[Show abstract][Hide abstract] ABSTRACT: Inappropriate use of indwelling urinary tract catheters (IUTCs) in the hospital setting is widespread and associated with nosocomial urinary tract infections. In a prior observational study, we found less than half of IUTCs placed in hospitalized elderly patients had appropriate indications. We tested an emergency department (ED) intervention to increase appropriate use of IUTCs.
The intervention included ED staff education and an indication checklist attached to each catheter kit for staff to complete prior to use. We completed a chart audit on appropriate use of urinary catheters in 100 consecutive catheterized ED patients and tracked catheter billing data before and after the intervention.
Appropriate use of catheters increased from 37% to 51% (P=0.06). The presence of a physician order for catheter placement significantly increased from 43% to 63% (P< 0.01). There was a large and sustained decrease in the total number of catheters placed in the ED after the intervention (N=2029 in 2001 and N=2188 in 2002 to N=300 in 2004 and N= 512 in 2005).
Education and use of an indication sheet produced a dramatic reduction in total number of catheters used and had a smaller impact on appropriateness of use and documentation.
American Journal of Infection Control 11/2007; 35(9):589-93. DOI:10.1016/j.ajic.2006.12.004 · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An estimated 4 million patients per year in the United States are subjected to urinary catheterization. Approximately 25% of patients who are hospitalized have an indwelling urinary tract catheter placed at some time during their hospital stay and nosocomial urinary tract infections develop in 5% per day, with associated bacteremia in 4% of patients.
We sought to assess the prevalence and the appropriateness of the use of urinary catheters at a community teaching hospital in medical patients age 65 years and older.
We randomly selected 285 charts from a total of 2845 patients admitted during the year 2000 who were 65 years and older and had an indwelling urinary tract catheter inserted during the first 24 hours after admission. We excluded patients who had a urinary catheter placed before admission and patients admitted for operation.
On chart review we found an appropriate indication for catheterization for 46% of these patients. A physician or nurse explicitly documented the reason for catheter placement in only 13%. No order for catheterization was written in 33% of the charts. Mean duration of catheter use was 3 days.
Less than half of urinary catheterizations in this teaching hospital were indicated and even fewer had an explicit indication recorded in the chart. Other investigators have had similar findings at other hospitals. Interventions are needed to decrease the inappropriate use of urinary catheters.
American Journal of Infection Control 07/2004; 32(4):196-9. DOI:10.1016/j.ajic.2003.08.007 · 2.21 Impact Factor