Urethral catheters: can we reduce use?

M Elske Van Den Akker-Van Marle,Jan C Wille,Pieter J Van Den Broek,Birgit Hb Van Benthem,Barbara S Niël-Weise,Rom Jm Perenboom

doi:10.1186/1471-2490-11-10

Abstract

BackgroundIndwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.MethodsThe efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated.ResultsOf a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537.ConclusionTargeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or where catheterization is prolonged, can expect important improvements.

Highlights

Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections
We studied the efficacy of an implementation strategy focused on a limited number of recommendations from the Working Party on Infection Prevention (WIP) guideline, all aimed at reduction of the use of urethral catheters
Hospitals and patients The hospitals were visited a total of 791 times; 16,495 patients were admitted to the participating wards

Summary

Introduction

Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. In 1927 the indwelling urinary catheter was introduced by F. In the beginning the catheters drained into an open bucket; in the sixties of the previous century the closed drainage system was introduced. Urinary tract infections were substantially reduced by this change [2,3]. Prevention of urinary tract infections has been a major focus of hospital infection control. The present situation, at least in the Netherlands, is that all hospitals have guidelines and protocols to reduce urinary tract infections in patients

Methods

Results

Discussion

Conclusion