Indwelling Urinary Catheter Articles


  • [Impact of an intervention to improve indwelling urinary catheter use and reduce urinary tract infections].

    OBJECTIVE - To evaluate the impact of an intervention regarding the adequate use and improvement in the care of indwelling urinary catheters (IUC) and the frequency of catheter-associated urinary tract infections (CAUTI) in hospitalised patients.

    Published March 9, 2016
  • A randomized crossover study of silver-coated urinary catheters in hospitalized patients - Abstract

    BACKGROUND: Urinary tract infections (UTIs) account for 30% to 40% of nosocomial infections resulting in morbidity, mortality, and increased length of hospital stay.

    OBJECTIVE: To assess the efficacy of a silver-alloy, hydrogel-coated latex urinary catheter for the prevention of nosocomial catheter-associated UTIs.

    METHODS: A 12-month randomized crossover trial compared rates of nosocomial catheter-associated UTI in patients with silver-coated and uncoated catheters. A cost analysis was conducted.

    RESULTS: There were 343 infections among 27,878 patients (1.23 infections per 100 patients) during 114,368 patient-days (3.00 infections per 1000 patient-days). The relative risk of infection per 1000 patient-days was 0.79 (95% confidence interval, 0.63-0.99; P =.04) for study wards randomized to silver-coated catheters compared with those randomized to uncoated catheters. Infections occurred in 291 of 11,032 catheters used on study units (2.64 infections per 100 catheters). The relative risk of infection per 100 silver-coated catheters used on study wards compared with uncoated catheters was 0.68 (95% confidence interval, 0.54-0.86; P =.001). Fourteen catheter-associated UTIs (4.1%) were complicated by secondary bloodstream infection. One death appeared related to the secondary infection. Estimated hospital cost savings with the use of the silver-coated catheters ranged from $14,456 to $573,293.

    CONCLUSIONS: The risk of infection declined by 21% among study wards randomized to silver-coated catheters and by 32% among patients in whom silver-coated catheters were used on the wards. Use of the more expensive silver-coated catheter appeared to offer cost savings by preventing excess hospital costs from nosocomial UTI associated with catheter use.

    Written by:
    Karchmer TB, Giannetta ET, Muto CA, Strain BA, Farr BM. Are you the author?
    PO Box 800473, University of Virginia Health System, Charlottesville, VA 22908, USA.

    Reference: Arch Intern Med. 2000 Nov 27;160(21):3294-8.


    Published January 15, 2013
  • Are physicians aware of which of their patients have indwelling urinary catheters? - Abstract

    PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters.

    METHODS:The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient.

    RESULTS:Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Overall, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7; 95% confidence interval, 2.1 to 6.7, P <0.001).

    CONCLUSIONS:Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often "forgotten" than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted.

    Written by:
    Saint S, Wiese J, Amory JK, Bernstein ML, Patel UD, Zemencuk JK, Bernstein SJ, Lipsky BA, Hofer TP. Are you the author?
    Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School,;, Ann Arbor, Michigan, USA.

    Reference: Am J Med. 2000 Oct 15;109(6):476-80.


    Published January 15, 2013
  • Change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: results of a before/after survey study.

    To evaluate changes in staff perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project.

    Repeated cross-sectional survey at baseline (October 2016) and 12-month follow-up (October 2017).

    Published November 10, 2019
  • Compliance with handwashing in a teaching hospital - Abstract

    BACKGROUND:Transmission of microorganisms from the hands of health care workers is the main source of cross-infection in hospitals and can be prevented by handwashing.

    OBJECTIVE: To identify predictors of noncompliance with handwashing during routine patient care.

    DESIGN: Observational study.

    SETTING: Teaching hospital in Geneva, Switzerland.

    PARTICIPANTS: Nurses (66%), physicians (10%), nursing assistants (13%), and other health care workers (11%).

    MEASUREMENTS: Compliance with handwashing.

    RESULTS: In 2834 observed opportunities for handwashing, average compliance was 48%. In multivariate analysis, noncompliance was higher among physicians (odds ratio [OR], 2.8 (95% CI, 1.9 to 4.1)), nursing assistants (OR, 1.3 (CI, 1.0 to 1.6)), and other health care workers (OR, 2.1 (CI, 1.4 to 3.2)) than among nurses and was lowest on weekends (OR, 0.6 (CI, 0.4 to 0.8)). Noncompliance was higher in intensive care than in internal medicine units (OR, 2.0 (CI, 1.3 to 3.1)), during procedures that carry a high risk for contamination (OR, 1.8 (CI, 1.4 to 2.4)), and when intensity of patient care was high (compared with < or = 20 opportunities for handwashing per hour of care, 21 to 40 opportunities: OR, 1.3 (CI, 1.0 to 1.7); 41 to 60 opportunities: OR, 2.1 (CI, 1.5 to 2.9); and > 60 opportunities: OR, 2.1 (CI, 1.3 to 3.5)).

    CONCLUSIONS:Compliance with handwashing was moderate. Variation across hospital ward and type of health care worker suggests that targeted educational programs may be useful. Even though observational data cannot prove causality, the association between noncompliance and intensity of care suggests that understaffing may decrease quality of patient care.

    Written by:
    Pittet D, Mourouga P, Perneger TV. Are you the author?
    University of Geneva Medical School and University of Geneva Hospitals, Switzerland.

    Reference: Ann Intern Med. 1999 Jan 19;130(2):126-30. 


    Published January 15, 2013
  • Complications of Foley catheters--is infection the greatest risk? - Abstract

    PURPOSE:Foley catheters cause a variety of harms, including infection, pain and trauma. Although symptomatic urinary tract infection and asymptomatic bacteriuria are frequently discussed, genitourinary trauma receives comparatively little attention.

    MATERIALS AND METHODS:A dedicated Foley catheter nurse prospectively reviewed the medical records of inpatients with a Foley catheter at the Minneapolis Veterans Affairs Medical Center from August 21, 2008 to December 31, 2009. Daily surveillance included Foley catheter related bacteriuria and trauma. Data were analyzed as the number of event days per 100 Foley catheter days.

    RESULTS:During 6,513 surveyed Foley catheter days, urinalysis/urine culture was done on 407 (6.3%) days. This testing identified 116 possible urinary tract infection episodes (1.8% of Foley catheter days), of which only 21 (18%) involved clinical manifestations. However, the remaining 95 asymptomatic bacteriuria episodes accounted for 39 (70%) of 56 antimicrobial treated possible urinary tract infection episodes (for proportion of treated episodes with vs without symptomatic urinary tract infection manifestations, p = 0.005). Concurrently 100 instances of catheter associated genitourinary trauma (1.5% of Foley catheter days) were recorded, of which 32 (32%) led to interventions such as prolonged catheterization or cystoscopy. Trauma prompting an intervention accounted for as great a proportion of Foley catheter days (0.5%) as did symptomatic urinary tract infection (0.3%) (p = 0.17).

    CONCLUSIONS: In this prospective surveillance project, intervention triggering Foley catheter related genitourinary trauma was as common as symptomatic urinary tract infection. Moreover, despite recent increased attention to the distinction between asymptomatic bacteriuria and symptomatic urinary tract infection in catheterized patients, asymptomatic bacteriuria accounted for significantly more antimicrobial treatment than did symptomatic urinary tract infection. Elimination of unnecessary Foley catheter use could prevent symptomatic urinary tract infection, unnecessary antimicrobial therapy for asymptomatic bacteriuria and Foley catheter related trauma.

    Written by:
    Leuck AM, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Are you the author?
    VA Medical Center, University of Minnesota, Minneapolis, Minnesota, USA.

    Reference: J Urol. 2012 May;187(5):1662-6. doi: 10.1016/j.juro.2011.12.113.


    Published January 15, 2013
  • Estimating health care-associated infections and deaths in U.S. hospitals, 2002 - Abstract

    OBJECTIVE: The purpose of this study was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals.

    METHODS:No single source of nationally representative data on HAIs is currently available. The authors used a multi-step approach and three data sources. The main source of data was the National Nosocomial Infections Surveillance (NNIS) system, data from 1990-2002, conducted by the Centers for Disease Control and Prevention. Data from the National Hospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplement NNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with the HAI from NNIS data was used to estimate the number of deaths.

    RESULTS: In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-baby nurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites.

    CONCLUSION: HAIs in hospitals are a significant cause of morbidity and mortality in the United States. The method described for estimating the number of HAIs makes the best use of existing data at the national level.

    Written by:
    Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Are you the author?
    Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS A-24, Atlanta, GA 30333, USA.

    Reference: Public Health Rep. 2007 Mar-Apr;122(2):160-6.


    Published January 15, 2013
  • Guide to the elimination of catheter-associated urinary tract infections (CAUTIs)

    PURPOSE: The purpose of this document is to provide evidence-based practice guidance for the prevention of catheter-associated urinary tract Infections (CAUTI) in acute and long-term care settings.

    BACKGROUND: Health-care associated infections (HAIs) are infections acquired during the course of receiving treatment for other conditions within a health care setting. HAIs are one of the top 10 leading causes of death in the United States, according to the Centers for Disease Control and Prevention (CDC), which estimates that 1.7 million infections were reported annually among patients. It has long been acknowledged that CAUTI is the most frequent type of infection in acute care settings. In a study that provided a national estimate of health-care associated infections, urinary tract infections comprised 36% of the total HAI estimate.




    Association for Professionals in Infection Control and Epidemiology (APIC)

    Published January 17, 2013
  • Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship - Abstract

    BACKGROUND: Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection (ARI).

    METHODS:A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI.

    RESULTS:In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from $18,588 to $29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4-12.7 days, and attributable mortality was 6.5%. The societal costs were $10.7-$15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of $13.35 million in 2008 dollars in this patient cohort.

    CONCLUSIONS: The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.

    Written by:
    Roberts RR, Hota B, Ahmad I, Scott RD 2nd, Foster SD, Abbasi F, Schabowski S, Kampe LM, Ciavarella GG, Supino M, Naples J, Cordell R, Levy SB, Weinstein RA. Are you the author?
    Department of Emergency Medicin, John H Stroger Jr Hospital of Cook County, Chicago, Illinois 60612, USA.

    Reference: Clin Infect Dis. 2009 Oct 15;49(8):1175-84.
    doi: 10.1086/605630. 


    Published January 15, 2013
  • Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: An integrative review.

    In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort.

    Published October 24, 2018
  • Innovating urinary catheter design: An introduction to the engineering challenge.

    Every day, people around the world rely on intermittent and indwelling urinary catheters to manage bladder dysfunction, but the potential or actual harm caused by these devices is well-recognised. Current catheter designs can cause urinary tract infection and septicaemia, bladder and urethral trauma and indwelling devices frequently become blocked.

    Published May 27, 2018
  • Reducing inappropriate urinary catheter use: a statewide effort - Abstract

    BACKGROUND: Indwelling urinary catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use.

    METHODS:Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention promoting adherence to appropriate urinary catheter indications. The data were collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of educating clinicians about the appropriate indications for urinary catheter use and promoting the daily assessment of urinary catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of urinary catheter use and adherence to appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methods to estimate rates over time while accounting for the clustering of patients within hospital units.

    RESULTS: The urinary catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P < .001). The proportion of catheterized patients with appropriate indications increased from 44.3% (95% CI, 40.3%-48.4%) to 57.6% (95% CI, 51.7%-63.4%) by the end of year 2 (P = .005).

    CONCLUSIONS: A statewide effort to reduce inappropriate urinary catheter use was associated with a significant reduction in catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.

    Written by:
    Fakih MG, Watson SR, Greene MT, Kennedy EH, Olmsted RN, Krein SL, Saint S. Are you the author?
    University of Michigan Patient Safety Enhancement Program, Ann Arbor, MI 48109-0429, USA.

    Reference: Arch Intern Med. 2012 Feb 13;172(3):255-60.
    doi: 10.1001/archinternmed.2011.627.



    Published January 15, 2013
  • Urologic Complications in Patients Receiving Indwelling Urinary Catheters During Transcatheter Aortic Valve Replacement.

    The minimalist approach to transcatheter aortic valve replacement (TAVR) focuses on avoiding extraneous invasive measures. Data describing the clinical impact of routine indwelling urinary catheter (IUC) in TAVR patients is limited.

    Published July 13, 2020