Decreasing Inappropriate Urinary Catheter Use in Hospitals

Urinary tract infections represent a large portion of all hospital-acquired infections, with catheter-associated urinary tract infection (CAUTI) accounting for the majority of cases. Results of a retrospective analysis from 163 inpatient units in 71 participating Michigan hospitals found that reducing inappropriate urinary catheter use was associated with a considerable reduction in catheter use and improved compliance with appropriate use. The effect of the statewide intervention was sustained for almost 2 years [Arch Intern Med. 2012;172(3):255-260].

In 2007, the Michigan Health and Hospital Association (MHA) Keystone Center implemented a statewide intervention program to reduce the unnecessary use of urinary catheters in the state’s hospitals. The initiative was based on the success of a pilot intervention program at 1 Michigan hospital that saw a 45% reduction in inappropriate catheter use. The objective of the current study was to evaluate the effect of the statewide initiative on urinary catheter use and to assess multiyear sustainability.

The researchers conducted a retrospective review of the MHA data collected as part of the CAUTI prevention initiative from 2007 to 2010. All participating hospitals created a team to implement the process. The team included a nursing and physician champion, an infection preventionist, and other stakeholders. Webinars were given to the participating hospitals that addressed the proper insertion technique, maintenance of the urinary catheter, and a detailed description of how to implement the process at each facility. The primary end points were change in prevalence of urinary catheter use and adherence to appropriate indications.

A total of 194,162 patient-days of data were collected from the hospitals. Urinary catheters were used for 29,990 patient-days across the study period. The results showed the average urinary catheter use rate decreased from 18.1% (95% confidence interval [CI], 16.8%-19.6%) at baseline to 17.2% (95% CI, 16.0%-18.4%; P=.01) at week 3 (the second week of the intervention), representing a statistically significant 6% decrease in the odds of catheter use. The rate continued to decrease at weeks 8 and 20 (15.9%; 95% CI, 14.7%-17.2%; P<.001 and 14.8%; 95% CI, 13.6%-16.0%; P<.001, respectively).

The rate of appropriate catheter use increased from 44.3% (95% CI, 40.3%-48.4%) at baseline to 46.8% (95% CI, 42.6%-51.0%; P<.001) at week 3, representing an 11% increase in the odds of appropriately indicated catheter use. By weeks 8 and 20, the rate increased to 50.4% (95% CI, 45.4%-55.4%; P<.001) and 53.5% (95% CI, 48.7%-58.4%; P<.001), respectively.

After 2 years, the catheter use rate was 13.8% (95% CI, 12.9%-14.8%; P<.001), and appropriate catheterization increased to 57.6% (95% CI, 51.7%-63.4%; P=.005).

Appropriate indications for catheter use include urinary tract obstruction, neurogenic bladder dysfunction and urinary retention, and end-of-life care. Along with reducing infection risk, promoting proper catheter use can lead to fewer noninfection complications, such as urethral injury. Furthermore, patients might experience less discomfort and be free of the restraints associated with the catheter.

The results indicated that educational interventions and promoting urinary catheter awareness can help reduce improper catheterization, and such efforts can be successfully implemented on a broad scale.