Can In-Hospital Urinary Catheterization Rates Be Reduced?
Can In-Hospital Urinary Catheterization Rates Be Reduced?
Urinary catheterization has risks and its use should be limited because it is the main cause of healthcare-associated urinary tract infection. Other risks are the potential for urethral injuries and the possibility that the catheter will be left in permanently. Rates of urinary catheterization in internal medicine departments generally range from 8% to 20%, with higher rates in older adult patients. Various attempts have been made to decrease catheterization rates with variable success. A major problem is that the guidelines and criteria for urinary catheterization are inconsistent and open to variable interpretations. More restrictive criteria based on observable patient benefit can reduce rates of urinary catheterization and may improve patient care.
Urinary catheterization has risks and its use should be limited because it is the main cause of healthcare-associated urinary tract infection. Other risks are the potential for urethral injuries and the possibility that the catheter will be left permanently in the body.
In certain clinical situations, catheterization can improve patient care, but broad definitions of appropriate use lead to variable interpretations (Table 1). For example, catheterizations in patients hospitalized for palliative care in general do not include any statement about patient preference or the reason for use.4,7–9 For patients requiring urine volume measurements, there are some but not universally clarifying statements that catheterization is acceptable only in patients who require continuous, accurate urine volume measurements or for whom it is not possible to collect urine. One study included as an acceptable indication aggressive treatment with diuretic medications or fluids. Urinary retention is generally an acceptable indication without any qualifiers. Another study included such acceptable indications as unresponsiveness, severe hypoxia, the need for administration of ≥6 L/min of oxygen, or intubation.
Estimations of inappropriate catheterization rates vary from 11% to 71.4%, but these are highly dependent on the criteria used. In one study, adding restrictions to broadly defined criteria increased inappropriate catheterization rates from 14.8% to 71.4%.
Abstract and Introduction
Abstract
Urinary catheterization has risks and its use should be limited because it is the main cause of healthcare-associated urinary tract infection. Other risks are the potential for urethral injuries and the possibility that the catheter will be left in permanently. Rates of urinary catheterization in internal medicine departments generally range from 8% to 20%, with higher rates in older adult patients. Various attempts have been made to decrease catheterization rates with variable success. A major problem is that the guidelines and criteria for urinary catheterization are inconsistent and open to variable interpretations. More restrictive criteria based on observable patient benefit can reduce rates of urinary catheterization and may improve patient care.
Introduction
Urinary catheterization has risks and its use should be limited because it is the main cause of healthcare-associated urinary tract infection. Other risks are the potential for urethral injuries and the possibility that the catheter will be left permanently in the body.
In certain clinical situations, catheterization can improve patient care, but broad definitions of appropriate use lead to variable interpretations (Table 1). For example, catheterizations in patients hospitalized for palliative care in general do not include any statement about patient preference or the reason for use.4,7–9 For patients requiring urine volume measurements, there are some but not universally clarifying statements that catheterization is acceptable only in patients who require continuous, accurate urine volume measurements or for whom it is not possible to collect urine. One study included as an acceptable indication aggressive treatment with diuretic medications or fluids. Urinary retention is generally an acceptable indication without any qualifiers. Another study included such acceptable indications as unresponsiveness, severe hypoxia, the need for administration of ≥6 L/min of oxygen, or intubation.
Estimations of inappropriate catheterization rates vary from 11% to 71.4%, but these are highly dependent on the criteria used. In one study, adding restrictions to broadly defined criteria increased inappropriate catheterization rates from 14.8% to 71.4%.