Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes

McNulty, C.; Bowen, J.; Foy, Chris; Gunn, Kim; Freeman, Elaine; Tompkins, David; Brady, Angela; Ejidokun, T.; Donald, Ian; Smith, Grace

doi:10.1177/14690446060070010701

Cited by 9 publications

(21 citation statements)

References 6 publications

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“…, 1997), poststroke (Bean et al. , 2003), use of long‐term indwelling urethral catheters as a management technique (McNulty et al. , 2006a,b), night‐time sleep and bed mobility (Schnelle et al.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies were undertaken in the USA. The number of care homes involved ranged from four to 841 care homes, although one study did not specify (McNulty et al. , 2006a,b).…”

Section: Resultsmentioning

confidence: 99%

“…, 1997; Bean et al. , 2003), staff (mangers and care staff) questionnaires about residents (McNulty et al. , 2006a,b) and bed side monitoring equipment (Schnelle et al.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes

Roe¹,

Flanagan²,

Jack³

et al. 2011

Int J Older People Nursing

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Section: Resultsmentioning

confidence: 99%

“…Most studies were undertaken in the USA. The number of care homes involved ranged from four to 841 care homes, although one study did not specify (McNulty et al. , 2006a,b).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes

Roe¹,

Flanagan²,

Jack³

et al. 2011

Int J Older People Nursing

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“…Although all staff reported using a sterile pack and almost all reported appropriate hand-washing, 16% of nursing staff, and 17% of care staff reported using multi-use lubricant (from a tube) for catheter insertion ( McNulty et al, 2006b ). The need for sterile single-use lubricant should be made clear in all education about catheter insertion.…”

Section: Insertion Of Urinary Cathetersmentioning

confidence: 98%

Reducing urinary catheter related infections in care homes: a review of the literature

McNulty

2009

Journal of Infection Prevention

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lthough much guidance indicates that indwelling urinary catheters should only be used for the management of urinary retention and incontinence as a last resort, approximately 10% of care home residents have them, leading to increased risks of catheter associated infections and mortality. Catheterisation rates and subsequent infections can be reduced through more proactive management of incontinence and toileting, and removal of urinary catheters from residents discharged from hospital. Staffi ng in care homes should match residents' nursing and continence needs to allow this proactive approach. Audit of care home should and hospital discharge catheterisation rates, combined with feedback and staff training will raise awareness of the benefi ts of reducing catheterisation rates. Use of the Department of Health's Essential Steps to Safe, Clean Urinary Catheter Care (2006a) will also help to reduce catheter associated infections. How common are urinary catheterisation and associated infections in care homes? Prevalence of incontinence and urinary catheterisationIndwelling urinary catheterisation may be used to manage urinary retention and incontinence after alternative methods of management have been considered. Urinary incontinence caused by urinary obstruction, neurological abnormality or dementia, is present in about 50% of the elderly population, ( Brocklehurst, 1993 ;Sommer et al, 1990 ) and 34-70% of residents in care homes ( Georgiou et al, 2001 ;McNulty et al, 2006a ). Recent surveys in UK care homes found that about 10% of residents in registered homes had long-term urinary catheters ( Georgiou et al, 2001 ;McNulty et al, 2003 ). There is however a wide variation in the prevalence of catheterisation, ranging from zero to over 40% ( Georgiou et al, 2001 ;McNulty et al, 2003 ). Catheterisation rates are higher in nursing homes (10%) than residential homes (5%), ( Georgiou et al, 2001 ) and lower in those caring for residents with dementia (5%) ( McNulty et al, 2003 ). Although you would expect homes with higher catheterisation rates to have more residents with greater degrees of dependence and incontinence, studies have not shown this ( McNulty et al, 2006a ). Risk of infection with urinary catheterisation in care homesA recent Norwegian survey found that 78% of care home residents were aged >81 years. ( Eriksen et al, 2007 ) The elderly population are at increased risk of infection, due to decreased immunity and increasing often complex medical problems. In a prospective study researchers recorded the rate of healthcare associated infections (HCAI) in Norwegian care homes. The overall rate of new HCAIs was 0.5% of residents per day. ( Eriksen et al, 2007 ) Antibiotics were given in 94% of episodes of infection. Urinary tract infections (UTIs) formed 38% of the HCAIs. Residents with indwelling catheters were twice as likely to have a symptomatic UTI. The most recent data on prevalence of catheter related UTI from US nursing homes comes from Tsan et al who undertook a point prevalence survey of all infections ...

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“…A US study showed that 23% of 39,282 postoperative patients discharged to nursing homes had urinary catheters; those patients discharged with catheters had a greater risk of rehospitalisation and death (Wald et al, 2008). The wide variation in urinary catheterisation has previously been explored by us (McNulty et al, 2006(McNulty et al, , 2008 and is not due to differences in rates of residents' incontinence or nursing needs). Homes with lower prevalence of catheterisation or no catheters took a more proactive approach to removing inherited catheters, toileting, managing continence, and mobility; these homes often had a different culture of care aimed at maintaining residents' dignity and independence.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

McNulty

Verlander

Turner

et al. 2014

Journal of Infection Prevention

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Peer reviewed article he extent to which the use of catheter care bundles and other interventions has led to a reduction in urinary catheterisation rates is unknown. We aimed to determine current urinary catheterisation rates in care homes with residents over 65 years old, and determine the extent to which residents are discharged from the hospital setting with urinary catheters. A point prevalence questionnaire survey was used in care homes that looked after residents over 65 years in six UK health boards or primary care trusts, to determine urinary catheterisation rates, and where these catheters were inserted. Questionnaires for 445 of 461 care homes (96.5%) were completed, 425 of 445 care homes cared for residents over 65 years; 888 (6.9%) of 12,827 residents had a urethral (82.5%) or supra-pubic (17.5%) urinary catheter. Over half of all catheters (both urethral and suprapubic, 57.4%, 509 of 888 catheters), and 3.1% of all residents had a catheter inserted while the residents were hospital inpatients, and then discharged back to the care home still catheterised. There was a significant variation in urinary catheterisation rates in the care homes surveyed, and rates remain similar to previous English surveys in 2003 and 2009. More still needs to be done to understand the variation in urinary catheterisation rates in care homes and reduce these rates, including the numbers of residents that are discharged from hospital with a urinary catheter. IntroductionRecent surveys in UK care homes found that about 8% of residents in registered homes had long-term urinary catheters (McNulty et al, 2006;Lomas et al, 2009). This mean UK figure conceals a wide range of prevalence of urinary catheterisation from zero to almost 50% (Lomas et al, 2009), indicating that there is an opportunity to reduce catheterisation rates. Urinary catheterisation is associated with significant morbidity; residents with urinary catheters in care homes have up to an eightfold greater risk of harbouring resistant bacteria such as extended-spectrum β-lactamase-producing Gram-negative bacteria (Tinelli et al, 2012) and these patients are significantly more likely to be taking antimicrobials (Cotter et al, 2012), develop healthcare associated infections (Eriksen et al, 2007) and bacteraemia (Chazan et al, 2009).Care home staff have indicated that many of their residents are discharged from hospital after an inpatient stay with a catheter (McNulty et al, 2008) and indeed our 2008 survey confirmed that 57% of urinary catheters in Gloucestershire care homes were inserted in hospitals (Lomas et al, 2009). Over the last five years there have been a series of care bundles introduced for community and hospital care (Wilson, 2011, pp. 16-25), with the aim of reducing urinary catheterisation rates and catheter associated urinary tract infections (CAUTI). Study aims

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Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes

Cited by 9 publications

References 6 publications

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes

Reducing urinary catheter related infections in care homes: a review of the literature

Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012

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