Patients with long-term indwelling urinary catheters are at an increased risk for urinary tract infection due to bacteriuria. Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity and mortality in long-term care facilities as well as in ambulatory patients requiring long-term catheterization. There is increased interest in the financial impact of CAUTI as Medicare no longer provides reimbursement for nosocomial CAUTIs. Ascending bacteria may in part enter the closed drainage system when the patient switches between leg and night collection bags. In an attempt to reduce this ascent, a double valve lock-out system was devised that maintains a closed system during bag exchange. The concept is introduced and CAUTIs are reviewed. 1. Introduction The urinary catheter is a device that serves as a tube to mechanically drain the bladder for a variety of pathological conditions or surgical procedures. Methods of collection for urinary catheterization include intermittent catheterization, condom or Texas catheters, adherent urine collection bags, and indwelling urethral or suprapubic catheters. Each type of urinary catheters has its own indications and associated risks and benefits. Indwelling urinary catheters have the highest risk of nosocomial infection due to the fact that they remain in the bladder for a long period of time and allow microbial colonization and invasion . In general, catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in the United States, accounting for nearly a third of all hospital infections [2, 3]. In fiscal year 2006, there were 11,780 Medicare cases of CAUTI with an average Medicare payment for admission in which CAUTI was present of $40,347 . However, as of 2008, Medicare will no longer be reimbursing for CAUTI . Reduction of CAUTI would decrease morbidity, mortality, length of hospital stay, and overall healthcare cost . There is a daily infection rate of 5% in patients with long-term (>30 days) indwelling catheters . One study showed that, after 8 weeks, 113 out of 115 patients with urinary catheters were infected . Of note, the remaining 2 patients that were not infected were on antibiotics at that time. Urinary tract infection occurs when bacteria bypass normal host defenses  and gain access to the bladder while avoiding the urothelium’s bactericidal peptides, cytokines, defensins, and adhesion molecules of the urothelium . Bacteria gain access to the urinary tract via two routes: from within the catheter or from the outside of the
L. A. Jewes, W. A. Gillespie, A. Leadbetter et al., “Bacteriuria and bacteraemia in patients with long-term indwelling catheters—A Domiciliary Study,” Journal of Medical Microbiology, vol. 26, no. 1, pp. 61–65, 1988.
M. J. Richards, J. R. Edwards, D. H. Culver, et al., “Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System,” Critical Care Medicine, vol. 2, pp. 887–892, 1999.
R. A. Garibaldi, J. P. Burke, M. L. Dickman, and C. B. Smith, “Factors predisposing to bacteriuria during indwelling urethral catheterization,” The New England Journal of Medicine, vol. 291, no. 5, pp. 215–219, 1974.
G. F. Thornton and V. T. Andriole, “Bacteriuria during indwelling catheter drainage. II. Effect of a closed sterile drainage system,” Journal of the American Medical Association, vol. 214, no. 2, pp. 339–342, 1970.
J. DeGroot-Kosolcharoen, R. Guse, and J. M. Jones, “Evaluation of a urinary catheter with a preconnected closed drainage bag,” Infection Control and Hospital Epidemiology, vol. 9, no. 2, pp. 72–76, 1988.
S. Wenzler-R？ttele, M. Dettenkofer, E. Schmidt-Eisenlohr, A. Gregersen, J. Schulte-M？nting, and M. Tvede, “Comparison in a laboratory model between the performance of a urinary closed system bag with double non-return valve and that of a single valve system,” Infection, vol. 34, no. 4, pp. 214–218, 2006.