The frequency of UTIs in people who undertake intermittent catheterization: A systematic review

Abstract Background Intermittent Catheterization (IC) is a common procedure used for the management of incomplete bladder emptying in various diseases such as spinal cord injury, multiple sclerosis and benign prostatic hypertrophy. Catheterization is associated with several complications and particularly with an increased risk of developing urinary tract infections (UTIs) responsible for high morbidity worldwide and significant costs to health systems and society.Today, this health problem is still underestimated. Therefore, the aim of this study was to summarize the available evidence on the clinical and epidemiological burden of UTIs among patients performing IC. Methods A systematic literature review was performed querying two online database (PubMed,Web of Science) from January 2012 to January 2022. All studies in English language and focused on the clinical-epidemiological burden of UTIs related to IC in the adult population were included. Results Overall, 43 studies were considered. It was described a range of UTIs from 26% to 63%, with an increased number of hospital admissions and length of stay. UTIs were more common in patients with spinal cord injuries (about 40%) and with multiple sclerosis (24-34%).The main risk factors associated with UTIs were catheter reuse, type of catheter and catheterization procedure adopted. Conclusions Data on IC-associated UTIs are still limited. Estimating the UTIs load in patients with IC could support healthcare professionals to identify the most appropriate type of catheter to reduce the risk of this important complication. Proper management of catheterization could improve patients’ quality of life and also reduce the impact of diseases associated with this procedure on health systems and society. Key messages Catheterization is associated with an increased risk of UTIs causing morbidity and relevant costs to health systems and society. Knowing the burden of IC-associated UTIs could support better patients management in terms of suitable procedures to apply and more appropriate catheters to use.

As the inevitable ageing of the population progresses, the pressure on the public health system increases. The predicted rise in the share of people aged 65 and more from 19% in 2020 to 33% in 2050 jeopardises the capacity of the long term care in Poland. It demands immediate actions in public policies to strengthen the system and to provide the silver generation with the proper and adjusted services. That topic is one of the main issues for the map of health needs, developed by the Ministry of Health in Poland. The analyses investigate the current and future state of this part of the system, e.g. the number of visits, average length of stay, types of services, care-giver support ratio. Conclusions drawn from the data allowed to formulate a number of challenges, which include: 1. levelling up the access to the services, 2. increasing the number of outpatient services, provided at home or close to the place of residence, 3. implementation of the eHealth solutions, 4. support for the informal care-givers.In line with these information, the actions and strategic frameworks have been established at the national level and included: 1. strategic approach for deinstitutionalisation, in order to bring the long term care closer to the patients' environment, to provide them with an optimal level of comfort and to make them self-reliant for as long as possible, 2. enhancement of the inpatient care through transformation of less occupied wards into long term wards in district hospitals.

Key messages:
The Maps of Health Needs help to create national public policies and strategic frameworks aimed at coping with the foreseen challenges of aging society pressuring the healthcare system. The main challenge for the long term care in the future is to channel the available resources in the appropriate way.

Background:
Intermittent Catheterization (IC) is a common procedure used for the management of incomplete bladder emptying in various diseases such as spinal cord injury, multiple sclerosis and benign prostatic hypertrophy. Catheterization is associated with several complications and particularly with an increased risk of developing urinary tract infections (UTIs) responsible for high morbidity worldwide and significant costs to health systems and society.Today, this health problem is still underestimated. Therefore, the aim of this study was to summarize the available evidence on the clinical and epidemiological burden of UTIs among patients performing IC.

Methods:
A systematic literature review was performed querying two online database (PubMed,Web of Science) from January 2012 to January 2022. All studies in English language and focused on the clinical-epidemiological burden of UTIs related to IC in the adult population were included.

Results:
Overall, 43 studies were considered. It was described a range of UTIs from 26% to 63%, with an increased number of hospital admissions and length of stay. UTIs were more common in patients with spinal cord injuries (about 40%) and with multiple sclerosis (24-34%).The main risk factors associated with UTIs were catheter reuse, type of catheter and catheterization procedure adopted.

Conclusions:
Data on IC-associated UTIs are still limited. Estimating the UTIs load in patients with IC could support healthcare professionals to identify the most appropriate type of catheter to reduce the risk of this important complication. Proper management of catheterization could improve patients' quality of life and also reduce the impact of diseases associated with this procedure on health systems and society.

Key messages:
Catheterization is associated with an increased risk of UTIs causing morbidity and relevant costs to health systems and society.
Knowing the burden of IC-associated UTIs could support better patients management in terms of suitable procedures to apply and more appropriate catheters to use.

Introduction:
Despite the best intentions, public health (PH) interventions can have adverse and other unintended consequences (AUCs). AUCs may arise in novel PH interventions, as well as from known and tested PH interventions implemented in a new context. Despite their importance, this topic has been largely overlooked. Therefore, we used a structured value-guided as well as evidence-based approach, to develop a framework to support researchers, practitioners, and policy-makers in anticipating and assessing AUCs of PH interventions.

Methods:
We employed the 'best-fit' synthesis approach starting with an a priori framework and iteratively revising this based on systematically identified evidence. The a priori framework was derived from both the WHO-INTEGRATE framework and the Behaviour Change Wheel, to root the framework in global health norms and values, established mechanisms of PH interventions, and a complexity perspective. The a priori framework was advanced based on theoretical and conceptual publications and systematic reviews on the topic of AUCs in PH. Thematic analysis was used to revise the framework and identify new themes. To validate the framework, it was coded against four selected systematic reviews of AUCs of PH interventions.

Results:
The CONSEQUENT framework includes two components: the first focuses on AUCs and serves to categorise them; the second iii400 European Journal of Public Health, Volume 32 Supplement 3, 2022