Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection
Introduction
Urinary tract infection associated with indwelling urinary catheters remains a leading source of nosocomial infections.1, 2 Infections and other adverse effects associated with indwelling urinary catheters lead to increases in healthcare costs, patient discomfort, morbidity and even mortality.3, 4 Large prospective studies have identified a number of risk factors predictive of catheter-associated urinary tract infections (CAUTI) such as being female, duration of catheterization, microbial colonization of the drainage bag and disconnection of the catheter-collecting tube junction.5, 6 Several catheter-care practices are universally recommended to prevent CAUTI: avoidance of unnecessary catheterization based on the consideration of alternatives to urethral catheterization, aseptic insertion techniques, maintaining uncompromised closed drainage, keeping the collection tubing and bag below the level of the patient's bladder and the drainage tubing above the collection bag as well as minimizing manipulations of the drainage system.5 However, the most important, potentially modifiable, risk factor identified in every study is the prolonged catheterization.7, 8 The daily rate of acquisition of bacteriuria varies from 3 to 10%.9 Urinary catheters are often used and maintained inappropriately and physicians are often unaware that urinary catheterization has been excessively prolonged in their patients, with the devices often remaining in place until a catheter-related complication occurs.9, 10 These observations stress the importance of reducing the duration of catheterization as the most important clinical intervention that can be identified for prevention.11, 12 In our hospital, urinary infections are the most frequent type of nosocomial infection (33%), with about 80% of these cases being CAUTI.13 Concern about the high frequency of these urinary tract infections led us to introduce an enhanced programme of CAUTI control in our hospital. We report here the impact of this intervention on the duration of urinary catheterization and the frequency of CAUTI.
Section snippets
Clinical setting and study period
Besançon Hospital is a university-affiliated hospital with 1205 acute-care beds in 59 departments (35 medical departments, 21 surgical departments and three intensive care units). Approximately 50 000 admissions and 350 000 patient-days are recorded per year.
Five departments with high levels of urinary catheterization activity were selected for this study: neurosurgery, cardiovascular surgery, orthopaedic surgery, neurology and geriatrics. All patients hospitalized and undergoing non-chronic
Study population characteristics
The demographic characteristics of the study population are listed in Table I. There were no significant differences between the observational and intervention groups in terms of age and sex.
Duration of urinary catheterization and incidence of CAUTI
The duration of catheterization was 8.4 days in the observation period and 6.7 days in the intervention period but this difference was not significant (P = 0.14). The duration of catheterization decreased significantly in two departments (orthopaedic and cardiovascular surgery) and was stable in three others
Discussion
A simple intervention aimed at reducing the duration of catheterization may decrease the frequency of CAUTI and antibiotic use for CAUTI, even if the impact of the intervention is variable according to the type of unit. Indeed, we recommended the removal of unnecessary urinary catheters on the fourth day of catheterization because CAUTI incidence peaked on the sixth day of catheterization during the observational phase. It is likely that a continuous daily review from the time of insertion
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