Approximately 25% of hospitalised adults require an indwelling urinary catheter (IDC) during their hospital stay. IDCs expose patients to risks of infectious and non-infectious complications.
Aims
To identify IDC prevalence, assess adherence to clinical practice guidelines and patient-reported involvement in IDC care for adult hospital inpatients.
Methods
This point prevalence study was conducted in 22 wards in a single quaternary hospital. Data was collected by clinical and research nurses working in pairs on a single day. Study outcomes were reported descriptively as frequencies and percentages.
Results
Of 502 patients included, 77 (15.3%) had an IDC (median duration 99.6 h). The median age of patients with an IDC was 64 years (interquartile range 22–88 years), 54 (70%) were male and one-quarter (n = 19; 25%) of IDCs were inserted at another hospital. More than half (n = 44; 57%) of the 77 IDCs had no documented removal plan. Three patients were unavailable for review for observed clinical practices, and it was found 43% (n = 32/74) lacked a securement device. Of 77 people with IDCs, there were 44 patient responses, and 27 (61.4%) patients did not know the reason for their catheter.
Discussion
Areas for improvement included securement device use, timely removal plans and patient education for the reason for the device. Regular point prevalence studies to assess use and adherence to clinical practical guidelines can improve safety outcomes for patients requiring IDCs.
AnsellT (2016) Indwelling urinary catheters: should we secure them?British Journal of Nursing25(18): S22–S25.
2.
AppahYHunterKFMooreKN (2016) Securement of the indwelling urinary catheter: a prevalence study. The Journal of Wound, Ostomy and Continence Nursing43(2): 173–177.
Centers for Disease Control and Prevention (2023) Urinary tract infection (Catheter-Associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) events. National healthcare safety network. United States of America: Centers for Disease Control and Prevention, 1–18.
ChenowethCEGouldCSaintS (2014) Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infectious Disease Clinics of North America28(1): 105–119.
7.
CoventryLLPattonVWhyteA, et al. (2021) Adherence to evidence-based guidelines for indwelling urinary catheter management: a cross-sectional study. Collegian28(5): 515–520.
8.
CoyerFCookJLDoubrovskyA, et al. (2022) Exploring medical device-related pressure injuries in a single intensive care setting: a longitudinal point prevalence study. Intensive and Critical Care Nursing68: 103155.
9.
EllahiAStewartFKiddEA, et al. (2021) Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database of Systematic Reviews2021(6): 1–305.
10.
FumarolaSAllawayRCallaghanR, et al. (2020) Overlooked and underestimated: medical adhesive-related skin injuries. Journal of Wound Care29(Sup3c): S1–S24.
11.
GengVCobussen-BoekhorstHFarrellJ, et al. (2012). Catheterisation. Indwelling catheters in adults. Urethral and suprapubic. Evidence-based guidelines for best practice in urological health care. Arnhem, The Netherlands: European Association of Urology Nurses (EAUN).
12.
GilesMGrahamLBallJ, et al. (2019) Variations in indwelling urinary catheter use in four Australian acute care hospitals. Journal of Clinical Nursing28(23-24): 4572–4581.
13.
GouldCUmscheidCAgarwalR, et al. (2019) Guideline for prevention of catheter-associated urinary tract infections 2009.Atlanta, Georgia. Centers for Disease Control and Prevention (CDC).
14.
HarrisPATaylorRThielkeR, et al. (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics42(2): 377–381.
15.
HollingsworthJRogersMAKreinSL, et al. (2013) Determining the noninfectious complications of indwelling urethral catheters. Annals of Internal Medicine159(6): 401–410.
16.
HolroydS (2019) The importance of indwelling urinary catheter securement. British Journal of Nursing28(15): 976–977.
17.
LeuckA-MWrightDEllingsonL, et al. (2012) Complications of foley catheters—is infection the greatest risk?The Journal of Urology187(5): 1662–1666.
18.
LoENicolleLECoffinSE, et al. (2014) Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology35(5): 464–479.
19.
LovedayHPWilsonJAPrattRJ, et al. (2014) Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in england. Journal of Hospital Infection86: S1–S70.
20.
MeddingsJRogersMAMMacyM, et al. (2010) Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clinical Infectious Diseases51(5): 550–560.
21.
MeddingsJSkolarusTFowlerK, et al. (2019) Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method. BMJ Quality and Safety28(1): 56–66.
22.
MitchellBGFergusonJKAndersonM, et al. (2016) Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. Journal of Hospital Infection93(1): 92–99.
23.
National Health and Medical Research Council (NHMRC) (2019) Australian Guidelines for the Prevention and Control of Infection in Healthcare Canberra. 1–31. Available at: https://www.magicapp.org.
24.
OgrincGDaviesLGoodmanD, et al. (2016) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Quality and Safety25(12): 986–992.
25.
ÖztürkRMurtA (2020) Epidemiology of urological infections: a global burden. World Journal of Urology38(11): 2669–2679.
SaintSTrautnerBWFowlerKE, et al. (2018) A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Internal Medicine178(8): 1078–1085.
28.
ShenharCMansvetovMBanielJ, et al. (2020) Catheter-associated meatal pressure injury in hospitalized males. Neurourology and Urodynamics39(5): 1456–1463.
29.
SoKHabashyDDoyleB, et al. (2014) Indwelling urinary catheters: pattern of use in a public tertiary- level Australian hospital. Urologic Nursing34(2): 69–73.
30.
WoollerKRBackmanCGuptaS, et al. (2018) A pre and post intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center. BMC Health Services Research18(1): 642.
31.
WynneRPatelMPascualN, et al. (2014) A single centre point prevalence survey to determine prevalence of indwelling urinary catheter use and nurse-sensitive indicators for the prevention of infection. Healthcare Infection19(1): 13–19.
