title: Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters.
abstract: OBJECTIVE
  Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion.
  
  
  METHODS
  A time-sequence nonrandomized intervention study.
  
  
  METHODS
  Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center.
  
  
  METHODS
  All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days).
  
  
  METHODS
  Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion.
  
  
  RESULTS
  The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 + 1.1 days to 4.6 +/- 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 +/- 3.1 to 8.3 +/- 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from 4021 dollars +/- 1800 dollars to 1220 dollars +/- 941 dollars; P = .004).
  
  
  CONCLUSIONS
  This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.
authors.affiliation: Intensive Care Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Huang
authors.forename: Shue-Ren
authors.initials: SR
authors.lastname: Wann
authors.forename: Shoa-Lin
authors.initials: SL
authors.lastname: Lin
authors.forename: Calvin M
authors.initials: CM
authors.lastname: Kunin
authors.forename: Ming-Ho
authors.initials: MH
authors.lastname: Kung
authors.forename: Chin-Hsun
authors.initials: CH
authors.lastname: Lin
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
authors.forename: Susan Shin-jung
authors.initials: SS
authors.lastname: Lee
authors.forename: Yung-Ching
authors.initials: YC
authors.lastname: Liu
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: Tzu-Wen
authors.initials: TW
authors.lastname: Lin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D020878:Device Removal / Q000451:nursing*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019555:Physician-Nurse Relations; D017010:Reminder Systems; D013624:Taiwan / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000451:nursing*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents