Advertisement

Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital

      Abstract

      Background

      An estimated 4 million patients per year in the United States are subjected to urinary catheterization. Approximately 25% of patients who are hospitalized have an indwelling urinary tract catheter placed at some time during their hospital stay and nosocomial urinary tract infections develop in 5% per day, with associated bacteremia in 4% of patients.

      Objective

      We sought to assess the prevalence and the appropriateness of the use of urinary catheters at a community teaching hospital in medical patients age 65 years and older.

      Methods

      We randomly selected 285 charts from a total of 2845 patients admitted during the year 2000 who were 65 years and older and had an indwelling urinary tract catheter inserted during the first 24 hours after admission. We excluded patients who had a urinary catheter placed before admission and patients admitted for operation.

      Results

      On chart review we found an appropriate indication for catheterization for 46% of these patients. A physician or nurse explicitly documented the reason for catheter placement in only 13%. No order for catheterization was written in 33% of the charts. Mean duration of catheter use was 3 days.

      Conclusions

      Less than half of urinary catheterizations in this teaching hospital were indicated and even fewer had an explicit indication recorded in the chart. Other investigators have had similar findings at other hospitals. Interventions are needed to decrease the inappropriate use of urinary catheters.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wong E.S
        Guideline for prevention of catheter-associated urinary tract infections.
        Am J Infect Control. 1983; 11: 28-36
        • Jarvis W.R
        Selected aspects of the socioeconomic impact of nosocomial infection: morbidity, mortality, cost and prevention.
        Infect Control Hosp Epidemiol. 1996; 17: 552-557
        • Karchmer T.B
        • Gianetta E.T
        • Muto C.A
        • Strain B.A
        • Farr B.M
        A randomized crossover study of silver coated urinary catheters in hospitalized patients.
        Arch Intern Med. 2000; 160: 3294-3298
        • Centers for Disease Control
        Public health focus: surveillance, prevention and control of nosocomial infections.
        MMWR Morb Mortal Wkly Rep. 1992; 41: 783-787
        • Stamm W.E
        Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention.
        Am J Med. 1991; 91: 655-671
        • Saint S
        Clinical and economic consequences of nosocomial catheter related bacteriuria.
        Am J Infect Control. 2000; 28: 68-75
        • Warren J.W
        Catheter associated urinary tract infections.
        in: Andriole V.T Infectious disease clinics of North America: urinary tract infections. WB Saunders Co, Philadelphia1995: 609-622
        • Slade N
        • Gillespie W.A
        Intermediate and long term catheter drainage. General principles of management in surgical, medical, geriatric, and neurological patients. Incontinence. The use of substitutes for catheter drainage.
        in: Kunin C.M The urinary tract and the catheter: infection and other problems. J Wiley and Sons, Chicester, Great Britain1985: 47-63
        • Kunin C.M
        Care of the urinary catheter.
        in: Slade N Gillespie W.A Detection, prevention and management of urinary tract infections. 4th ed. Lea and Febinger, Philadelphia1987: 245-297
        • Munasinghe R.L
        • Yazdani H
        • Siddique M
        • Hafeez W
        Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service.
        Infect Control Hosp Epidemiol. 2001; 22: 647-649
        • Prasoon J
        • Parada J.P
        • David A
        • Smith G.L
        Overuse of the indwelling urinary tract catheter in hospitalized medical patients.
        Arch Intern Med. 1995; 155: 1425-1429
        • Hartstein A.I
        • Garber S.B
        • Ward T.T
        • Jones S.R
        • Morthland V.H
        Nosocomial urinary tract infection: a prospective evaluation of 108 catheterized patients.
        Infect Control. 1981; 2: 380-386
        • Gardam M.A
        • Amihod B
        • Orenstein P
        • Consolacion N
        • Miller M.A
        Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections.
        Clin Performance Quality Health Care. 1998; 6: 99-102
        • Garibaldi R.A
        • Burke J.P
        • Dickman M.L
        • Smith C.B
        Factors predisposing to bacteriuria during indwelling urethral catheterization.
        N Engl J Med. 1974; 291: 215-219
        • King R.B
        • Carlson C.E
        • Mervine J
        • Wu Y
        • Yarkony G.M
        Clean and sterile intermittent catheterization methods in hospitalized patients with spinal cord injury.
        Arch Phys Med Rehabil. 1992; 73: 798-802
        • Zimakoff J
        • Stickler D.J
        • Pontoppidan B
        • Larsen S.O
        Bladder management and urinary tract infections in Danish hospitals, nursing homes and home care: a national prevalence study.
        Infect Control Hosp Epidemiol. 1996; 17: 215-221
        • Moseley C.B
        The impact of federal regulations on urethral catheterization in Virginia nursing homes.
        Am J Med Qual. 1996; 11: 222-226