Overuse of the Indwelling Urinary Tract Catheter in Hospitalized Medical Patients

Jain, Prasoon; Parada, Jorge P.; David, Annette M.; Smith, Lawrence

doi:10.1001/archinte.1995.00430130115012

Cited by 221 publications

(63 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Yet, multiple studies show that between 21% and 55.7%2 4 20 23–25 of urinary catheters are placed in patients who do not have an appropriate indication and, therefore, may not even need a catheter. Over the past decade, several studies have employed interventions to decrease unnecessary catheter placement (described in the online supplementary appendix table).…”

Section: What Strategies May Reduce Unnecessary Catheter Use?mentioning

confidence: 99%

“…Urinary catheters are commonly left in place when no longer needed 4 25. In most hospitals, four steps are required to remove a urinary catheter21: (1) a physician recognises the catheter is in place, (2) the physician recognises the catheter is no longer needed, (3) the physician writes the order to remove the catheter and (4) a nurse removes the catheter.…”

Section: What Strategies May Reduce Unnecessary Catheter Use?mentioning

confidence: 99%

See 1 more Smart Citation

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

et al. 2013

View full text Add to dashboard Cite

BackgroundCatheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use.MethodsTo summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation.Results30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs.ConclusionsUC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

show abstract

Section: What Strategies May Reduce Unnecessary Catheter Use?mentioning

confidence: 99%

Section: What Strategies May Reduce Unnecessary Catheter Use?mentioning

confidence: 99%

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Virtually all healthcare-associated UTIs (HAUTIs) are caused by instrumentation of the urinary tract with 80% traced to the use of indwelling urinary catheters 10. The use of urethral catheters is very common with 15–25% of hospitalised patients receiving a short-term indwelling urinary catheter, hence high HAUTI rates are not surprising 11 – 14. Calculation of how many catheter-associated UTIs (CAUTIs) may be preventable varies considerably with estimates from unpublished data ranging from 17% to 69% 15.…”

Section: Introductionmentioning

confidence: 99%

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

et al. 2014

View full text Add to dashboard Cite

ObjectivesUrinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs.SettingData were collected from three public and three private Australian hospitals over the first 6 months of 2013.ParticipantsA total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded.Outcome measuresThe primary outcome measures were the HAUTI and CAUTI point prevalence.ResultsOverall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition.ConclusionsThese study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.

show abstract

“…UC is a common procedure performed on a daily basis in hospitals, often by the most junior member of the team (an intern). Certain studies report that up to 25% of patients will require a catheter while in hospital [14]. Overall, it is a safe procedure with low rates of iatrogenic injuries [1]; however, such injuries are potentially avoidable.…”

Section: Discussionmentioning

confidence: 99%

YouTube as an educational tool regarding male urethral catheterization

Nason

Kelly

et al. 2014

Scandinavian Journal of Urology

100

View full text Add to dashboard Cite

show abstract

Overuse of the Indwelling Urinary Tract Catheter in Hospitalized Medical Patients

Abstract: The IUTCs are significantly overused in hospitalized medical patients and careful attention to this aspect of medical care may reduce catheter-related complications by primary prevention.

Cited by 221 publications

References 24 publications

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

YouTube as an educational tool regarding male urethral catheterization

Contact Info

Product

Resources

About