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
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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
References: Apisarnthanarak, A., Thongphubeth, K., Sirinvaravong, S., Kitkangvan, D., Yuekyen, C., Warachan, B., … Fraser, V.J. (2007). Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infection Control & Hospital Epidemiology, 28(7), 791798. Cochran, S. (2007). Care of the indwelling urinary catheter: Is it evidence based? Journal of Wound Ostomy & Continence Nursing, 34(3), 282-288. Cornia, P.B., Amory, J.K., Fraser, S., Saint, S., & Lipsky, B.A. (2003). Computerbased order entry decreases duration of indwelling urinary catheterization in hospitalized patients. American Journal of Medicine, 114(5), 404-407. Crouzet, J., Bertrand, X., Venier, A.G., Badoz, M., Husson, C., & Talon, D. (2007). Control of the duration of urinary catheterization: Impact on catheter-associated urinary tract infection. Journal of Hospital Infection, 67(3), 253-257. Dingwall, L., & McLafferty, E. (2006). Nurses’ perceptions of indwelling urinary catheters in older people. Nursing Standard, 21(14-16), 35-42. Elpern, E.H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal of Critical Care, 18(6), 535541. Fakih, M.G., Dueweke, C., Meisner, S., Berriel-Cass, D., Savoy-Moore, R., Brach, N., … Saravolatz, L.D. (2008). Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infection Control & Hospital Epidemiology, 29(9), 815819. Fernandez, R. S., & Griffiths, R. D. (2006). Duration of short-term indwelling catheters – A systematic review of the evidence. Journal of Wound Ostomy and Continence Nursing, 33(2), 145155. Gardam, M.A., Amihod, B., Orenstein, P., Consolacion, N., & Miller, M.A. (1998). Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections. Clinical Performance & Quality Health Care, 6(3), 99-102. Gokula, R.R., Hickner, J.A., & Smith, M.A. (2004). Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. American Journal of Infection Control, 32(4), 196-199. Gokula, R.M., Smith, M.A., & Hickner, J. (2007). Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of Foley catheters. American Journal of Infection Control, 35(9), 589-593. Gould, C.V., Umscheid, G.A., Agarwal, R.K., Kuntz, G., Pegues, D.A., & Healthcare Infection Control Practices Advisory Committee. (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Retrieved March 19, 2010, from http://www.cdc.gov.login.ezproxy. library.ualberta.ca/hicpac/cauti/001_ cauti.html Hampton, T. (2006). Urinary catheter use often “inappropriate” in hospitalized elderly patients. JAMA: Journal of the American Medical Association, 295(24), 2838. Hart, S. (2008). Urinary catheterisation. Nursing Standard, 22(27), 44-48. Hazelett, S.E., Tsai, M., Gareri, M., & Allen, K. (2006). The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatrics, 6, 15. Holroyd-Leduc, J.M., Sen, S., Bertenthal, D., Sands, L.P., Palmer, R.M., Kresevic, D.M., … Landefeld, C.S. (2007). The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. Journal of the American Geriatrics Society, 55(2), 227-233. Hooton, T.M., Bradley, S.F., Cardenas, D.D., Colgan, R., Geerlings, S.E., Rice, J.C., … Nicolle L.E. (2010). Diagnosis, prevention, and treatment of catheterassociated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases, 50(5), 625-663. Huang, W.C., Wann, S.R., Lin, S.L., Kunin, C.M., Kung, M.H., Lin, C.H., … Lin, T.W. (2004). Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infection Control & Hospital Epidemiology, 25(11), 974978. Jain, P., Parada, J.P., David, A., & Smith, L.G. (1995). Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Archives of Internal Medicine, 155(13), 1425-1429. Joanna Briggs Institute. (2008). Removal of short-term indwelling urethral catheters. Nursing Standard, 22(22), 42-45. Loeb, M., Hunt, D., O’Halloran, K., Carusone, S.C., Dafoe, N., & Walter, S.D. (2008). Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: A randomized controlled trial. Journal of General Internal Medicine, 23(6), 816820. Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia: Lippincott, Williams & Wilkins. Munasinghe, R. L., Yazdani, H., Siddique, M., & Hafeez, W. (2001). Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infection Control & Hospital Epidemiology, 22(10), 647649. Nazarko, L. (2008). Reducing the risk of catheter-related urinary tract infection. British Journal of Nursing, 17 (16), 56-58. Rabkin, D.G., Stifelman, M.D., Birkhoff, J., Richardson, K.A., Cohen, D., Nowygrod, R., … Hardy, M.A. (1998). Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplantation Proceedings, 30(8), 43144316. Raffaele, G., Bianco, A., Aiello, M., & Pavia, M. (2008). Appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy. Infection Control & Hospital Epidemiology, 29(3), 279-281. Robinson, S., Allen, L., Barnes, M.R., Berry, T.A., Foster, T.A., Friedrich, L.A., … Weitzel, T. (2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURG Nursing, 16(3), 157-161. Saint, S. (2000). Clinical and economic consequences of nosocomial catheterrelated bacteriuria. American Journal of Infection Control, 28(1), 68-75. Saint, S., Lipsky, B.A., Baker, P.D., McDonald, L.L., & Ossenkop, K. (1999). Urinary catheters: What type do men and their nurses prefer? Journal of the American Geriatrics Society, 47(12), 1453-1457. Saint, S., Lipsky, B.A., & Goold, S.D. (2002). Indwelling urinary catheters: A onepoint restraint? Annals of Internal Medicine, 137(2), 125-127. Topal, J., Conklin, S., Camp, K., Morris, V., Balcezak, T., & Herbert, P. (2005). Prevention of nosocomial catheterassociated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. American Journal of Medical Quality, 20(3), 121-126. Wald, H.L., & Kramer, A.M. (2007). Nonpayment for harms resulting from medical care: Catheter-associated urinary tract infections. JAMA: Journal of the American Medical Association, 298, 2782-2784. Warren, J.W., Tenney, J.H., Hoopes, J.M., Muncie, H.L., & Anthony, W.C. (1982). A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. Journal of Infectious Diseases, 146(6), 719-723. 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