Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

Abstract

Background Use of indwelling urinary catheters can lead to complications, most commonly catheter-associated urinary tract infections. Duration of catheterization is the major risk factor. These infections can result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. Objectives To implement and evaluate the efficacy of an intervention to reduce catheter-associated urinary tract infections in a medical intensive care unit by decreasing use of urinary catheters. Methods Indications for continuing urinary catheterization with indwelling devices were developed by unit clinicians. For a 6-month intervention period, patients in a medical intensive care unit who had indwelling urinary catheters were evaluated daily by using criteria for appropriate catheter continuance. Recommendations were made to discontinue indwelling urinary catheters in patients who did not meet the criteria. Days of use of a urinary catheter and rates of catheter-associated urinary tract infections during the intervention were compared with those of the preceding 11 months. Results During the study period, 337 patients had a total of 1432 days of urinary catheterization. With use of guidelines, duration of use was significantly reduced to a mean of 238.6 d/mo from the previous rate of 311.7 d/mo. The number of catheter-associated urinary tract infections per 1000 days of use was a mean of 4.7/mo before the intervention and zero during the 6-month intervention period. Conclusions Implementation of an intervention to judge appropriateness of indwelling urinary catheters may result in significant reductions in duration of catheterization and occurrences of catheter-associated urinary tract infections.

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

“…However, similar to other studies [23,30], we found its use in the context of this study of limited value, as it failed to reflect important practice changes. Comparable intervention studies show similar results with respect to catheter use and CAUTI rate [6,11]; despite fewer catheter days [31] or reduced duration of inappropriate urinary catheterization [10], the CAUTI rate is not always reduced. This may be explained by how the CAUTI rate is calculated [3], i.e.…”

“…Nurses are therefore in a key position to influence decisions about the insertion, continuing use and removal of catheters [11]. However, as they may base their decisions on personal preference rather than evidence-based guidelines [16] and existing routines within their practice, it is of the utmost importance to engage nurses and raise their awareness about evidence-based recommendations for preventing CAUTIs.…”

“…Diverse interventions that focus on limiting catheter use and on their prompt removal may significantly reduce CAUTIs [3, [9][10][11]. Education of nursing staff, electronic reminders aimed at reducing the duration of invasive devices [6,12], such as automatic stop orders [13], and the use of nurses specially trained to lead implementation projects (change champions) [12] have proved to be effective in changing practice and reducing CAUTIs [14].…”

Epidemiology and Control of Urinary Tract Infections in Intensive Care Patients

“…A specific recommendation for the appropriate urinary catheter use (category IB) is: "Minimize urinary catheter use and duration of use in all patients, particularly those at www.intechopen.com Clinical Management of Complicated Urinary Tract Infection 8 higher risk for CAUTI or mortality from catheterization such as women, the elderly, and patients with impaired immunity" (Gould et al, 2009). In this contest, a recent study (Elpern et al, 2009) has been conducted in a medical ICU in order to implement and evaluate the efficacy of an intervention, based on the decreasing use of urinary catheters, to reduce CAUTI. Results of this study report that the implementation of an intervention targeting the appropriate use of indwelling urinary catheters may result in a significant reduction in the duration of catheterization as well as in the occurrences of CAUTIs.…”

“…Use of urinary catheters in the ICU causes breaches in the mucosa or may provide a surface for colonization, thus, increasing the incidence of CAUTI. The risk for infection is at least 5% per day of catheterization (Tissot et al, 2001;Elpern et al, 2009). Other factors have been reported as potential risk factors for CAUTI including constitutional factors such as female gender, pregnancy and older age and potential modifiable factors such as poor nutrition, fecal incontinence, use of systemic antibiotics, severity of illness, impaired immune system function, and elevated creatinine level (Gray, 2010).…”