Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections.
OBJECTIVE
To assess the impact of the overutilization of indwelling urinary catheters in the emergency department on the development of nosocomial urinary tract infection.


METHODS
Prospective cohort study.


METHODS
638-bed tertiary-care hospital.


METHODS
118 consecutive medical and surgical admissions from the emergency department collected over 3 weeks.


METHODS
Catheterized patients were assessed. The completeness of documentation relating to catheter insertion and two outcomes were measured: asymptomatic bacteriuria and urinary tract infection.


RESULTS
24 (20.3%) had catheters inserted, of whom 12 (50%) were catheterized for justifiable indications. Positive urine cultures were found in 10 of the catheterized patients (42%), 5 of whom fulfilled the definition for catheter-associated urinary tract infection. Three of the five infections occurred in patients for whom catheterization was not justifiable. An order was written for catheter insertion in 62.5% of charts, while the rationale for catheterization was documented in 16.7%.


CONCLUSIONS
Many nosocomial urinary tract infections are due to the inappropriate placement of indwelling urinary catheters in the emergency department. The prevention of these infections should begin with restricting catheterization to those patients for whom it is appropriate.
Gardam
M A
MA
Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Québec, Canada.
Amihod
B
B
Orenstein
P
P
Consolacion
N
N
Miller
M A
MA
D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D006746:Hospital Bed Capacity, 500 and over; D006769:Hospitals, General; D006801:Humans; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology*