A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of CatheterAssociated Urinary Tract Infections Michael S. Bernard, Kathleen F. Hunter, and Katherine N. Moore
ndwelling urinary catheters are widely used in hospitalized patients and can be an appropriate means of therapeutic management under specific circumstances. However, many indwelling urinary catheters are used without clear indications (Gokula, Hickner, & Smith, 2004; Jain, Parada, David, & Smith, 1995), thus putting patients at an unnecessary risk for complications during their hospitalization. Catheter-associated complications include physical and psychological discomfort to the patient, bladder calculi, renal inflammation, and most frequently, catheter-associated urinary tract infections (CAUTI) (Gokula, Smith, & Hickner, 2007). The development of CAUTI in older adults can result in falls, delirium, and immobility (Hazelett, Tsai, Gareri, & Allen, 2006).
© 2012 Society of Urologic Nurses and Associates Bernard, M.S., Hunter, K.F., & Moore, K.N. (2012). A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urologic Nursing, 32(1), 29-37.
The use of indwelling urinary catheters in hospitalized patients presents an increased risk of the development of complications, including catheter-associated urinary tract infection (CAUTI). With regard to the risk of developing a CAUTI, the greatest factor is the length of time the catheter is in situ. The aim of this article is to review the evidence on the prevention of CAUTI, particularly ways to ensure timely removal of indwelling catheters. Published studies evaluating interventions to reduce the duration of catheterization and CAUTI in hospitalized patients were retrieved. The research identified two types of strategies to reduce the duration of indwelling urinary catheters and the incidence of CAUTI: nurseled interventions and informatics-led interventions, which included two subtypes: computerized interventions and chart reminders. Current evidence supports the use of nurse-led and informatics-led interventions to reduce the length of catheterizations and subsequently the incidence of CAUTI. Key Words: Catheter-associated urinary tract infection (CAUTI), indwelling urinary catheters, informatics, hospital-acquired infections, bacteremia.
Michael S. Bernard, MN, RN(EC), NPAdult, is a Nurse Practitioner, VON 360 Degree Nurse Practitioner-Led Clinic, Peterborough, Ontario, Canada. Kathleen F. Hunter, PhD, RN, NP GNC(C), is an Assistant Professor, University of Alberta, Edmonton, Alberta, Canada. Katherine N. Moore, PhD, RN, CCCN, is a Professor, University of Alberta, Edmonton, Alberta, Canada.
Urinary tract infections (UTIs) account for at least 35% of all hospital-acquired infections (Hart, 2008), with 80% of those being attributed to the use of indwelling catheters (Gokula et al., 2007). In addition to the impact on quality of life, CAUTIs place a financial burden on the health care system in terms of treatment and increased length of stay. The exact cost of CAUTI is difficult to calculate due to changes in clinical and billing practices (Saint, 2000).
However, in the U.S., concern over care costs resulting from a largely preventable problem has resulted in changes to the Centers for Medicare & Medicaid Services’ (CMS) reimbursement system, with hospitals no longer receiving additional payment for CAUTIs that were not present at the time of admission (Wald & Kramer, 2007). In addition to financial cost, CAUTIs affect patient well-being. In a systematic review that examined the clinical and economic 29
UROLOGIC NURSING / January-February 2012 / Volume 32 Number 1
Introduction Prevention of catheter-associated urinary tract infections (CAUTIs) has become a major focus of health care...