Quick to Wick: External Female Catheters and Urinary Catheter Utilization

Abstract

<h3>Background</h3> Urinary tract infections (UTI) are common hospital-acquired infections (HAI), causing increased morbidity and hospital costs among patients. Over 75% of HAI UTI are associated with urinary catheters (CAUTI), and between 15-25% of hospitalized patients have urinary catheters. Avoidance of urinary catheters is a primary method to prevent CAUTIs. <h3>Methods</h3> Two community hospitals (450 and 472 licensed beds) implemented an external female urinary catheter device in an effort to decrease prolonged urinary catheterization. To facilitate implementation of the device, nursing education was provided to augment traditionally accepted indwelling catheter necessity with external devices. A retrospective review compared electronic pre-implementation data (1/2017 – 8/2018), to post-implementation data (10/2018 – 10/2019). Urinary catheter utilization measured by device utilization ratio (DUR) and CAUTI were compared using Chi-square analysis (Epi Info, CDC). Urinary catheter DUR and CAUTI were compared for both ICU and non-ICU patient populations. The impact on urinary catheter device utilization ratios (DUR) and CAUTI standardized infection ratios (SIR) were evaluated. <h3>Resultsw</h3> Hospital-wide urinary catheter DUR significantly decreased 13% (pre-DUR 0.15, post-DUR 0.13, p < 0.01). While Hospital A observed a reduced DUR in the ICU, Hospital B did not observe a reduction. Both hospitals saw 18% decrease in non-ICU urinary catheter DUR (p < 0.01). Hospital A saw a 34% reduction in CAUTI while Hospital B saw an increase in CAUTI, although neither were statistically significant. <h3>Conclusions</h3> Implementation of a female external catheter at two hospitals resulted in significant reduction of indwelling urinary catheter utilization, but no significant impact on CAUTI. Female gender and prolonged catheterization have been repeatedly cited in the literature as risk factors for CAUTI. This device may have a considerable impact on urinary catheter utilization and CAUTI, improving patient outcomes, reimbursement programs, and hospital ratings.