A review of multiple international studies suggests that hospitals can cut their catheter-associated urinary tract infections by 52% by implementing simple systems that trigger staff to regularly check the patient still needs one.
"Interventions to routinely prompt physicians or nurses to remove unnecessary urinary catheters significantly decrease the rate of CA UTIs, and no evidence indicates that these interventions increase the need for re-catheterization," wrote the researchers, affiliated with the University of Michigan and Ann Arbor VA Medical Center.
The report is published in the September issue of the journal Clinical Infectious Diseases.
"Many of the studies suggested that physicians simply forget to look for the catheter, or they forget to reassess," said Jennifer Meddings, MD, lead author of the report and a researcher and lecturer at the University of Michigan Department of Internal Medicine.
In an interview, Meddings said that only one in 10 U.S. hospitals is using such reminder systems. "Physicians simply forget to look for a catheter, and they also forget to reassess (whether the patient still needs one)" Meddings said. "Catheters then stay in for days when they are no longer necessary, and every day that they stay in, the risk of infection is increased."
Her report also notes that catheters "often are placed unnecessarily, remain in use without physician awareness and are not removed promptly when no longer needed.
"Catheters also cause discomfort, restrict mobility and delay hospital discharges. Interventions that prompt removal of unnecessary catheters may therefore enhance patient safety."
Removing them is not always a simple process. "In most hospitals, four key steps are required in the lifecycle of the urinary catheter before removal from the patient:
- The physician recognizes that a urinary catheter is present
- The physician recognizes that the catheter is unnecessary
- The physician writes the order for catheter removal
- The nurse removes the catheter in response to the order.
The researchers suggest that systems that seem to work elsewhere involve programs that impose an automatic reminder either on the electronic medical record or through some other mechanism, requiring a physician, physician's assistant or registered nurse to check daily on whether the catheter is still required.
Also effective are "stop orders," in which the order for a catheter expires in the same fashion as an order for restraints in a patient with behavioral issues or antibiotics in a patient with an infection.
"Stop orders directed at physicians required an order to renew or discontinue the catheter on the basis of review at specific intervals, such as every 24 to 72 hours or on specific post-procedure days," the report said. Stop orders directed at nurses might empower nurses to remove the catheter on the basis of indications without requiring the nurse to first obtain a physician-signed order.
"Overall, decreased catheter use was reported in all 11 studies publishing at least one outcome of catheter use, with 8 studies revealing a statistically significant decrease between non-intervention groups and the first post-intervention measure."
The authors wrote that they "hope that our results will encourage more hospitals to adopt reminders or stop orders as low-cost interventions that enhance patient safety."