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

Abstract

U p to 25% of hospitalized patients will have an indwelling urinary catheter inserted ( 1 Haley R.W. Hooton T.M. Culver D.H. et al. Nosocomial infections in U.S. hospitals, 1975-1976; estimated frequency by selected characteristics of patients. Am J Med. 1981; 70: 947-959 Abstract Full Text PDF PubMed Scopus (342) Google Scholar ). While most of these catheters are required for optimal patient care, about one in five is unnecessary ( 2 Jain P. Parada J.P. David A. Smith L.G. Overuse of the indwelling urinary catheter in hospitalized medical patients. Arch Intern Med. 1995; 155: 1425-1429 Crossref PubMed Scopus (210) Google Scholar ). 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 Haley R.W. Hooton T.M. Culver D.H. et al. Nosocomial infections in U.S. hospitals, 1975-1976; estimated frequency by selected characteristics of patients. Am J Med. 1981; 70: 947-959 Abstract Full Text PDF PubMed Scopus (342) Google Scholar , 3 Garibaldi R.A. Burke J.P. Dickman M.L. Smith C.B. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med. 1974; 291: 215-219 Crossref PubMed Scopus (424) Google Scholar , 4 Platt R. Polk B.F. Murdock B. Rosner B. Risk factors for nosocomial urinary tract infection. Am J Epidemiol. 1986; 124: 977-985 PubMed Google Scholar , 5 Haley R.W. Culver D.H. White J.W. et al. The nationwide nosocomial infection rate. A new need for vital statistics. Am J Epidemiol. 1985; 121: 159-167 Crossref PubMed Scopus (605) Google Scholar ). Bacteremia occurs in 1% to 4% of those who develop nosocomial bacteriuria ( 6 Bryan C.S. Reynolds K.L. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol. 1984; 132: 494-497 PubMed Google Scholar ). Most patients also find an indwelling urinary catheter to be uncomfortable and activity restricting ( 7 Saint S. Lipsky B.A. Baker P.D. et al. Urinary catheters what type do men and their nurses prefer?. J Am Geriatr Soc. 1999; 47: 1453-1457 PubMed Google Scholar ). 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 Gardam M.A. Amihod B. Orenstein P. et al. Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections. Clin Perform Qual Health Care. 1998; 6: 99-102 PubMed Google Scholar ).