Impact of Foley Catheter Placement by Medical Students on Rates of Postoperative Urinary Tract Infection

Abstract

The aim of this study was to evaluate the impact of medical student placement of Foley catheters on rates of postoperative catheter-associated urinary tract infection (CAUTI). We included adult surgical patients in our institutional National Surgical Quality Improvement Program (NSQIP) database, and defined CAUTI according to NSQIP criteria. A multivariable model risk-adjusting for patient and operative variables associated with CAUTI in univariate analysis (exploratory p < 0.20) evaluated the independent effect of medical student placement of Foley catheters on the odds of CAUTI. There were 891 patients who had a Foley catheter placed by a surgical resident (61%; n= 547), operating room nurse (25%; n= 227), or medical student (13%; n= 117). After risk-adjustment, patients with Foleys placed by medical students were at a more than 4-fold increased risk of CAUTI (odds ratio [OR] 4.09, p= 0.02) compared with patients with catheters placed by nurses. Patients with catheters placed by residents did not have an increased risk-adjusted odds of CAUTI (OR 2.16, p= 0.15). Other significant predictors of postoperative CAUTI included female sex (OR 2.61, p= 0.01), partial/total functional dependence (OR 4.81, p= 0.008), blood transfusion (OR 34.7, p= 0.02), and increased length of Foley stay (OR 1.06, p < 0.001). Surgical patients with Foley catheters placed by medical students are at increased risk-adjusted odds of postoperative CAUTI. More intense supervision of medical students during urinary catheter insertion in the operating room and improved education regarding sterile technique may be important factors in reducing rates of postoperative CAUTI in academic institutions.