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American Journal of Critical Care. 2009;18: 535-541 doi:10.4037/ajcc2009938
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

By Ellen H. Elpern, MSN, APN, CCNS, Kathryn Killeen, MSN, APN, CCNS, Alice Ketchem, RN, MSN, Amanda Wiley, RN, MSN, CCRN, Gourang Patel, PharmD and Omar Lateef, DO. Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois.

Corresponding author: Ellen H. Elpern, 1725 W Harrison, Ste 054, Chicago, IL 60612 (e-mail: Ellen_H_Elpern{at}rush.edu)

Background Use of indwelling urinary catheters can lead to complications, most commonly catheter-associated urinary tract infections. Duration of catheterization is the major risk factor. These infections can result in sepsis, prolonged hospitalization, additional hospital costs, and mortality.

Objectives To implement and evaluate the efficacy of an intervention to reduce catheter-associated urinary tract infections in a medical intensive care unit by decreasing use of urinary catheters.

Methods Indications for continuing urinary catheterization with indwelling devices were developed by unit clinicians. For a 6-month intervention period, patients in a medical intensive care unit who had indwelling urinary catheters were evaluated daily by using criteria for appropriate catheter continuance. Recommendations were made to discontinue indwelling urinary catheters in patients who did not meet the criteria. Days of use of a urinary catheter and rates of catheter-associated urinary tract infections during the intervention were compared with those of the preceding 11 months.

Results During the study period, 337 patients had a total of 1432 days of urinary catheterization. With use of guidelines, duration of use was significantly reduced to a mean of 238.6 d/mo from the previous rate of 311.7 d/mo. The number of catheter-associated urinary tract infections per 1000 days of use was a mean of 4.7/mo before the intervention and zero during the 6-month intervention period.

Conclusions Implementation of an intervention to judge appropriateness of indwelling urinary catheters may result in significant reductions in duration of catheterization and occurrences of catheter-associated urinary tract infections.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Understand that catheter-associated urinary tract infections (CAUTIs) are among complications fundamentally linked to nursing care.
  2. Recognize that duration of catheterization is the major risk factor for CAUTIs.
  3. Describe how a nurse-based intervention can decrease CAUTIs.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Copyright © 2009 by the American Association of Critical-Care Nurses.