Indwelling Urinary Catheter Use Research Articles

Need to clamp indwelling urinary catheters before removal after different durations: a systematic review and meta-analysis

ObjectiveThis meta-analysis aimed to evaluate the effect of bladder training by clamping on bladder urethral function in patients with indwelling urinary catheters used for different durations.DesignSystematic review and meta-analysis.Data sourcesThe...

Addressing CAUTIs with an External Female Catheter

Catheter-associated urinary tract infections (CAUTIs) can lead to complications that prolong hospital stays and result in patient discomfort as well as increased health care costs and mortality. At our academic medical center in New York City, in 2016-17, 21 of 87 CAUTI cases (24%) were in bedbound female patients in whom indwelling catheters were used for incontinence. Although condom catheters were available as an alternative to indwelling urinary catheters for male patients, there was a lack of effective products for female patients. A team of clinical nurse specialists (CNSs) conducted a literature search, reviewed internal data on CAUTI rates and catheter use, and searched for available catheter alternatives that would meet the needs of bedbound female patients. The team identified two different external female urinary catheters and piloted both with a focus on efficacy as well as stakeholder satisfaction. In 2019-20, external female catheters were used in 1,195 unique patients. Approximately 90% of external female catheter use was to avoid using an indwelling urinary catheter. With a cost avoidance of $13,786 per patient, $16,473,912 in costs to the organization were avoided. CAUTI rates in bedbound female patients decreased after implementation of the external female catheters. This initiative demonstrates that external female urinary catheters can be used at other hospitals to decrease indwelling urinary catheter use and CAUTI rates in bedbound female patients.

Regional variation in urinary catheter use in the Netherlands from 2012 to 2021: a population-based cohort.

Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85 years old and male CIC users over 65 years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines.

Reducing Inappropriate Urinary Catheter Use by Involving Patients Through the Participatient App: Before-and-After Study

BackgroundThe risk of urinary tract infections is increased by the inappropriate placement and unnecessary prolongation of the use of indwelling urinary catheters. Sustained behavior change in infection prevention could be promoted by empowering patients through a smartphone app.ObjectiveThe aim of this study is to assess the feasibility and efficacy of implementation actions on patients’ use of the Participatient app on a clinical ward and to compare 3 survey methods for urinary catheter use.MethodsParticipatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. Over a period of 3 months, the number of new app users, days of use, and sessions were recorded. In a comparison of urinary catheter use before and after the implementation of the app, 3 methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in patients’ electronic medical records, parsing a survey of checkbox items, and parsing nursing notes.ResultsIn all, 475 patients were admitted to the ward, 42 (8.8%) installed the app, with 1 to 5 new users per week. The actions with the most ensuing app use were the kick-off with the clinical lesson and recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter use prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% (36/96) to 27% (23/86) after app introduction (OR 0.61, 95% CI 0.32-1.14).ConclusionsThe clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are also used. For surveying indwelling urinary catheter use prevalence, manual parsing is the best approach.

Effectiveness and safety of a program for appropriate urinary catheter use in stroke care: A multicenter prospective study.

Since patients with stroke frequently develop bladder dysfunction, a careful approach is required to reduce unnecessary indwelling urinary catheter (IUC) for preventing catheter-associated urinary tract infection (CAUTI). This study aimed to assess the effectiveness and safety of a program to promote appropriate IUC use in stroke care. We conducted a prospective interrupted time series study in three tertiary care hospitals in Japan. Adult patients with acute stroke were eligible. The study consisted of three phases: baseline, education and implementation. Our program included an assessment of IUC indications, educational meetings among healthcare professionals, reminders for removal of inappropriate IUC and a urinary retention protocol. The primary outcome was the proportion of inappropriate IUC use to assess effectiveness. The device utilization ratio and incidence of CAUTI were examined to assess effectiveness, and incidences of urinary retention and all symptomatic urinary tract infection (UTI) were examined to assess safety. Among 976 patients who met the inclusion criteria, 738 were analysed. Inappropriate IUC use decreased from 50.1% in the baseline phase to 22.5% in the implementation phase (absolute risk reduction in interrupted time series analysis 42.4% [95% confidence interval, 19.2%-65.6%]). The device utilization ratio decreased from 0.302 to 0.194 (p < 0.001), whereas CAUTI did not change significantly (from 8.81 to 8.28 per 1000 catheter-days; incidence rate ratio 0.95 [0.44-1.94]). All symptomatic UTI decreased from 9.5% to 4.9% (p=0.015), with no increase in urinary retention. Our program improved the appropriateness of IUC use in stroke care while ensuring safety.

Indwelling catheters increase altered mental status and urinary tract infection risk: A retrospective Cohort Study

BackgroundAlthough indwelling urinary catheters (IUCs) are used intraoperatively and may cause complications (e.g., delirium), only few robust studies have investigated the association between intraoperative IUC use and complications. We hypothesized that IUC use might increase the postoperative incidence of altered mental status and/or urinary catheter infection. Materials and methodsIn this retrospective single-center cohort study, we analyzed the data of adult patients undergoing surgery at our facility between January 2013 and December 2018. The primary endpoint was altered mental status and/or incidence of urinary catheter infections. The patients were divided into IUC and control groups. A multivariable logistic regression model was used to identify the predictors of postoperative complications, and a multivariable Cox proportional hazards regression model was used to analyze hospital discharge in unmatched and inverse propensity-weighted patients. ResultsOf the 14,284 patients that were reviewed, we analyzed 5112 patients (control group, 44.0%; IUC group, 56.0%). Almost all procedures comprised less invasive surgeries. The prevalence of postoperative altered mental status and postoperative urinary catheter infection were 3.56% and 0.04%, respectively. After inverse propensity weighting, all baseline characteristics were similar between the two groups. However, patients with IUCs had a higher risk of postoperative complications (adjusted odds ratio, 1.97; 95% confidence interval [CI], 1.50–2.59) and prolonged hospital stays (hazard ratio, 0.84; 95% CI, 0.80–0.89). ConclusionIn patients undergoing less invasive surgery, IUCs may be associated with a relatively high risk of altered mental status or urinary catheter infection. These data may facilitate preoperative discussions regarding the perioperative use of IUCs.

Urinary catheterization from 1997 to 2018: a Dutch population-based cohort.

Background:Our aim was to evaluate the use of indwelling, intermittent and external urinary catheters in neurogenic and non-neurogenic bladder patients in the Netherlands from 1997 to 2018.Methods:Data were retrieved from a population-based cohort containing information about the extramural use of medical devices in the insured population in the Netherlands. The insured population increased from 9.9 million people in 1997 to 17.1 million people in 2018 (64–100% of the Dutch population). Users are expressed by users per 100,000 insured people and total users, corrected for the overall Dutch population. The expenditures are corrected for inflation and expressed by total costs and costs per user.Results:During this 21-year period, indwelling catheter (IC) users doubled from 159 per 100,000 people (24,734 users) to 315 per 100,000 people (54,106 users). Clean intermittent catheter (CIC) users increased from 92 per 100,000 people (14,258 users) in 1997 to 267 per 100,000 people (45,909 users) in 2018. Of all users, 20.7% had an associated neurogenic disorder and 44.9% a non-neurogenic disorder in 2018. The total expenditure on extramural use of urinary catheters increased from 27.7 million euros in 1997 to 84.4 million euros in 2018. IC costs increased from 6.0 million euros in 1997 to 6.7 million euros in 2018, while CIC costs rose from 16.4 million euros to 74.6 million euros. Urine drainage bag costs decreased from 17.2 million in 2001 to 5.3 million in 2018.Conclusions:IC use has increased substantially over the past 21 years, despite the fact that CIC use increased as well. It seems that the main driver behind the prevalence in IC and CIC use, is the rise in incontinence care in older patients and the adaption of preferred CIC use in professional guidelines. At least one fifth of all users catheterize due to neurogenic reasons.

Purple Urinary Bag Syndrome (PUBS) in Benign Prostate Hyperplasia (BPH) with long-term indwelling urinary catheter use: a case report and literature review

Background: PUBS is one of the clinical manifestations of urinary tract infection. This condition often leads patients, patients’ families, and medical workers to worrisome. Metabolism of tryptophan and infection of sulfatase and phosphatase - producing bacteria is the most acceptable pathogenesis explaining PUBS. Many risk factors are underlying this condition, including long-term use of indwelling urinary catheters, constipation, dementia, chronic kidney disease, and bedridden patients. This case study aims to evaluate the recent treatment of supporting factors in treating the underlying urinary infection.Case Presentation: We presented a case report of a 67year-old man with Benign Prostate Hyperplasia (BPH) and long-term use of indwelling urinary catheter who complained of purple discoloration of urine a day prior to Transurethral Resection of the Prostate (TURP) surgery. The patient complained of no fever and pain while urinating and having no history of the same complaint and other diseases. In addition, the patient has diagnosed with BPH and Urinary Tract Infection. The administration of Cefazolin 2 grams dosage was given before the TURP procedure, and the following procedure continued.Conclusion: PUBS is a rare clinical course alarming the urinary tract infection. Appropriate treatment by Cefazolin 2 grams dosage following by TURP shows a favorable outcome in this case study.

Early removal or avoiding the use of perioperative indwelling urinary catheters with spontaneous pneumothorax surgery.

The study evaluated the safety and advantages of no using urinary catheters (UCs) during the perioperative period in patients undergoing spontaneous pneumothorax surgery. Forty-one patients aged 30years or younger who underwent spontaneous pneumothorax surgery at our hospital between January 2018 and March 2020 were screened. Patients with postoperative recurrence were excluded. Patients were divided into three groups: the indwelling UC group (n = 10, group A), the group with UC removal in the operating room before extubation (n = 23, group B), and the no UC group (n = 8, group C). Perioperative circulatory complications, UC insertion or re-insertion, and time to getting out of bed after surgery and confirmation of initial urination were investigated by group. There were no perioperative UC insertions or re-insertions, or perioperative circulatory problems in any group. The median time (interquartile range) required for confirmation of initial postoperative urination was shorter in groups B and C [group A: 13.5 (10.6, 17.3) vs group B: 6.0 (5.0, 6.8) vs group C: 5.5 (3.8, 6.8) h; p = 0.01]. However, the time to getting out of bed after surgery was not significantly different [10.5 (6.4, 15) vs 6.0 (5.0, 7) vs 5.0 (3.8, 8) h; p = 0.12)]. Multivariable analysis showed that group A had a significantly different time to confirmation of initial urination (p = 0.001). Postoperative and intraoperative avoidance of indwelling UC use is acceptable in spontaneous pneumothorax surgery that satisfies certain conditions. Avoiding UC use has the potential to improve the patient experience and facilitate postoperative management.

Use of Education to Improve Compliance With Recommended Bladder-Management Practices for Patients in Labor With an Epidural

The aim of this project is to change the nursing culture so bladder-management interventions are individualized for patients in labor with regional anesthesia. To achieve this aim, we sought to improve nursing compliance with intrapartum regional anesthesia bladder-management orders that were designed to reduce exposure to indwelling urinary catheters (IUCs). The hospital’s regional anesthesia-in-labor orders were changed to reflect the desired practices for bladder management. Electronic health records (EHRs) were reviewed for 30 patients who received regional anesthesia in labor for nursing compliance with orders pre- and posteducational intervention. Nursing education was provided in a staff meeting in an effort to improve compliance with bladder-management orders. Education included review of rates of urinary retention during labor with epidural anesthesia, Centers for Disease Control and Prevention (CDC) recommendations on catheterization, and review of current bladder-management orders. After education, 30 EHRs were reviewed for compliance with orders. The order-set changes were not effective in reducing use of IUC in patients in labor with an epidural. After the educational intervention, IUC use decreased by 50% (from 18 preintervention to 9 postintervention), there was no change in the number of patients that did not did not receive a catheter (5 preintervention and postintervention), there was a 100% increase in straight catheter use (7 preintervention to 14 postintervention), and there was a 66% increase in bedpan use (from 3 preintervention to 5 postintervention). Educational interventions achieved a moderate change in nursing compliance with bladder-management orders for patients with regional anesthesia. Future educational interventions are needed to increase nursing comfort in assessing for urinary retention and offering a bedpan in this patient population.

Eliminating Catheter-Associated Urinary Tract Infections in a Pediatric Cardiac ICU.

To eliminate catheter-associated urinary tract infections in a pediatric cardiac ICU. Quality improvement methodology. Twenty-five bed cardiac ICU in a quaternary freestanding children's hospital. All patients with an indwelling urinary catheter admitted to the cardiac ICU. Catheter-associated urinary tract infection was defined according to National Healthcare Safety Network criteria. Failure modes and effects analysis and Pareto charts were used to determine etiology of process failures. We implemented a team-based multi-interventional approach in 2012 using the Model for Improvement, which included as follows: 1) establish indications for inserting and/or maintaining bladder catheterization, 2) standardization of maintenance care for the indwelling urinary catheters, 3) protocol for management of the leaking urinary catheters, 4) incorporation of urinary catheter days and prompts for removal in daily rounds, and 5) review of all cases of prolonged indwelling urinary catheter use (> 3 d). Process control charts were used to evaluate change. From 2011 to 2018, we showed an early and sustained improvement in catheter-associated urinary tract infection prevention standards compliance from 44% to 96% (52% improvement). These interventions showed a reduction and then elimination of catheter-associated urinary tract infections from January 2012 to the present day, despite fluctuations in total indwelling urinary catheter days. Utilization of quality improvement methodology allowed us to identify components of care that contributed to catheter-associated urinary tract infections. After addressing these issues, we noted a substantial reduction and then elimination of catheter-associated urinary tract infections in our pediatric cardiac ICU. Widely disseminating these interventions across multiple pediatric hospitals to determine the ability to achieve similar results are important next steps.

Catching CAUTIs Midstream: Impact of a Nurse-driven Infection Prevention Initiative in a Neurotrauma Intensive Care Unit

<h3>Background</h3> A preventable hospital-associated condition, Catheter-Associated Urinary Tract Infection (CAUTI) increases morbidity, mortality, and hospital length of stay and cost. Neurologic and injured patients are at high-risk for adverse outcomes associated with bladder dysfunction. Thus, higher utilization, reinsertion and infection rates related to indwelling urinary catheter use is reported in these complex populations. What is the impact of an innovative nurse-driven initiative to reduce CAUTI incidence in a neurotrauma intensive care unit (NTICU) to a Standardized Infection Ratio (SIR) < 1.0? <h3>Methods</h3> A nurse-led interprofessional team utilized a Define-Measure-Analyze-Improve-Control model to implement an evidence-based CAUTI prevention initiative. A 12-bed unit providing care to neurologic and injured patients in a level one trauma, academic medical center was the study setting. Cornerstone interventions included conduct of a staff culture of safety survey; revision of ICU Fever and Bladder Management Guidelines; interprofessional education; and use of a trial without catheter (TWOC) checklist to assess for catheter removal readiness. To sustain improvements, a nursing clinical team leader (CTL) driven initiative included daily patient rounds and audits of catheter care bundle and guideline compliance over a two-year period. Infection rates, device utilization rates and SIR were compared pre and post intervention. <h3>Results</h3> CAUTI rates reduce post intervention by nearly 40% (CAUTI rate 2017, 5.48; 2018, 2.91) and sustained through 2019 (2.97). The SIR for CAUTI reduce nearly 50% from 2.0 in 2017 to 1.06 in 2018 and sustained at 0.92 in 2019. No significant change in the utilization rate was noted (2017, 0.49; 2018, 0.55; 2019, 0.50). <h3>Conclusions</h3> At the unit level, a CTL driven initiative sustains quality improvements in catheter care bundle and guideline compliance, significantly reducing CAUTI incidence in a NTICU. Innovative use of an additional assessment checklist for catheter removal readiness may further support CAUTI reduction in high-risk neurologic and injured ICU populations.

Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections on a medical hospital unit.

Urinary tract infections (UTI) are one of the most common hospital-acquired infections with 80% as a result of urinary catheterisation. This study examined the impact of a simple intervention consisting of a daily chart reminder in patients with indwelling urinary catheters (IUC) on the duration of catheter use and the incidence of catheter-associated UTIs (CAUTIs). The trial used a prospective pretest-post-test design with a control group over a six-month period conducted on two medical units of a community teaching hospital. We included all patients admitted to two medical units between 1 June and 30 November 2016 who had an IUC inserted at the study site. During the intervention phase, a sticker was placed in the charts of patients with urinary catheters reminding physicians to assess for catheter removal if not clinically necessary. A total of 195 patients participated in this study (112 control unit, 83 intervention unit). There was a decrease in the duration of IUC use on the intervention unit from 11.7 days to 7.5 days (P = 0.0028). There was a decrease in repeated catheterisation from 11.1% to 2.1% (P = 0.0882), and CAUTIs from 17.5% to 4.6% (P = 0.0552) but this did not reach statistical significance. The implementation of a daily IUC reminder sticker in patient charts was associated with a significant reduction in the mean duration of indwelling catheter use with a trend towards a reduction in the frequency of repeated urinary catheterisation and rate of CAUTIs.

Barriers and facilitators to implementation of a multifaceted nurse-led intervention in acute care hospitals aimed at reducing indwelling urinary catheter use: A qualitative study.

It is essential to evaluate the ways in which practice changes are implemented and received in and across contexts, identifying barriers and enablers, and mechanisms for enhancing success. To provide insights into the experiences of clinicians in implementing a multifaceted bundled urinary catheter care intervention in four acute care hospitals in New South Wales, Australia. The catheter care bundle was implemented using a pre- and postintervention study design. The intervention was implemented in all adult inpatient wards, emergency departments and operating theatres of four hospitals. The bundle consisted of an integrated set of evidence-based practices to assist clinicians in making better informed decisions related to catheter insertion, care and removal practices. Focus groups at each participating hospital evaluated the implementation processes from the clinicians' perspective, identifying barriers and enablers to successful implementation. Eight focus groups were held with 35 participants. Four key inter-related themes were identified: early and sustained engagement with key stakeholders; good planning but remaining flexible; managing the burden of practice change; and adopting and sustaining practice change. These themes capture and highlight the complexity and the challenges associated with implementation of the practice change across contexts and the project timeline. It is imperative to understand the challenges associated with complex practice change and ways in which implementation can be optimised. This study identified barriers and enablers experienced by staff implementing the bundled intervention. The themes encapsulate factors central to success of practice change within the complex, multilayered healthcare environment. Key challenges highlight the need for forward planning, strategic engagement of key players, continuing monitoring and feedback together with adequate resourcing tailored to result in sustainable normalisation of the intervention over time. The COREQ checklist for qualitative studies has been used in reporting this study.

Multi-atlas-based auto-segmentation for prostatic urethra using novel prediction of deformable image registration accuracy.

Accurate identification of the prostatic urethra and bladder can help determine dosing and evaluate urinary toxicity during intensity-modulated radiation therapy (IMRT) planning in patients with localized prostate cancer. However, it is challenging to locate the prostatic urethra in planning computed tomography (pCT). In the present study, we developed a multiatlas-based auto-segmentation method for prostatic urethra identification using deformable image registration accuracy prediction with machine learning (ML) and assessed its feasibility. We examined 120 patients with prostate cancer treated with IMRT. All patients underwent temporary urinary catheter placement for identification and contouring of the prostatic urethra in pCT images (ground truth). Our method comprises the following three steps: (a) select four atlas datasets from the atlas datasets using the deformable image registration (DIR) accuracy prediction model, (b) deform them by structure-based DIR, (3) and propagate urethra contour using displacement vector field calculated by the DIR. In (a), for identifying suitable datasets, we used the trained support vector machine regression (SVR) model and five feature descriptors (e.g., prostate volume) to increase DIR accuracy. This method was trained/validated using 100 patients and performance was evaluated within an independent test set of 20 patients. Fivefold cross-validation was used to optimize the hype parameters of the DIR accuracy prediction model. We assessed the accuracy of our method by comparing it with those of two others: Acostas method-based patient selection (previous study method, by Acosta et al.), and the Waterman's method (defines the prostatic urethra based on the center of the prostate, by Waterman et al.). We used the centerlines distance (CLD) between the ground truth and the predicted prostatic urethra as the evaluation index. The CLD in the entire prostatic urethra was 2.09±0.89mm (our proposed method), 2.77±0.99mm (Acosta et al., P=0.022), and 3.47±1.19mm (Waterman et al., P<0.001); our proposed method showed the highest accuracy. In segmented CLD, CLD in the top 1/3 segment was highly improved from that of Waterman et.al. and was slightly improved from that of Acosta et.al., with results of 2.49±1.78mm (our proposed method), 2.95±1.75mm (Acosta et al., P=0.42), and 5.76±3.09mm (Waterman et al., P<0.001). We developed a DIR accuracy prediction model-based multiatlas-based auto-segmentation method for prostatic urethra identification. Our method identified prostatic urethra with mean error of 2.09mm, likely due to combined effects of SVR model employment in patient selection, modified atlas dataset characteristics and DIR algorithm. Our method has potential utility in prostate cancer IMRT and can replace use of temporary indwelling urinary catheters.

Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial.

An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as "poor outcome," scores 3-6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13-1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59-2.18). The number exposed to IUC for poor outcome was 13. IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.

The UriCath study: characterization of the use of indwelling urinary catheters among hospitalized older patients in the Internal Medicine Departments of Portugal.

Approximately 25% of older inpatients have an indwelling urinary catheter (IUC), 45-54% unnecessarily. This study aims to describe the prevalence, indications, and complications of IUC use in Portuguese older inpatients. Multicentric, cross-sectional, observational study conducted in Portuguese internal medicine wards (UriCath). Of a total of 3135 inpatients from 39 hospitals, we included 628 patients with 65years old or more using an IUC, mean age 82.0 ± 7.5. Prevalence of IUC use was 20.0%. The average Barthel Index was 44.0 ± 37.3 and Charlson comorbidity Index was 7.0 ± 2.8. The main reasons for IUC use were: urinary output monitoring (47.5%), urinary retention (22.5%), and pressure ulcers (11.0%). The IUC removal was attempted in 9.1% and 24.7% developed a complication. IUC use among older inpatients is prevalent and often inappropriate. Clinical awareness and development guidelines for restricted use of IUC are essential to reduce morbimortality and healthcare costs.

Indwelling urinary catheter placement and removal practices among surgical patients at Kigali University Teaching Hospital

Background: Indwelling urinary Catheters (IUCs) are routinely used medical devices among patients undergoing surgery and their undue use is a risk factor for urinary tract infections (UTIs). The study aim was to assess IUCs placement and removal practices among patients undergoing surgery. Methods: We carried out a cross-sectional study on 207 patients operated at Kigali University Teaching Hospital (KUTH). A pretested observation checklist (Cronbach: α=0.851) was used for data collection. The data were analyzed using SPSS version 20. Chi-square test was used to determine the association between patients’ characteristics and IUCs placement and removal. Results: The IUC placement rate was 56.5% (n=117). There was significant association of IUCs use with gender, age, type and urgency of surgical procedures performed and the type of anesthesia used. Appropriate indication for IUC placement was established in 95.7% patients (n=112). Although 99.1% (n=116) patients were discharged from theatre with IUCs in situ, only 56.5% (n=66) had documented removal instructions. Conclusion: This study established that IUCs use is common and justified in surgery. However, lack of removal instruction was found to be a challenge. Therefore, the authors recommend patients’ re-evaluation for post-surgery IUC need and its early removal where inappropriate to prevent CAUTIs and other complications. Keywords: Indwelling urinary catheter use, surgical patients, surgery

Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study

This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted "bundled" care intervention. Indwelling urinary catheters present a risk for patients through the potential development of catheter-associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. Catheter-associated urinary tract infection is considered preventable yet accounts for over a third of all hospital-acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. A cluster-controlled pre- and poststudy at a facility level with a phased intervention implementation approach. A multifaceted intervention involving a "No CAUTI" catheter care bundle was implemented, in 4 acute-care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. Indwelling urinary catheter point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at preintervention and 1,677 and 1,551 at 4 and 9months postintervention. This study is presented in line with the StaRI checklist (see Appendix S1). A nonsignificant trend towards reduction in IDC prevalence was identified, from 12% preintervention to 10% of all inpatients at 4 and 9months. Variability in preintervention IDC prevalence existed across hospitals (8%-16%). Variability in reduction was evident across hospitals at 4months (between -2% and 4%) and 9months (between 0%-8%). Hospitals with higher preintervention prevalence showed larger decreases, up to 50% when preintervention prevalence was 16%. Indwelling urinary catheter duration increased as more of the short-term IDC placements were avoided. Implementation of a multifaceted intervention resulted in reduced IDC use in four acute-care hospitals in Australia. This result was not statistically significant but did reflect a positive trend of reduction. There was a significant reduction in short-term IDC use at 9months postintervention. Clinical nurse leaders can effectively implement change strategies that influence patient outcomes. Implementation of the evidence-based "No CAUTI" bundle increased awareness of appropriate indications and provided nurses with the tools to inform decision-making related to insertion and removal of IDCs in acute inpatient settings. Working in partnership with inpatients and the multidisciplinary team is essential in minimising acute-care IDC use.

Adverse Effects Associated with Urethral Catheter Placement- Patient’s Perspective

Introduction: Although Indwelling Urinary Catheter (IUC) have an important role in the care of hospitalised patients, nevertheless it is associated with numerous issues that must be addressed on a daily basis. Due to its invasive nature, it is a cause of discomfort and/or pain and also a potential threat to patients safety. The various adverse effects of IUC are associated with higher risk of infection, longer hospital stay and negative impact on daily activities of the patients. Patients perspective is the best source of information for IUC related adverse effects. Aim: To estimate the incidence of all adverse effects (complications) associated with the IUC use and to reproduce patients perception about how their well-being and safety is affected by it. Materials and Methods: In this observational study, hospitalised patients with an IUC were identified and followed-up for 30 days after its insertion. Information regarding both infectious and non-infectious IUC related adverse effects (complications) was collected through patients interviews. Follow-up assessments were performed 15 days and 30 days after the catheter insertion. During this assessment patient’s perspectives about the IUC and its adverse effects were collected. All variables were categorical and percentage and proportions were calculated manually. Results: Total 390 patients were evaluated and analysed. Study comprised of 73.85% males and 26.15% females. The mean age was of 56.7±6.5 years. The IUCs was inserted before surgical procedures in 305 patients (78.2%) with 284 patients (72.82%) having them removed within five days of insertion. A total of 259 patients (66.4%) reported at least one complication because of the IUC. The non-infectious complications were 54.1% and infectious were 12.3%. Both infectious and noninfectious complications were described more commonly by patients who still had their IUC. Most common complications were feeling of urgency/bladder spasms (25.9%) in catheter removal group and pain/ discomfort (52.7%) in catheter in situ group. Conclusion: As per the patients perspective the non-infectious complications are also bothersome in addition to the infectious one and management programme should include both the component essentially.