![[ Visit SHEA online ]](images/banner.gif)
Background: Although indwelling urethra catheterization is a medical intervention with well-defined risks such as catheter-associated urinary tract infection (CA-UTI), it is often placed without a specific medical indication.
Objective: To describe the prevalence of indwelling urethra catheters in the Netherlands and to determine which factors are associated with an inappropriate use of these catheters in hospitalized patients.
Methods: In 26 Dutch hospitals, prevalence surveys among in-patients were performed at three moments in 2009 and 2010. Information on demographics, catheter use, indication for catheterization at the time of initial placement and at the time of the prevalence survey, and UTI were collected at the hospitals wards. Pre-determined criteria, based on published guidelines with revision by a multidisciplinary expert team, were used to make the distinction between appropriate or inappropriate indication for catheterization. We deemed inappropriate indication for catheterization as inappropriate catheter use. Logistic regression was used to identify factors associated with the inappropriate use of indwelling urethra catheters.
Results: A total of 12049 patients were included, of which 2575 (21.4%) had an indwelling urethra catheter placed (range hospitals 15.0-27.3). Of these 2575 patients, 79 had a symptomatic UTI, of which 74 was catheter-related. Indication at the time of placement of an indwelling urethra catheter and at the time of the prevalence survey could not be defined in 128 and 151 patients, respectively. Initial catheter placement was inappropriate in 135 of 2447 patients (5.5%), and 193 of 2424 patient (8.0%) had an inappropriate indication at the day of the survey. Urinary incontinence without open sacral or perineal wounds was one of the most common inappropriate indications for both placement (36.3%) and catheterization at the time of the survey (28.0%). In multivariate analyses, inappropriate catheter use at the time of placement was independent associated with female sex, older age, admission on a non intensive care ward, and not having had surgery (table 1). Inappropriate catheter use at the time of survey showed comparable associated factors.
Conclusions: Inappropriate indwelling urethra catheter use is common in hospitalized patients. Females, older patients and those not having surgery are at high risk for catheterization without a specific medical indication. To reduce the inappropriate use of indwelling urethra catheters, education and awareness campaign about appropriate indications for indwelling urethra catheters should be available, especially for the medical workers on the non intensive care wards. Moreover, recommended components of care (bundle for UTI) should be introduced for all patients with an urethra catheter aimed at reducing catheter-related complications.
