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A Review of Strategies to
Decrease the Duration of Indwelling
Urethral Catheters and Potentially
Reduce the Incidence of CatheterAssociated Urinary Tract Infections
Michael S. Bernard, Kathleen F. Hunter, and Katherine N. Moore
Research Summary
Introduction
Prevention of catheter-associated urinary tract infections
(CAUTIs) has become a major focus of health care providers,
accrediting agencies, and reimbursement sources.
Purpose
Evaluate current literature for research-based strategies
to decrease the length of time of catheter placement, the
effects of strategies on the duration and removal of catheters,
and the incidence of CAUTI.
Methods
A search of electronic databases using key words yielded 53 abstracts that were appraised. Only 9 research studies focused on reducing the duration of catheter use and
CAUTI incidence.
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Findings
The available evidence supports nurse-led or informatics-led interventions for reducing the length of catheterizations and incidence of CAUTI. However, no specific intervention was clearly superior than the others.
Conclusions
More evidence, particularly through randomized controlled trials, to determine the best method of ensuring timely removal of indwelling urinary catheters in all settings is
required.
Level of Evidence V
(Melnyk & Fineout-Overholt, 2011)
Methods
A search of the electronic
databases MEDLINE, CINAHL,
Cochrane Database, Google, and
Google Scholar was conducted.
Grey literature (abstracts from
conferences or presentations)
was also sought for the years
2000 to 2010 using Google
Scholar.
Search terms were indwelling urinary catheter*, Foley
catheter*, and urinary catheter*,
UTI, added UTI*, bacturia,
pyuria, CAUTI*, catheter acquired urinary tract infection,
acute care, acute-care, tertiary
care, tertiary-care, and hospitalized. Fifty-three abstracts were
appraised, and only research
studies that addressed acute-care
patients, the timely removal of
catheters (removal once no
longer indicated), and the outcome measures of duration of
indwelling urinary catheter and
incidence of CAUTIs were
included. Of the 53 abstracts
reviewed, 9 were relevant to the
research questions.
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Author/Year
Participants
All participants in the MICU
at an acute care hospital in
Chicago who had an
indwelling urinary catheter
during their unit stay were
included.
Three-month prospective
observational phase
followed by a three-month
prospective intervention
phase.
Quasi-experimental design.
11-month observational
period compared against a
6-month intervention period.
Quasi-experimental design.
Methods
Interventions
No significant reduction of
duration between pre- and
post-intervention periods
(p = 0.32).
Outcomes
Table 1.
Studies that Focused on the Duration of Catheter Use with Nursing-Led Interventions
Comments
Unnecessary, catheterization
was not clearly defined.
Duration of catheterization
decreased from 7.0 + 1.1
days to 4.6 + 0.7 days
(p < 0.001).
12-month retrospective
observational period through
chart review followed by a
12-month prospective
period.
Two-week needs
assessment followed by a
two-week prospective study.
Unnecessary catheterization
was not described.
Comments
Outcomes
Interventions
Participants
Methods
Author/Year
Table 1.
Studies that Focused on the Duration of Catheter Use with Nursing-Led Interventions (continued)
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Quasi-experimental
design.
by a 12-month
interventional period.
Interventions
Participants
A nurse-generated daily
reminder to physicians three
days after initiation of an
indwelling urinary catheter via
the computerized order-entry
system to remove catheters
that were no longer indicated.
Methods
Author/Year
Outcomes
No significant difference in
CAUTI rate between the two
groups (p = 0.71).
Table 2.
Informatics-Led Interventions: Computerized Reminders
Comments
A significant decrease in
CAUTI and reduction in
duration was found over an
extended period of time but
not initially.
The first part of the
intervention that utilizes the
computerized order-entry
system focuses on every
second day assessments
as opposed to daily
assessments.
Study completed in a
nonNorth American
setting, which may limit
generalizability to other
settings.
Comments
Outcomes
Interventions
Participants
Methods
Author/Year
Table 3.
Informatics-Led Interventions: Chart Reminders
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catheters in all settings. The current studies identify both nurseled and informatics-led interventions as successful in reducing
the length of catheterizations,
and subsequently, the incidence
of CAUTI. Research into the barriers of translating knowledge
about CAUTI into practice may
be important in application of
these interventions.
References
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