Anesthesia Management: Reducing Unnecessary Urinary Catheter Use

Authors: Fakih MG et al., Ann Emerg Med 2014 Mar 20;

Guidelines and education reduce unnecessary catheterizations.

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection, with greater than 560,000 nosocomial cases annually. Investigators recently assessed the effects of an intervention designed to decrease CAUTI risk by reducing inappropriate urinary catheterization. The intervention, which involved establishing guidelines, appointing nurse and physician champions, and providing education, was implemented in the emergency departments (EDs) of 18 hospitals within a Catholic nonprofit healthcare system.

The researchers analyzed a sample of 13,215 patients with hospital admission following ED visits that occurred during a 2-week baseline period, the 2-week intervention period, or the 6 months immediately after the intervention. Catheterization rates during these periods were 9%, 6%, and 5%, respectively. Catheters were deemed appropriate in 74%, 91%, and 92% of placements.

Comment

Impressively, this program eliminated most inappropriate urinary catheterization episodes in a large network of emergency departments. Urinary catheters are appropriate in a limited number of circumstances (see CDC guidelines). In the emergency department setting, they are probably appropriate only in cases of urinary flow obstruction and in critically ill patients requiring accurate monitoring of urine output. Just being involved in a trauma and just having abdominal pain are not appropriate indications for catheter placement.