., 2012b, Rosenthal et al., 2021c, Rosenthal et al., 2010a, Rosenthal et al., 2008b, Rosenthal et al., 2014a).
• Over the past 20 years, several hospitals have reported significant decline in VAE rates; however, it is unclear whether these drops are due to better treatment or to stricter application of subjective monitoring criteria (Dudeck et al., 2011a, Dudeck et al., 2011b, Klompas, 2012).
• According to clinical surveys, 5–10% of ventilated patients are still receiving treatment for VAE, and a Centers for Medicare and Medicaid Services independent audit found that VAE rates remained consistent between 2005 and 2013 (Novosel et al., 2012, Skrupky et al., 2012, Thomas et al., 2011).
• The coronavirus disease 2019 pandemic has been associated with an increase in the incidence of VAE due to hospital-acquired severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infections and hospital-acquired bacterial superinfections in patients admitted with COVID-19 pneumonia. Due to the significant overlap in clinical symptoms, separating superinfection from underlying COVID-19 pneumonia and COVID-19-related ARDS might be difficult (Klompas et al., 2021, Lumley et al., 2021, Russell et al., 2021).
• VAE are expensive and harmful to patients (Rosenthal et al., 2005a). Estimated to be 10%, the attributable mortality of VAE varies greatly depending on the kind and degree of underlying disease (Bekaert et al., 2011, Melsen et al., 2011, Nguile-Makao et al., 2010, Steen et al., 2021). VAE prolong invasive mechanical ventilation for longer periods of time, lengthen hospital stays and ICU stays, and raise mortality risk (Klompas et al., 2012, Rosenthal et al., 2005a, Rosenthal et al., 2011). Additionally, they are linked to increased usage of antibiotics and higher expenses (Hayashi et al., 2013, Rosenthal et al., 2005a).

RISK FACTORS OF NOSOCOMIAL PNEUMONIA
Following variables were identified as risk factor for acquisition of VAE: Trauma patients (Charles et al., 2014, Rello et al., 1992) , post-surgical patients (Garibaldi et al., 1981), burns patients (Garibaldi et al., 1981), longer duration of surgery (Grobmyer et al., 1996), history of smoking (Grobmyer et al., 1996), low serum albumin concentration (Garibaldi et al., 1981), high score on the American Society of Anesthesiologists Physical Status Classification System (Garibaldi et al., 1981), Acute respiratory distress syndrome (ARDS) (Chastre et al., 1998) , lung injury (Chastre et al., 1998) , chronic obstructive pulmonary disease (COPD) (Rello et al., 1994), upper respiratory tract colonization (Chastre and Fagon, 2002) , sinusitis (Rouby et al., 1994), enteral feeding (Bonten et al., 1995), enteral feeding by nasogastric tube (Kostadima et al., 2005) , biofilm on the surface and within lumen of the endotracheal tube (Sottile et al., 1986), duration of mechanical ventilation (Rello et al., 1999, Trouillet et al., 1998), frequent change in ventilator circuit (Fink et al., 1998) , lack of use of heat and moist exchange humidifiers (Prat et al., 2003) , open suctioning systems (Cobley et al., 1991, Darvas and Hawkins, 2003, Freytag et al., 2003), supine position (Pelosi et al., 2002) , airway colonisation prior to tracheostomy (Sugerman et al., 1997),tracheostomy (Sugerman et al., 1997), frequent reintubation (Chastre and Fagon, 2002), paralytic agents (Park, 2005), stress ulcer prophylaxis (Atherton and White, 1978), and patients transported out of ICU (A'Court et al., 1993).

SUGGESTED PRACTICE TO PREVENT VENTILATOR ASSOCIATED EVENTS

SUGGESTED PRACTICE TO PREVENT CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS

EPIDEMIOLOGY AND CLINICAL OUTCOMES OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS

• Urinary tract infection is one of the most common HAI. And 70%–80% of these infections are attributable to an indwelling urethral catheter (Saint and Chenoweth, 2003, Weber et al., 2011).
• Twelve to sixteen percent of adult hospital inpatients will have a urinary catheter at some time during admission (Weinstein et al., 1999).
• The daily risk of acquisition of bacteriuria varies from 3% to 7% when an indwelling urethral catheter remains in situ (Saint and Chenoweth, 2003, Weber et al., 2011, Weinstein et al., 1999).
• Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means the cumulative burden of CAUTI is substantial (Burton et al., 2011, Saint and Chenoweth, 2003, Schaeffer, 2003, Tambyah et al., 2002, Weber et al., 2011).
• Infection is the most important adverse outcome of urinary catheter use (Burton et al., 2011, Dudeck et al., 2011a, Dudeck et al., 2011b, Dudeck et al., 2013, Edwards et al., 2008, Edwards et al., 2007, Edwards et al., 2009, Klevens et al., 2008, Nguyen et al., 2017).
• The CAUTI rates reported for facilities reporting to the CDC NHSN were 0.2–4.8 per 1,000 catheter-days for adult inpatient units and 0–1.6 per 1,000 days for pediatric units (Dudeck et al., 2011a, Dudeck et al., 2011b, Dudeck et al., 2013, Edwards et al., 2008, Edwards et al., 2007, Edwards et al., 2009, Klevens et al., 2008, Nguyen et al., 2017).
• International Nosocomial Infection Control Consortium (INICC) surveillance data from January 2013 through December 2018 (664 ICUs in 45 countries) reported a CAUTI rate of 3.16 per 1000 urinary catheter days (Rosenthal et al., 2016, Rosenthal et al., 2020b, Rosenthal et al., 2012b, Rosenthal et al., 2021c, Rosenthal et al., 2010a, Rosenthal et al., 2008b, Rosenthal et al., 2014a).
• At one Veterans Affairs hospital, 0.3% of catheter-days involved symptomatic UTI (Leuck et al., 2012, Trop and Bennett, 1992).
• CAUTI rates from ICUs that reported to CDC NHSN ranged from 1.2 to 4.5 per 1,000 urinary catheter–days in adult ICUs and from 1.4 to 3.1 per 1,000 urinary catheter–days in pediatric ICUs (Dudeck et al., 2011a, Dudeck et al., 2011b, Dudeck et al., 2013, Edwards et al., 2008, Edwards et al., 2007, Edwards et al., 2009, Klevens et al., 2008, Nguyen et al., 2017).
• Symptomatic UTIs in adult ICUs voluntarily reporting to CDC NHSN declined from 1990 to 2007, with a range of an 18.6% decline in cardiothoracic units to a 67% decline in medical-surgical ICUs (Burton et al., 2011).
• A 7% reduction was observed nationally in CAUTI incidence reported between 2009 and 2011, with modest reductions in incidence reported from ward locations but no changes in incidence reported from ICUs (Dudeck et al., 2011a, Dudeck et al., 2011b, Dudeck et al., 2013, Edwards et al., 2008, Edwards et al., 2007, Edwards et al., 2009, Klevens et al., 2008, Nguyen et al., 2017).
• Catheter use is associated with negative outcomes in addition to infection, including nonbacterial urethral inflammation, urethral strictures, mechanical trauma, and mobility impairment.(Hollingsworth et al., 2013, Saint et al., 1999).
• Genitourinary trauma events are reported to occur in 1.5% of catheter-days (Leuck et al., 2012, Trop and Bennett, 1992).
• CAUTI has been reported to be associated with increased mortality and length of stay, but the association with mortality may be a consequence of confounding by unmeasured clinical variables (Clec'h et al., 2007, Chant et al., 2011).
• Inappropriate treatment of catheter-associated asymptomatic bacteriuria promotes antimicrobial resistance and Clostridium difficile infection in acute care facilities (Cope et al., 2009, Pratt et al., 2021, Trautner et al., 2011).

RISK FACTORS OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS
• The duration of catheterization is the most important risk factor for developing CAUTI (Huth et al., 1992, Johnson et al., 1990, Riley et al., 1995).
• Additional risk factors include female sex, older age, and not maintaining a closed drainage system (Hooton et al., 2010).
• Risk factors for developing hospital-acquired urinary tract infection include neutropenia, renal disease, and male sex (Greene et al., 2012).
• The drainage bag of the bacteriuric patient is a reservoir for organisms that may contaminate the environment and be transmitted to other patients through the hands of healthcare personnel (Bukhari et al., 1993).
• Outbreaks of infections associated with resistant gram negative organisms attributable to bacteriuria in catheterized patients have been reported (Jarvis et al., 1985, Kim et al., 2006, Schaberg et al., 1976, Yoon et al., 2005).

SUGGESTED PRACTICE TO PREVENT CATHETER ASSOCIATED URINARY TRACT INFECTIONS

INFRASTRUCTURE SUITABLE FOR PREVENTING CAUTI (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• Ensure that catheters are inserted only by qualified, dedicated people.
• Ensure that the materials needed for catheter insertion using an aseptic technique are readily accessible.
• Ensure that there is an adequate number of trained individuals and technological resources to enable surveillance of catheter use and outcomes.
• Establish a system for recording the following information in the patient record: the physician's order for the placement of the catheter, the indications for the catheter's insertion, the date and time of the catheter's insertion, the person's name who did it, the nursing documentation of the placement, the catheter's daily presence and maintenance tasks, and the date and time of the catheter's removal.
• Provide written instructions for catheter insertion, usage, and maintenance, and put them into practice.
• Keep track of the conditions for removal or the reasons for continuous usage.

SURVEILLANCE FOR CAUTI (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• Determine the standardized infection ratio (SIR) and/or CAUTI rates for the target groups.
• Compile data on catheter-days, patient-days (denominator data), and catheter insertion indications for each patient in the patient groups or units under observation.
• Take into account offering unit-specific feedback.
• Determine the patient populations or facilities where monitoring should be carried out based on risk assessment, taking into account catheter usage frequency and potential hazard (eg, types of surgery, obstetrics, critical care).
• Implement a process of monitoring compliance with recommendations to prevent CAUTI and provide feedback of the monitoring to health care professionals in charge of care of patients (Kanj et al., 2013, Leblebicioglu et al., 2013a, Navoa-Ng et al., 2013, Rosenthal et al., 2012j)
• Use standardized criteria, such as CDC's National Healthcare Safety Network (NHSN) definitions, to identify patients who have a CAUTI (numerator data).
• Use surveillance methods for case finding that are documented to be valid and appropriate for the institution.

EDUCATION AND TRAINING (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• Evaluate HCP competency in catheter care, maintenance, and usage.
• Train medical staff (HCP) who insert, maintain, and care for urinary catheters about CAUTI prevention, including alternatives to indwelling catheters and techniques for catheter placement, management, and removal.

PROPER PROCEDURE FOR INSERTING A CATHETER (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• When possible, take into account other bladder management such intermittent catheterization.
• Insert catheters using sterile instruments and aseptic method.
• Only place urinary catheters when absolutely necessary for patient care, and only leave in place for as long as indications still exist.
• perform hand hygiene (according to CDC or WHO recommendations) before and after manipulating the catheter site or apparatus, as well as before and after inserting the catheter.
• To reduce urethral trauma, use a catheter that is as thin as feasible while yet allowing for appropriate drainage.
• When cleaning the urethral meatus, use sterile or antiseptic solution, sterile single-use lubricating jelly packets, and sterile gloves, drapes, and sponges.

MANAGEMENT OF INDWELLING CATHETERS (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• Avoid setting the bag on the floor.
• Practice good hygiene.
• It is not required to clean the meatal region with antiseptic solutions.
• Use a different collecting container for each patient and routinely empty the collecting bag.
• Refrain from contacting the collecting container with the draining spigot.
• To collect a small quantity of fresh urine for testing, wipe the needleless sampling port with a disinfectant before aspirating the urine with a sterile syringe/cannula adaptor.
• Prevent kinking of the collection tube and catheter.
• At all times, keep the collecting bag below the bladder's level.
• Maintain a sterile drainage system that is always closed.
• Maintain free-flowing flow of urine.
• Aseptically collect bigger volumes of urine from the drainage bag for specialized tests.
• After insertion, firmly secure indwelling catheters to avoid movement and urethral traction.
• When leaks, disconnections, or breaks in aseptic technique occur, replace the catheter and the collecting system as soon as possible.

SPECIAL INTERVENTION FOR PREVENTING CAUTI (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• These unique methods and special interventions are advised for usage in areas and/or populations within the hospital where CAUTI rates or SIRs remain unacceptably high after the application of the fundamental CAUTI prevention measures previously mentioned.
• Evaluate the risk of CAUTI.
• Create a plan for managing postoperative urinary retention that includes bladder scanner use and intermittent catheterization under the direction of a nurse.
• Implement an organization-wide program to identify and remove catheters that are no longer necessary using one or more documented effective procedures.
• Establish a system for assessing and reporting data on catheter use and adverse events from catheter use.

METHODS THAT SHOULD NOT BE CONSIDERED AS USUAL IN CAUTI PREVENTION (Hooton et al., 2010, Loveday et al., 2014, Panknin and Althaus, 2001, Pellowe et al., 2005, Pratt et al., 2007).
• Avoid irrigation of the catheter.
• Avoid routine catheter replacement.
• Antimicrobial/antiseptic-impregnated catheters should NOT be used frequently.
• In catheterized patients, DO NOT test for asymptomatic bacteriuria.
• In catheterized patients, treat asymptomatic bacteriuria ONLY prior to invasive urologic procedures.
• Systemic antimicrobials should NOT be used frequently for prophylaxis.

 

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