Abstract
Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking. To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications. Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation). In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001). A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.
Highlights
The use of transurethral urinary catheters is common in acute care hospitals
Noninfectious complications from catheterization have not received widespread attention to date [6,7], they may be as common as Catheter-associated urinary tract infections (CAUTIs) [8,9]; they include mechanical trauma to the lower urinary tract, false passage, and accidental inflation of a catheter balloon in the urethra or prostate
Data on 25,880 patients were analysed, with 13,171 patients included at baseline (AugusteOctober 2016) and 12,709 patients included post intervention (AugusteOctober 2017)
Summary
With catheterization proportions of 12e25% [1e5] and nearly 1.5 million hospitalizations in Switzerland in 2016 (Source: Federal Statistics Office, accessed 27th February 2018), it is estimated that more than 200,000 urinary catheters are placed in Switzerland each year, eventually causing infectious and non-infectious complications, increased morbidity and mortality, and additional healthcare costs. Catheter-associated urinary tract infections (CAUTIs) are a well-known complication of urinary tract catheterization, with rates ranging from 0.2 to 4.8 per 1000 catheter-days. Noninfectious complications from catheterization have not received widespread attention to date [6,7], they may be as common as CAUTIs [8,9]; they include mechanical trauma to the lower urinary tract, false passage, and accidental inflation of a catheter balloon in the urethra or prostate. The presence of a urinary catheter and the duration of catheterization are the main risk factors for catheterassociated complications; 21e65% of all catheter insertions are not necessary [10e12], and prolonged catheterization without clear indication is common [5,13]
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