Abstract and Introduction
Abstract
Background Duration of indwelling urinary catheterization is an important risk factor for urinary tract infection.
Objectives To determine whether a reminder approach reduces the use of urinary catheters and the incidence of catheterassociated urinary tract infections.
Methods A randomized control trial was performed in 2 respiratory intensive care units in a 2990-bed tertiary referral medical center. Patients who had urinary catheters in place for more than 2 days from April through November 2008 were randomly assigned to either the intervention group (use of a criteria-based reminder to remove the catheter) or the control group (no reminder).
Results A total of 278 patients were recruited. Utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group compared with the control group (relative risk, 0.78; 95% CI, 0.76–0.80; P < .001). The intervention significantly shortened the median duration of catheterization (7 days vs 11 days for the control group; P < .001). The success rate for removing the catheters in the intervention group by day 7 was 88%. The reminder intervention reduced the incidence of catheter-associated infections by 48% (relative risk, 0.52; 95% CI, 0.32–0.86; P = .009) in the intervention group compared with the control group.
Conclusions Use of a criteria-based reminder to remove indwelling urinary catheters can diminish the use of urinary catheterization and reduce the likelihood of catheter-associated urinary infections. This reminder approach can prevent catheter-associated urinary infections, and its use should be strongly considered as a way to enhance the safety of patients.
Introduction
Urinary tract infections (UTIs) are common hospital-acquired infections and account for up to 40% of the 2 million nosocomial infections reported per year (UTIs are the most common nosocomial infections). The incidence is 3.1 to 6.4 catheter-associated urinary tract infections (CAUTIs) per 1000 catheter-days, whereas urinary catheters are used in 56% to 89% of adult patients in critical care units. Nevertheless, 80% of UTIs are due to the presence of indwelling urinary catheters. The risk of a UTI increases as the duration of catheterization increases. A patient with an indwelling urinary catheter has a 5% daily risk for development of a UTI. Evidence clearly indicates that early catheter removal can lower the incidence of CAUTIs. The US Centers for Disease Control and Prevention (CDC) strongly recommends placement of indwelling urinary catheters only when indicated and removal of the devices when the indication no longer exists. Nonetheless, 41% of physicians do not follow this recommendation, and clinical nursing staff may also neglect to perform the evaluation necessary to determine whether a catheter should be removed. As a result, up to 47% of catheterization days in hospitalized patients are unnecessary.
Prevention of UTIs has been a global effort, and the CDC recommends use of reminder systems to prevent such infections. However, the results of previous studies have been contradictory. Some researchers reported that this approach could be effective in decreasing the UTI rate, but other investigations found no significant difference in the UTI rate with the approach. Therefore, our research hypothesis was that use of a catheter reminder system can reduce the duration of urinary catheterization and the incidence of CAUTIs. The purpose of our study was to evaluate the outcomes of the use of the criteria- based reminder system on the removal of indwelling catheters.