Urethral catheters: can we reduce use?

BMC Urology

Research Article

Jan C Wille¹  Pieter J van den Broek²  Birgit HB van Benthem³  Rom JM Perenboom⁴  M Elske van den Akker-van Marle⁵  Barbara S Niël-Weise⁶ 

[1] Dutch Institute for Healthcare Improvement, Utrecht, The Netherlands;Leiden University Medical Centre, Department of Infectious Diseases, Leiden, The Netherlands;National Institute for Public Health and the Environment. Centre for Infectious Disease Control, Bilthoven, The Netherlands;TNO Quality of Life. Department Innovation in Healthcare, Leiden, The Netherlands;TNO Quality of Life. Department Innovation in Healthcare, Leiden, The Netherlands;Leiden University Medical Centre, Department of Medical Decision Making, Leiden, The Netherlands;Working Party Infection Prevention, Leiden, The Netherlands;

关键词: Catheter;    Urinary Tract Infection;    Urinary Catheter;    Bacteriuria;    Coronary Care Unit;   

DOI  :  10.1186/1471-2490-11-10

 received in 2010-08-30, accepted in 2011-05-23,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIndwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.MethodsThe efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated.ResultsOf a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537.ConclusionTargeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or where catheterization is prolonged, can expect important improvements.

【 授权许可】

CC BY   
© van den Broek et al; licensee BioMed Central Ltd. 2011