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332 Use and Misuse of Indwelling Urinary Catheters at Two Cleveland, Ohio Teaching Hospitals

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Donald M. Dumford, MD , Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
Steven F. Greer, MD , Metrohealth Medical Center, Cleveland, OH
Ajay K. Sethi, PhD , University of Wisconsin-Madison, Madison, WI
Trina F. Zabarsky , Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
Michelle T. Hecker, MD , Metrohealth Medical Center, Cleveland, OH
Curtis J. Donskey, MD , Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH

Background:   Inappropriate use of indwelling urinary catheters is an important risk factor for catheter-associated urinary tract infection (CAUTI).  

Objective:   To evaluate patterns of appropriate and inappropriate indwelling urinary catheter use in 2 Cleveland teaching hospitals in order to identify specific wards and types of use that may be amenable to interventions.

Methods: A prospective cohort of patients with newly-inserted indwelling urinary catheters was studied at a Veterans Affairs hospital and a 650-bed university-affiliated hospital. Information on demographics, indication for catheterization, and ward location at time of insertion was obtained through review of medical records. Pre-determined criteria based on published guidelines were used to evaluate the appropriateness of initial catheter placement and the duration of catheterization.

Results: A total of 115 patients were studied. The table provides a summary of the results. Of 1,049 total catheter days, 501 (48%) were deemed to be inappropriate. Initial catheter placement was inappropriate in 19 of 115 patients (17%), resulting in 115 unnecessary catheter days (11% of all catheter days). Duration of catheterization was longer than necessary in 70 patients (61%), resulting in 386 catheter days (37% of all catheter days). Urine output monitoring was the most common indication for catheter use (31% of all catheters and 38.8% of all catheter days), and accounted for a majority of the inappropriate catheter days (172 of 501 inappropriate catheter days). The Emergency Department and Medical-Surgical wards were the most common sites of catheter insertion.

Conclusions: Inappropriate use of indwelling urinary catheters is very common in the 2 study hospitals. Future interventions should include efforts to limit inappropriate use of indwelling catheters for urine output monitoring and to ensure that the Emergency Departments and Medical-Surgical wards receive education regarding appropriate indications for catheter insertion.