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Can use of catheter alternatives decrease use of urinary catheters? Amy Lucas, MSN, RN, CCNS, CCRN-K - Clinical Nurse Specialist, Nursing Quality & Safety The purpose of this project was to reduce urinary catheter use at CRMH by providing appropriate products to manage urine in hospitalized patients. Reduction of catheter use should not only decrease risk of urinary tract infection, but also of other complications, such as meatal trauma and bacterial resistance or clostridioides difficile (formerly known as clostridium difficile) infection related to antibiotic overuse1. Literature Review CAUTI (catheter-associated urinary tract infection), the most common healthcare acquired infection in adults in acute care facilities, is associated with higher mortality and longer lengths of stay2. Recommendations to prevent CAUTI, commonly known as the ‘foley bundle’, are to: only place catheters for specific indications, remove them as soon as possible, and maintain them appropriately while in place1,3,4. No guidelines advocate inserting a urinary catheter solely to manage urinary incontinence or to measure output when another method can be used 3,4,5. Despite the recommendations and the evidence that reducing catheter days does reduce CAUTI 6, between 21-50% of urinary catheters may be placed for inappropriate reasons 7. The Association for Professionals in Infection Control and Epidemiology (APIC) 2014 guidelines list several factors that contribute to the delayed removal of catheters, including a lack of supplies to manage incontinence. Scott et al.8 considered this in a project to decrease urinary catheter placement in the Emergency Department (ED). They used focus groups to understand practice related to placing catheters and then created education, a decision support tool, and improved the availability of catheter alternatives for their staff. These interventions lead to fewer catheters being placed in their ED as well as an increase in the use of catheter alternatives. Interventions such as these can ultimately prevent CAUTI by reducing urinary catheter placements and decreasing catheter dwell times. IRB Determination The Carilion Clinic IRB determined that this study did not meet the regulatory definition of human subjects research as outline in the Department of Health and Human Services (DHHS) regulations. Methods and Procedures The project took place in several stages starting in late 2016. First, nursing and medical staff were surveyed about catheter alternatives and their perceived needs for other products. This survey indicated a need for better products for both men and for incontinent and immobile women. Next, products were found to fill these needs. The first products searched for based on the survey were a new device for incontinent women and a better version of male condom catheter. Later, as more needs were identified, a pouch for men who could not wear a condom catheter was also found. These products were piloted and implemented. Finally, champions were recruited from nursing units and educated about the new products, acceptable reasons for a urinary catheter, and current policy. They helped to advocate for and educate about the new products. The clinical nurse specialist also rounded in areas with catheters of long duration to identify opportunities for removal and further needs for different products. Outcome Measures and Data Collection The main outcome measure for this project was catheter use. This was monitored using Infection Control reports of catheter duration that included utilization ratio as well as catheter hours and
