Abstract
Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community. To investigate the prevalence of indwelling urinary catheters on district nursing caseloads in the UK. Participants were recruited through the Infection Prevention Society (IPS). An electronic survey was undertaken on a single day between November 2017 and January 2018. Data were analysed using descriptive statistics. A total of 49,575 patients were included in the survey, of whom 5352 had an indwelling urinary catheter. This gave a point prevalence of 10.8% (95% confidence interval [CI] = 10.53-11.07), which varied between organisations, ranging from 2.36% (95% CI = 2.05-2.73) to 22.02% (95% CI = 20.12-24.05). Of catheters, 5% were newly placed (within four weeks). Of these, most (77%) had a documented indication for insertion. Only half of patients with a newly placed catheter had a plan for its removal. This varied between organisations in the range of 20%-96%. Only 13% of patients had a patient-held management plan or 'catheter passport' but these patients were significantly more likely to also have an active removal plan (28/36 [78%] vs. 106/231 [46%]; P < 0.0001). Alternative bladder management strategies had been considered for 70/267 (26%) patients. The management of patients with an indwelling urinary catheter represents a significant component of district nursing caseloads. Given the high proportion of newly catheterised patients without an active management plan for removal of the catheter, the establishment of an optimal management pathway should be the focus of future prevention efforts.
Highlights
Indwelling urinary catheters are commonly employed as a bladder management strategy in healthcare and are known to be overused in hospitals (Murphy et al, 2015; Tiwari et al, 2012), where they are a major predisposing factor for urinary tract infection (UTI) and other complications (Public Health England, 2016; Saint et al, 2018)
Effective strategies to decrease unnecessary urinary catheter use in hospitals require clear criteria for appropriate placement (Meddings et al, 2014; Murphy et al, 2014; Meddings et al, 2015), which extend to those catheters still in place when the patient is discharged from hospital
The aim of the present study was to investigate the prevalence of patients with indwelling urinary catheters on district nursing caseloads in the UK and Republic of Ireland, and for patients recently referred to the district nursing caseload with a newly placed catheter, evidence of documentation of the reason for the catheter and a management plan for its continued use or removal
Summary
Indwelling urinary catheters are commonly employed as a bladder management strategy in healthcare and are known to be overused in hospitals (Murphy et al, 2015; Tiwari et al, 2012), where they are a major predisposing factor for urinary tract infection (UTI) and other complications (Public Health England, 2016; Saint et al, 2018). Getliffe and Newton (2006) reported limitations in the quality and consistency of catheter-related information collected by community healthcare services They concluded that this, together with the lack of a standardised approach to monitoring the rate of catheter-associated UTI (CAUTI) among patients on district nursing caseloads, made it difficult to estimate CAUTI prevalence and impact as a baseline to inform improvement interventions. Evidence-based practice relating to the use and management of urinary catheters is well-defined, both in hospitals and the community (Loveday et al, 2014; National Institute for Health and Care Excellence [NICE], 2017). Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community
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