A Multivariate Analysis of Risk Factors for Acquiring Bacteriuria in Patients With Indwelling Urinary Catheters for Longer Than 24 Hours

Chi

American Journal of Critical Care

et al. 2013

Background Duration of indwelling urinary catheterization is an important risk factor for urinary tract infection. Objectives To determine whether a reminder approach reduces the use of urinary catheters and the incidence of catheterassociated urinary tract infections. Methods A randomized control trial was performed in 2 respiratory intensive care units in a 2990-bed tertiary referral medical center. Patients who had urinary catheters in place for more than 2 days from April through November 2008 were randomly assigned to either the intervention group (use of a criteria-based reminder to remove the catheter) or the control group (no reminder). Results A total of 278 patients were recruited. Utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group compared with the control group (relative risk, 0.78; 95% CI, 0.76-0.80; P < .001). The intervention significantly shortened the median duration of catheterization (7 days vs 11 days for the control group; P < .001). The success rate for removing the catheters in the intervention group by day 7 was 88%. The reminder intervention reduced the incidence of catheter-associated infections by 48% (relative risk, 0.52; 95% CI, 0.32-0.86; P = .009) in the intervention group compared with the control group. Conclusions Use of a criteria-based reminder to remove indwelling urinary catheters can diminish the use of urinary catheterization and reduce the likelihood of catheter-associated urinary infections. This reminder approach can prevent catheter-associated urinary infections, and its use should be strongly considered as a way to enhance the safety of patients.

Section: Discussionsupporting

confidence: 93%

Section: Study Interventionmentioning

confidence: 99%

Using A Criteria-Based Reminder To Reduce Use Of Indwelling Urinary Catheters And Decrease Urinary Tract Infections

Chi

American Journal of Critical Care

et al. 2013

The American Journal of Medicine

“…We did not have adequate power to detect a difference in the rate of catheter-associated urinary tract infections. While this would be the outcome of most interest, it is strongly correlated with days of urinary catheterization (3,4,20). Future studies may choose to focus on catheterrelated urinary tract infection as the outcome of interest and to assess whether noncomputerized reminders are also effective.…”

Section: Discussionmentioning

confidence: 99%

Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients

Cornia

Amory

Fraser

et al. 2003

114

U p to 25% of hospitalized patients will have an indwelling urinary catheter inserted (1). While most of these catheters are required for optimal patient care, about one in five is unnecessary (2). Catheter-related urinary tract infections are the leading cause of nosocomial infection. They account for up to 40% of hospital-acquired infections, with an incidence of 3% to 10% per day of indwelling catheterization (1,(3)(4)(5). Bacteremia occurs in 1% to 4% of those who develop nosocomial bacteriuria (6). Most patients also find an indwelling urinary catheter to be uncomfortable and activity restricting (7). Given these potential morbidities, it is remarkable how infrequently the use of a urinary catheter is documented by a physician's order in the medical record (8).The strongest predictor for catheter-associated bacteriuria is the duration of catheterization (3,4). Thus, methods to shorten this period should reduce the risk of nosocomial urinary tract infection, yet physicians are often unaware that their own hospitalized patients have a urinary catheter in place (9). Furthermore, these "forgotten" catheters were about twice as likely to be unnecessary as those remembered by the physician (9). Thus, a system that would remind physicians which of their patients had urinary catheters might shorten the duration of catheterization.One such approach involves using automatic reminders to physicians through computerized medical record systems (10 -15). At our Veterans Affairs (VA) medical center, nearly all patient records and orders are entered into a computer. We hypothesized that a computer-based order for inserting an indwelling urinary catheter, combined with computer-generated reminders to remove the catheter, would improve documentation of urinary catheters, alert physicians that the catheter was in place, and encourage discontinuing catheterization that was no longer required. METHODSAll inpatients at the VA Puget Sound Health Care System are cared for by teams of resident physicians supervised by University of Washington faculty. Patients on the medicine and cardiology services are predominantly housed on two hospital wards (second and fourth floor), with most of each team's patients on a single ward. During the first 8 weeks of the study, the fourth floor served as the study ward and the second floor served as the control ward; during the second 8 weeks, the second floor became the study ward and the fourth floor became the control.At the beginning of each month, a training session is held to teach incoming residents about the computer system. During this session, one of the investigators (PBC) explained the purpose of the study, including the direct association between duration of catheterization and catheter-associated urinary tract infection, and instructed residents on use of the computerized urinary catheter study order. We also explained the purpose of the study to the ward nurses and encouraged them to remind physicians to place a computerized order for each indwelling urinary catheter. Physicians whos...

“…Statistically significant risk factors found on univariate analysis were female sex (relative risk [RR] = 1.7), rapidly fatal underlying illness (RR = 2.5), age older than 50 years (RR = 2.0), lack of receipt of systemic antibiotic drug therapy (RR = 2), and nonsurgical disease (RR = 2.2). 8 Ten years later, Shapiro et al 17 prospectively collected data on 112 patients consecutively admitted to an Israeli hospital who had a urinary catheter in place for longer than 24 hours. Bacteriuria, defined as more than 10 3 CFU/mL of growth, developed in 36 patients (32.1%).…”

Section: Risk Factors For Bacteriuriamentioning

confidence: 99%

Preventing Catheter-Related Bacteriuria

1999

Up to 25% of hospitalized patients undergo urinary catheterization, and about 5% develop bacteriuria each day of catheterization. Catheter-related bacteriuria is associated with increased morbidity and mortality. We performed an evidence-based synthesis of the literature on preventing catheter-associated urinary tract infections (UTIs) to develop recommendations for clinicians. Catheterization should be avoided when not required and when needed, should be terminated as soon as possible. Use of suprapubic and condom catheters may be associated with a lower risk of UTI than use of urethral catheters. Aseptic catheter insertion and a properly maintained closed drainage system are crucial to reducing the risk of bacteriuria. Instillation of antimicrobial agents into the bladder or urinary drainage bag and rigorous meatal cleansing seem to be of little benefit. Use of urinary catheters coated with silver alloy may reduce the risk of UTI. Systemic antimicrobial drug therapy seems to prevent UTIs, but primarily for patients catheterized for 3 to 14 days. Antibiotic drug prophylaxis is especially valuable in patients undergoing transurethral resection of the prostate or renal transplantation. Using these methods, urinary catheter-associated UTI can often be prevented for weeks, but not longer terms.