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In our many columns on CAUTI’s (catheter-associated urinary tract infections) there is one topic we have seldom discussed – reinsertion of urinary catheters. A recent study by researchers at Henry Ford Hospital (Jamil 2022) brought that issue to our attention.
While we have focused efforts on avoiding urinary catheters that don’t meet criteria, Jamil et al. point out that it is estimated 25%-45% of adult patients will have an indwelling urinary catheter inserted at some point during their hospitalization, with rates as high as 89% for patients within the ICU. And we’ve also focused efforts on prompt removal of those catheters once they no longer meet criteria for continued use. But what happens once we remove those catheters?
The researchers developed a post-catheter removal bladder management protocol referred to as the Urinary Catheter Alleviation Navigator Protocol (UCANP) and piloted this protocol on four units, a neuro-intensive care unit, 2 neurosurgical and/or neurologic step-down units, and a neurosurgical and/or neurologic general practice unit.
After implementation of the protocol, the reinsertion rate of 16% was compared to 21% and 27% in the pre-pilot cohort and another historical cohort, respectively. The mean number of catheter days was significantly lower during the protocol period (1.4 days) compared to the pre-pilot (5.6 days) and other historical (9.5 days) cohorts (P = .006). Rates of CAUTI’s were 0.6% during the pilot, compared to 1.2% in the pre-pilot cohort and 1.7% in the other historical cohort. Investigated in a larger patient population would be required to assess statistical significance regarding reduction in CAUTI’s.
Successful implementation of the protocol looks like it drew upon many of the success factors from the Michigan Keystone Project. All medical personnel (physicians, nurses, nursing assistants) were provided educational material and instructions on the outlined protocol. Comprehensive Unit-Based Safety Program (CUSP) principles were used and debriefings were held every 3 weeks by clinical leadership. The EMR was used for both order entry and tracking of patients, with reminders and instructions for nursing staff about next steps in the protocol.
We think this is an exciting study. If it results in reductions in catheter days of this magnitude in other populations and settings, we’d expect a significant reduction in CAUTI’s.
Our other columns on urinary catheter-associated UTI’s:
· May 8, 2007 Tip of the Week “Doctor, when do I get this red rubber hose removed?”
· January 8, 2008 Tip of the Week “Urinary Catheter-Associated Infections”
·
April 2008 What’s New in the Patient Safety
World column “More
on Nosocomial UTI’s”
· June 24, 2008 Tip of the Week “Urinary Catheter-Related UTI’s: Bladder Bundles”
· April 21, 2009 Tip of the Week “Still Futzing with Foleys?”
· June 9, 2009 Tip of the Week “CDC Update to the Guideline for Prevention of CAUTI”
· March 2010 “IDSA CAUTI Guidelines”
· February 2011 What’s New in the Patient Safety World column “Catheters Not Needed in C-Sections?”
·
January
2012 “CAUTI’s Still Get No Respect”
·
May 2012
“Foley Catheter Hazards”
·
November
2012 “CAUTI
Conundrum”
·
December
18, 2012 “Unintended Consequences of the CAUTI Measure?”
·
January
2013 “Silver-Coated Urinary Catheters Don’t Reduce
CAUTI’s”
·
June
2013 “Barriers to CAUTI Prevention”
·
November
2013 “Further Reducing Urinary Catheter Use”
·
June
2014 “Updated HAI Prevention Guidelines from
SHEA/IDSA”
·
June 30,
2015 “What Are Appropriate Indications for Urinary
Catheters?”
·
December
2015 “CAUTI
Prevention Tools”
·
July
2016 “Holy
Moly, My Patient has a FOLEY!”
·
December
2016 “The
Joint Commission NPSG for CAUTI’s”
·
April 3,
2018 “Cost
of a CAUTI”
·
September
25, 2018 “Foley
Follies”
·
April
30, 2019 “Reducing Unnecessary Urine
Cultures”
·
March 2,
2021 “Barriers to Timely Catheter
Removal”
References:
Jamil ML, Wurst H, Robinson P, et al. Urinary catheter alleviation navigator protocol (UCANP): Overview of protocol and review of initial experience. AJIC 2022; 50(1): 81-85
https://www.ajicjournal.org/article/S0196-6553(21)00459-4/fulltext
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