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Urinary catheter policies in home healthcare agencies and hospital transfers due to urinary tract infection

Published:December 06, 2021DOI:https://doi.org/10.1016/j.ajic.2021.11.027

      Highlights

      • We evaluated home health care agency urinary catheter policies and rates of Urinary tract infections (UTI).
      • Home health patients with urinary catheters had frequent hospital transfers for UTI.
      • Urinary catheter policies were negatively associated with hospital transfer for UTI.

      Abstract

      Background

      Urinary tract infections (UTIs) are a frequent cause of hospital transfer for home healthcare (HHC) patients, particularly among patients with urinary catheters.

      Methods

      We conducted a cross-sectional, nationally representative HHC agency-level survey (2018-2019) and combined it with patient-level data from the Outcome and Assessment Information Set (OASIS) and Medicare inpatient data (2016-2018) to evaluate the association between HHC agencies’ urinary catheter policies and hospital transfers due to UTI. Our sample included 28,205 patients with urinary catheters who received HHC from 473 Medicare-certified agencies between 2016-2018. Our survey assessed whether agencies had written policies in place for (1) replacement of indwelling catheters at fixed intervals, and (2) emptying the drainage bag. We used adjusted logistic regression to estimate the association of these policies with probability of hospital transfer due to UTI during a 60-day HHC episode.

      Results

      Probability of hospital transfer due to UTI during a HHC episode ranged from 5.62% among agencies with neither urinary catheter policy to 4.43% among agencies with both policies. Relative to agencies with neither policy, having both policies was associated with 21% lower probability of hospital transfer due to UTI (P < .05).

      Conclusion

      Our findings suggest implementation of policies in HHC to promote best practices for care of patients with urinary catheters may be an effective strategy to prevent hospital transfers due to UTI.

      Key Words

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