Education reduces inappropriate urinary catheter use
MedWire News: Educating clinicians about the appropriate indications for indwelling urinary catheters significantly reduces unnecessary and inappropriate use within hospital settings for at least 2 years, researchers have found.
Best practice guidelines recommend both limiting the number of patients who receive a urinary catheter and promptly removing the device when it is no longer indicated in order to reduce the risk for catheter-associated urinary tract infection (CAUTI).
However, indwelling urinary catheters are still often used in hospital settings without appropriate indication, with CAUTI representing the majority of hospital-acquired UTIs.
Sanjay Saint (University of Michigan, Ann Arbor, USA) and colleagues performed a retrospective analysis of data collected from 163 inpatient units in 71 participating state hospitals following implementation of an educational intervention promoting adherence to appropriate urinary catheter indications during 2007 to 2010.
Using multiple webinars, clinicians were educated about the appropriate indications for urinary catheter use, infectious and noninfectious risks, and common situations where catheters are used inappropriately.
The intervention included efforts to reinforce appropriate use and discontinuation through unit-based rounds, and to teach the proper insertion technique and maintenance of the urinary catheter.
In addition, collaboration between sites to share best practices and barriers was promoted, and audit and feedback of catheter-use data were used as a framework for group learning and improvement of the intervention.
The researchers found that the average urinary catheter use rate decreased significantly from 18.1% at baseline to 17.2%, 15.9%, and 14.8% by the second, seventh, and 19th week of the intervention, respectively.
Furthermore, the proportion of appropriately indicated catheter days increased significantly from 44.3% at baseline to 46.8% by the second week, representing an 11% increase the odds of appropriately indicated catheter use. By the seventh and 19th week of the intervention, this proportion further increased to 50.4% and 53.5%.
Two years following implementation of the intervention, the catheter use rate was 13.8% and the appropriate catheterization rate increased to 57.6%, corresponding to a 28% reduction in the likelihood of catheter use and a 71% increase in the odds of appropriate placement, compared with baseline.
Writing in the Archives of Internal Medicine, the researchers conclude: "Our results indicate that hospitals can improve appropriate urinary catheter use and that such efforts can be successfully implemented on a broad scale. Our findings may help motivate and guide other hospitals to undergo similar intervention programs to reduce inappropriate catheter use, and collectively achieve the Department of Health and Human Services goal of reducing CAUTI rates by 25% by 2013."
In an associated editorial, Michelle Mourad (University of California, San Francisco, USA) said: "The challenge that lies ahead is in learning from this early work to more uniformly implement and sustain the bladder bundle across organizations amidst shifting resources and changing priorities.
"Examining the variability in implementation and sustainability of the bladder bundle may be the key to ensuring broader success in the future and to creating a safer healthcare environment."
By Ingrid Grasmo