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Czwikla J, Schmiemann G, Hoffmann F. Use of indwelling urinary catheters in nursing home residents: results from a cross-sectional study in 21 German nursing homes. BMC Urol 2024; 24:125. [PMID: 38877475 PMCID: PMC11177429 DOI: 10.1186/s12894-024-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Indwelling urinary catheters often lead to complications such as symptomatic urinary tract infections. In nursing home residents, catheter prevalence is high, but prevalence differences by sociodemographic characteristics, comorbidities, and health services use have rarely been investigated. The purpose of this work was to describe the use of indwelling urinary catheters in nursing home residents and to examine whether catheter use is associated with individual characteristics. METHODS Cross-sectional data of the "Inappropriate Medication in patients with REnal insufficiency in Nursing homes" (IMREN) study conducted in 21 German nursing homes between October 2014 and April 2015 were analyzed. For all residents of the involved care units, nurses of the participating institutions completed an anonymous questionnaire including the Modified Rankin Scale to assess physical impairments. The proportion of nursing home residents with indwelling urinary catheter was determined. Associations between catheter use and individual characteristics were investigated via cluster-adjusted multivariable logistic regression. RESULTS Of 852 residents (76.5% female; mean age 83.5 years), 13.4% had an indwelling urinary catheter. The adjusted odds ratios for catheter use for men vs. women was 2.86 (95% confidence interval 1.82-4.50). For residents with "moderate" disability vs. those with "no to slight" disability it was 3.27 (1.36-7.85), for individuals with "moderately severe" disability vs. the reference group it was 9.03 (3.40-23.97), and for those with "severe" disability vs. the reference group it was 26.73 (8.60-83.14). For residents who had been hospitalized within the last 12 months vs. those without a hospitalization it was 1.97 (1.01-3.87). For age, dementia, overweight/obesity, other indwelling devices, and long-term medications no significant associations were found. CONCLUSIONS Male nursing home residents, residents with a higher degree of physical impairment, and those who had been hospitalized within the last 12 months were more likely to use an indwelling urinary catheter than their counterparts. Data on circumstances of and indications for catheters, catheter types, and duration of catheterization are needed to evaluate the appropriateness of catheter use in nursing home residents and the need for interventions.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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2
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Zhao T, Du G, Zhou X. Inappropriate urinary catheterisation: a review of the prevalence, risk factors and measures to reduce incidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S13. [PMID: 35559693 DOI: 10.12968/bjon.2022.31.9.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Urinary tract infections (UTIs) comprise the second most common type of healthcare-associated infections, with up to 80% of UTIs caused by indwelling urinary catheters. Current research suggests that the best way to prevent catheter-associated UTIs (CAUTIs) is to reduce unnecessary catheterisation. Few reviews have focused on the prevalence, risk factors and preventive measures for inappropriate catheterisation. This article, consequently, sought to evaluate the current evidence on the prevalence, risk factors and measures that can be taken to prevent inappropriate urinary catheterisation.
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Affiliation(s)
- Tao Zhao
- Department of Hospital Infection Management, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Guiqin Du
- Department of Hospital Infection Management, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Xuan Zhou
- Department of Science and Education, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
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3
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Prieto J, Wilson J, Bak A, Denton A, Flores A, Lusardi G, Reid M, Shepherd L, Whittome N, Loveday H. A prevalence survey of patients with indwelling urinary catheters on district nursing caseloads in the United Kingdom: The Community Urinary Catheter Management (CCaMa) Study. J Infect Prev 2020; 21:129-135. [PMID: 32655693 DOI: 10.1177/1757177420901550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community. Aim To investigate the prevalence of indwelling urinary catheters on district nursing caseloads in the UK. Methods Participants were recruited through the Infection Prevention Society (IPS). An electronic survey was undertaken on a single day between November 2017 and January 2018. Data were analysed using descriptive statistics. Findings A total of 49,575 patients were included in the survey, of whom 5352 had an indwelling urinary catheter. This gave a point prevalence of 10.8% (95% confidence interval [CI] = 10.53-11.07), which varied between organisations, ranging from 2.36% (95% CI = 2.05-2.73) to 22.02% (95% CI = 20.12-24.05). Of catheters, 5% were newly placed (within four weeks). Of these, most (77%) had a documented indication for insertion. Only half of patients with a newly placed catheter had a plan for its removal. This varied between organisations in the range of 20%-96%. Only 13% of patients had a patient-held management plan or 'catheter passport' but these patients were significantly more likely to also have an active removal plan (28/36 [78%] vs. 106/231 [46%]; P < 0.0001). Alternative bladder management strategies had been considered for 70/267 (26%) patients. Discussion The management of patients with an indwelling urinary catheter represents a significant component of district nursing caseloads. Given the high proportion of newly catheterised patients without an active management plan for removal of the catheter, the establishment of an optimal management pathway should be the focus of future prevention efforts.
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Affiliation(s)
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | - Aggie Bak
- Richard Wells Research Centre, University of West London, London, UK
| | | | | | | | - Matthew Reid
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | | | - Heather Loveday
- Richard Wells Research Centre, University of West London, London, UK
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4
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Schweiger A, Kuster SP, Maag J, Züllig S, Bertschy S, Bortolin E, John G, Sax H, Limacher A, Atkinson A, Schwappach D, Marschall J. Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes. J Hosp Infect 2020; 106:364-371. [PMID: 32653433 DOI: 10.1016/j.jhin.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking. AIM To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications. METHODS Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation). FINDINGS In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001). CONCLUSION A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.
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Affiliation(s)
- A Schweiger
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland; Zug Cantonal Hospital, Zug, Switzerland
| | - S P Kuster
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - J Maag
- Swissnoso, National Centre for Infection Control, Bern, Switzerland
| | - S Züllig
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - S Bertschy
- Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - E Bortolin
- Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - G John
- Department of Internal Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland; University of Geneva, Geneva, Switzerland
| | - H Sax
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - A Limacher
- CTU Bern, University of Bern, Bern, Switzerland
| | - A Atkinson
- Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland
| | - D Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland; Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - J Marschall
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland.
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Giles M, Graham L, Ball J, Watts W, King J, Bantawa K, Paul M, Harris A, Paul O'Brien A, Parker V. Variations in indwelling urinary catheter use in four Australian acute care hospitals. J Clin Nurs 2019; 28:4572-4581. [PMID: 31469471 DOI: 10.1111/jocn.15048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are preventable healthcare-associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. DESIGN Two single-day point prevalence surveys collected baseline patient data as part of a larger pre-post control-intervention study. METHODS Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). RESULT Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). CONCLUSIONS Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. RELEVANCE TO CLINICAL PRACTICE IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision-making tools.
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Affiliation(s)
- Michelle Giles
- Hunter New England Local Health District, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Laura Graham
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Jean Ball
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Wendy Watts
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Jennie King
- University of Newcastle, Newcastle, New South Wales, Australia.,Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Kamana Bantawa
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Michelle Paul
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Alison Harris
- Central Coast Local Health District, Gosford, New South Wales, Australia
| | | | - Vicki Parker
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
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Forde L, Barry F. Point prevalence survey of indwelling urinary catheter use and appropriateness in patients living at home and receiving a community nursing service in Ireland. J Infect Prev 2018; 19:123-129. [PMID: 29796094 PMCID: PMC5956698 DOI: 10.1177/1757177417736595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/30/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Indwelling urinary catheters (IUC) are reported as the most common indwelling device in hospitals and residential/care home settings. AIM The aim of this study was to assess the prevalence and appropriateness of IUCs in people living at home and receiving a community nursing service. METHODS An IUC self-report questionnaire was sent to 66 community nurses in one community care area. A second questionnaire was completed by the researcher on each patient (n = 80) identified by the community nurses. Data were analysed using descriptive statistics and the chi-square test was used to test associations between patient demographics, catheter changes and nurses documentation. RESULTS The self-report questionnaire was completed by 46 of the 52 areas (88% response rate). The overall prevalence of IUCs was 1.9% with a higher prevalence among men (70%) and in the over-85-years age group (31%). The mean age was 76 years (age range = 34-98 years) and duration of use was approximately four years. Routine IUC changes were carried out by community nurses (52%), in the acute hospital (25%) or by general practitioners (20%) and the type of catheter influenced person/location of catheter changes (P = 0.001). DISCUSSION This study adds to the understanding of IUCs in patients at home and is the first to investigate if the IUC is appropriate in this setting. It prompted a review of current guidance and development of standard documentation for IUC management locally to ensure that the IUC in use is appropriate. It also suggests that there is a need for internationally accepted, appropriate indications for long-term IUC use to facilitate consistency and allow comparison across studies in future.
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Affiliation(s)
- Liz Forde
- Infection Prevention and Control Nurse, Cork Community Hospitals and Public Health Nursing Services, Ireland
| | - Fiona Barry
- School of Public Health, University College Cork, Ireland
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7
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Hu FW, Shih HI, Hsu HC, Chen CH, Chang CM. Dynamic changes in the appropriateness of urinary catheter use among hospitalized older patients in the emergency department. PLoS One 2018; 13:e0193905. [PMID: 29565991 PMCID: PMC5863961 DOI: 10.1371/journal.pone.0193905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 02/05/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives To investigate incidence, rationales, related factors and outcomes for changing from appropriate catheter placement to inappropriate use among hospitalized older patients in the emergency department. Methods A secondary analysis was adopted from a longitudinal study that was designed to follow the lifecycle of the urinary catheter among hospitalized older patients. Patients aged 65 and older with a urinary catheter that had been placed in the emergency department were included. Demographic factors, present health conditions, conditional factors of catheter placement, and rationales for daily urinary catheter use were collected from the original data. Inappropriate urinary catheter days were evaluated as an outcome. Results Appropriate urinary catheters were placed in the emergency department in 117 of the 156 patients (75%). Of these patients, 77 patients (65.8%) experienced a change from appropriate placement to inappropriate use, with a mean duration of 2.88±1.56 days. The common rationales were post-operation for hip fracture (36.3%) and no longer needing to monitor urine output (27.2%). A hierarchical regression model shows that a change from appropriate catheter placement to inappropriate use was associated with a diagnosis of urinary tract infection (OR = 0.15; 95% CI = 0.03–0.77; p = 0.02) and no record of the indication for catheter placement (OR = 4.76; 95% CI = 1.20–18.90; p = 0.02), and all variables together explained 35.9% of the variance. In addition, a change from appropriate placement to inappropriate use was further associated with prolonging inappropriate catheter-days (β = 5.34; 95% CI: 3.72–6.97; p <0.001). Conclusions The study highlights a considerable percentage of change from appropriate placement to inappropriate use. Efforts to construct reminder intervention, to improve the record of catheter placement and continued attention to catheter use are necessary to reduce inappropriate urinary catheter use.
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Affiliation(s)
- Fang-Wen Hu
- Department of Nursing, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Hsiang-Chin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Ching-Huey Chen
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan
| | - Chia-Ming Chang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
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Hu FW, Chang CM, Su PF, Chen HY, Chen CH. Gender differences in inappropriate use of urinary catheters among hospitalized older patients. J Women Aging 2018; 31:165-175. [PMID: 29334023 DOI: 10.1080/08952841.2018.1423918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study investigated the incidence, rationales, and associated factors of inappropriate urinary catheter use among hospitalized older patients by gender. A longitudinal study of 321 patients with urinary catheter was conducted. Demographic factors, present health factors, urinary catheter factors, and indications of catheter use were collected. A total of 53.7% of urinary catheter-days were inappropriate. For both men and women, there was no significant difference in the incidence and common rationales of inappropriate use. Women, however, have another associated factor with inappropriate use. More tailored alternatives are needed for women to increase comfort to avoid inappropriate catheter use.
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Affiliation(s)
- Fang-Wen Hu
- a Department of Nursing , National Cheng Kung University Hospital , Tainan City , Taiwan
| | - Chia-Ming Chang
- b Division of Geriatrics and Gerontology, Department of Internal Medicine , National Cheng Kung University Hospital , Tainan City , Taiwan
| | - Pei-Fang Su
- c Department of Statistics , National Cheng Kung University , Tainan City , Taiwan
| | - Hsuan-Ying Chen
- c Department of Statistics , National Cheng Kung University , Tainan City , Taiwan
| | - Ching-Huey Chen
- d Department of Nursing , College of Health Sciences, Chang Jung Christian University , Tainan City , Taiwan
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9
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Catheter-associated urinary tract infections: challenges and opportunities for the application of systems engineering. Health Syst (Basingstoke) 2017. [DOI: 10.1057/s41306-016-0017-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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10
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Norman RE, Ramsden R, Ginty L, Sinha SK. Effect of a Multimodal Educational Intervention on Use of Urinary Catheters in Hospitalized Individuals. J Am Geriatr Soc 2017; 65:2679-2684. [DOI: 10.1111/jgs.15074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Richard E. Norman
- Department of Medicine; University of Toronto; Toronto Ontario Canada
| | - Rebecca Ramsden
- Department of Nursing; Sinai Health System; Toronto Ontario Canada
| | - Leanne Ginty
- Department of Nursing; Sinai Health System; Toronto Ontario Canada
| | - Samir K. Sinha
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of General Internal Medicine and Geriatrics; Department of Medicine; Sinai Health System and University Health Network; Toronto Ontario Canada
- Institute of Health Policy; Management and Evaluation; University of Toronto; Toronto Ontario Canada
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11
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Shackley DC, Whytock C, Parry G, Clarke L, Vincent C, Harrison A, John A, Provost L, Power M. Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England. BMJ Open 2017; 7:e013842. [PMID: 28645950 PMCID: PMC5577876 DOI: 10.1136/bmjopen-2016-013842] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time. METHODS A prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer. RESULTS 1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p<0.001) and younger people (18-70 year 14.0% vs >70 year 12.8% p<0.001), utilisation was highest in hospital settings (18.6% p<0.001), particularly in critical care (76.6% p<0.001). Most catheters had been in situ <28 days (72.9% p<0.001). No clinically significant changes were seen over time in any setting or specialty. CONCLUSION Catheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.
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Affiliation(s)
| | | | - Gareth Parry
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
| | - Laurence Clarke
- Department of Urology, Salford Royal Foundation Trust, Salford, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Amber John
- Haelo, Salford Royal Foundation Trust, Salford, UK
| | - Lloyd Provost
- Associates in Process Improvement, Austin, Texas, USA
| | - Maxine Power
- Haelo, Salford Royal Foundation Trust, Salford, UK
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12
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Hu FW, Tsai CH, Lin HS, Chen CH, Chang CM. Inappropriate urinary catheter reinsertion in hospitalized older patients. Am J Infect Control 2017; 45:8-12. [PMID: 28065334 DOI: 10.1016/j.ajic.2016.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. METHODS A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. RESULTS A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. CONCLUSIONS This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion.
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13
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Neoh KG, Li M, Kang ET, Chiong E, Tambyah PA. Surface modification strategies for combating catheter-related complications: recent advances and challenges. J Mater Chem B 2017; 5:2045-2067. [DOI: 10.1039/c6tb03280j] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review summarizes the progress made in addressing bacterial colonization and other surface-related complications arising from catheter use.
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Affiliation(s)
- Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering
- National University of Singapore
- Singapore 119077
| | - Min Li
- Department of Chemical and Biomolecular Engineering
- National University of Singapore
- Singapore 119077
| | - En-Tang Kang
- Department of Chemical and Biomolecular Engineering
- National University of Singapore
- Singapore 119077
| | - Edmund Chiong
- Department of Surgery
- National University of Singapore
- Singapore 119077
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14
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Andrioli ER, Furtado GHC, Medeiros EA. Catheter-associated urinary tract infection after cardiovascular surgery: Impact of a multifaceted intervention. Am J Infect Control 2016; 44:289-93. [PMID: 26585248 DOI: 10.1016/j.ajic.2015.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aims of this study were to assess the impact of a multifaceted intervention on the incidence of catheter-associated urinary tract infection (CAUTI) and on the urinary catheter utilization (UCU) ratio, evaluating adherence to recommendations for the use of indwelling urinary catheters (IUCs). METHODS This prospective, before-and-after interventional study was conducted in three 6-month phases: preintervention (phase 1), intervention (phase 2), and postintervention (phase 3). We observed IUC insertion technique, maintenance care, and removal/nonremoval practices; provided training on CAUTI prevention measures; evaluated professional knowledge; provided adherence feedback; determined the incidence of CAUTI, and calculating the UCU ratio. RESULTS Between phases 1 and 3, CAUTI incidence fell from 11.42 to 4.40 cases/1000 catheter-days (P = .216), whereas the UCU ratio remained constant. The risk of CAUTI was 2.6-fold higher in phase 1 than in phase 3. Adherence to hand hygiene (before and after IUC insertion) improved significantly, as did adherence to attaching the IUC to the patient and maintenance care guidelines. The reasons for IUC use (including inappropriate reasons) did not differ significantly. Professional knowledge improved significantly after training. CONCLUSION A multifaceted intervention effectively reduced CAUTI incidence and improved the quality of care.
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Housestaff Knowledge Related to Urinary Catheter Use and Catheter-Associated Urinary Tract Infections. Infect Control Hosp Epidemiol 2015; 36:1355-7. [PMID: 26278269 DOI: 10.1017/ice.2015.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite published catheter-associated urinary tract infection prevention guidelines, inappropriate catheter use is common. We surveyed housestaff about their knowledge of catheter-associated urinary tract infections at a teaching hospital and found most are aware of prevention guidelines; however, their application to clinical scenarios and catheter practices fall short of national goals.
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Murphy C, Prieto J, Fader M. "It's easier to stick a tube in": a qualitative study to understand clinicians' individual decisions to place urinary catheters in acute medical care. BMJ Qual Saf 2015; 24:444-50. [PMID: 26065467 DOI: 10.1136/bmjqs-2015-004114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians' decisions need to be better understood. OBJECTIVE To explore why clinicians decide to place IUCs in acute medical care. METHODS We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used. RESULTS Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals. CONCLUSIONS These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.
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Affiliation(s)
- Catherine Murphy
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jacqui Prieto
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mandy Fader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Buckley C, Clements C, Hopper A. Reducing inappropriate urinary catheter use: quality care initiatives. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S18, S20-2. [PMID: 25978469 DOI: 10.12968/bjon.2015.24.sup9.s18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Healthcare-acquired urinary infection presents a substantial burden for patients and the healthcare system. Urinary tract infections have not gained the same level of media attention as other healthcare-associated infections, yet interventions to reduce urinary catheter use are one of the top ten recommended patient safety strategies. To improve practice around urinary catheter placement and removal requires interventions to change the expectations and habits of nurses, medical teams and patients regarding the need for a urinary catheter. In the authors' trust, a redesign of the existing urinary catheter device record was undertaken to help avoid unnecessary placement of catheters, and resulted in a reduction of urinary catheters in situ longer than 48 hours. Other strategies included implementation of catheter rounds in a high-usage area, and credit-card-sized education cards. A catheter 'passport' was introduced for patients discharged with a catheter to ensure information for insertion and ongoing use were effectively communicated.
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Hu FW, Chang CM, Tsai CH, Chen CH. Exploring initial inappropriate use of urinary catheters among hospitalised older patients in Taiwan. J Clin Nurs 2015; 24:1656-65. [DOI: 10.1111/jocn.12767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Fang-Wen Hu
- Institute of Allied Health Sciences; College of Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Chia-Ming Chang
- Department of Internal Medicine; Division of Geriatrics and Gerontology; National Cheng Kung University; Tainan City Taiwan
| | - Chuan-Hsiu Tsai
- Department of Nursing; College of Medicine; Tzu Chi University; Hualien City Taiwan
| | - Ching-Huey Chen
- Department of Nursing and Institute of Allied Health Sciences; College of Medicine; National Cheng Kung University; Tainan City Taiwan
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Hu FW, Yang DC, Huang CC, Chen CH, Chang CM. Inappropriate use of urinary catheters among hospitalized elderly patients: Clinician awareness is key. Geriatr Gerontol Int 2014; 15:1235-41. [DOI: 10.1111/ggi.12431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Fang-Wen Hu
- Institute of Allied Health Sciences; College of Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Deng-Chi Yang
- Division of Geriatrics and Gerontology; Department of Internal Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Chi-Chang Huang
- Division of Geriatrics and Gerontology; Department of Internal Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Ching-Huey Chen
- Department of Nursing; National Cheng Kung University; Tainan City Taiwan
| | - Chia-Ming Chang
- Division of Geriatrics and Gerontology; Department of Internal Medicine; National Cheng Kung University; Tainan City Taiwan
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Blodgett TJ, Gardner SE, Blodgett NP, Peterson LV, Pietraszak M. A Tool to Assess the Signs and Symptoms of Catheter-Associated Urinary Tract Infection: Development and Reliability. Clin Nurs Res 2014; 24:341-56. [PMID: 25246536 DOI: 10.1177/1054773814550506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this pilot study was to determine the inter-rater reliability of four clinical manifestations of catheter-associated urinary tract infections (CAUTI) among hospitalized adults with short-term indwelling urinary catheters using a tool developed for this purpose: the CAUTI Assessment Profile (CAP). Study participants included 30 non-pregnant English-speaking adults, recruited from two community hospitals. Three nurses assessed each participant for fever, suprapubic tenderness, flank tenderness, and delirium using standardized techniques. Based on the generalized Kappa statistic and 95% confidence intervals, there was evidence of strong inter-rater reliability for fever (K = 1.00, 0.793-1.207), suprapubic tenderness (K = 0.39, 0.185-0.598), and delirium (K = 0.58, 0.379-0.792), but not for flank tenderness (K = 0.29, -0.036 to 0.617). This study provides preliminary evidence that the CAP can be used to consistently identify these clinical signs and symptoms of CAUTI in hospitalized adults.
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Janzen J, Buurman BM, Spanjaard L, de Reijke TM, Goossens A, Geerlings SE. Reduction of unnecessary use of indwelling urinary catheters. BMJ Qual Saf 2013; 22:984-8. [DOI: 10.1136/bmjqs-2013-001908] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Commentary on “Can In-Hospital Urinary Catheterization Rates Be Reduced with Benefits Outweighing the Risks?”. South Med J 2013; 106:372-3. [DOI: 10.1097/smj.0b013e3182967d57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fernández-Ruiz M, Calvo B, Vara R, Villar RN, Aguado JM. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital. Enferm Infecc Microbiol Clin 2013; 31:523-5. [PMID: 23601704 DOI: 10.1016/j.eimc.2013.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. METHODS A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. RESULTS Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. CONCLUSIONS Further educational efforts should be focused on improving catheterization prescribing practices by physicians.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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Nosova K, Nuño M, Mukherjee D, Lad S, Boakye M, Black K, Patil C. Urinary tract infections in meningioma patients: analysis of risk factors and outcomes. J Hosp Infect 2013; 83:132-9. [DOI: 10.1016/j.jhin.2012.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
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Murphy C, Fader M, Prieto J. Interventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review. Int J Nurs Stud 2013; 51:4-13. [PMID: 23332716 DOI: 10.1016/j.ijnurstu.2012.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs. OBJECTIVES To evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care. DESIGN Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review. DATA SOURCES MEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library. REVIEW METHODS A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011. RESULTS 2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications. CONCLUSIONS More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs.
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Affiliation(s)
- Catherine Murphy
- Faculty of Health Sciences, University of Southampton, United Kingdom.
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Pickard R, Lam T, MacLennan G, Starr K, Kilonzo M, McPherson G, Gillies K, McDonald A, Walton K, Buckley B, Glazener C, Boachie C, Burr J, Norrie J, Vale L, Grant A, N'Dow J. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet 2012; 380:1927-35. [PMID: 23134837 DOI: 10.1016/s0140-6736(12)61380-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infection (CAUTI) is a major preventable cause of harm for patients in hospital. We aimed to establish whether short-term routine use of antimicrobial catheters reduced risk of CAUTI compared with standard polytetrafluoroethylene (PTFE) catheterisation. METHODS In our parallel, three group, multicentre, randomised controlled superiority trial, we enrolled adults (aged ≥16 years) requiring short-term (≤14 days) catheterisation at 24 hospitals in the UK. Participants were randomly allocated 1:1:1 with a remote computer allocation to receive a silver alloy-coated catheter, a nitrofural-impregnated catheter, or a PTFE-coated catheter (control group). Patients undergoing unplanned catheterisation were also included and consent for participation was obtained retrospectively. Participants and trial staff were unmasked to treatment assignment. Data were collected by trial staff and by patient-reported questionnaires for 6 weeks after randomisation. The primary outcome was incidence of symptomatic urinary tract infection for which an antibiotic was prescribed by 6 weeks. We postulated that a 3·3% absolute reduction in CAUTI would represent sufficient benefit to recommend routine use of antimicrobial catheters. This study is registered, number ISRCTN75198618. FINDINGS 708 (10%) of 7102 randomly allocated participants were not catheterised, did not confirm consent, or withdrew, and were not included in the primary analyses. Compared with 271 (12·6%) of 2144 participants in the control group, 263 (12·5%) of 2097 participants allocated a silver alloy catheter had the primary outcome (difference -0·1% [95% CI -2·4 to 2·2]), as did 228 (10·6%) of 2153 participants allocated a nitrofural catheter (-2·1% [-4·2 to 0·1]). Rates of catheter-related discomfort were higher in the nitrofural group than they were in the other groups. INTERPRETATION Silver alloy-coated catheters were not effective for reduction of incidence of symptomatic CAUTI. The reduction we noted in CAUTI associated with nitrofural-impregnated catheters was less than that regarded as clinically important. Routine use of antimicrobial-impregnated catheters is not supported by this trial. FUNDING UK National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Irwin NJ, McCoy CP, Jones DS, Gorman SP. Infection-Responsive Drug Delivery from Urinary Biomaterials Controlled by a Novel Kinetic and Thermodynamic Approach. Pharm Res 2012; 30:857-65. [DOI: 10.1007/s11095-012-0927-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/05/2012] [Indexed: 01/10/2023]
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