Assessing Urinary Catheter Management in Hong Kong Public Hospitals

Background:

Catheter-associated urinary tract infection is one of the most common healthcare-associated infections. US CDC revised the guidelines for prevention of CAUTI in 2009¹. The Centre for Health Protection, HK has promulgated local recommendations in 2010². Our aim is to explore the implementation of recommended practices in public hospitals in HK.

Objective:

To assess care practices of urinary drainage system so as to evaluate the compliance to recommendations.

 

To determine availability of alerts/reminders to identify catheterized patients to facilitate assessment of continued catheterization.  

Methods:

A stratified random sampling was applied for ward selection among 30 acute & convalescent hospitals. Observations were conducted on a single day for each hospital from July 1^st to September 30^th, 2010. All patients with urinary catheter in study wards on survey day were included. The followings were assessed:

Care of the catheter drainage system in terms of close drainage system, patency and position of drainage bag. Observations were focused on unobstructed urine flow, keeping catheter and collecting tube free from kinking; positioning of collection bag below level of the bladder without resting on the floor.

Whether alerts/reminders available to identify patients with urinary catheters.

Results:

Observations were conducted in 381 wards. Among 9,614 in-patients, a total of 1,109 (11.5%) patients with urinary catheters were observed:  1,102 (99.37%) patients with close urinary drainage systems , no kinking/obstruction in 1,091 (98.47 %) patients and drainage bag below level of bladder in 1,092 (98.38%) patients (Graph 1).

Non-compliance included outlets of drainage bag touching floor in 24 (2.16%) patients, drainage bags resting on floor in 4(0.36%) patients and overfilled drainage bags in 7(0.63%) patients. Outlet of drainage bags were opened on 2(0.18%) occasions during irrigation, which might introduce infection.

Among 381 study wards, 4 (1%) had bed-side signage identifying catheterized patients and 44 (11.5 %) had list of catheterized patients. Reminder list appeared in various forms, such as bed number in paper form, or on the notice-board at nursing station. Not all of them had patients' names as identifier. These kinds of reminders were designed for routine catheter care but not for assessing the need of continued catheterization. 

Conclusions:

This study provided an overview of the practices of catheter care in public hospitals in HK. We found excellent compliance on proper care of urinary drainage system. A more comprehensive survey should be conducted to explore current practices related to other areas of the recommendations.

Use of alerts/reminder system for catheterized patients should be encouraged in hospitals to enhance healthcare workers' daily assessment on indication of catheterization; thus ultimately reducing risk of CAUTI.