Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters.
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.
Huang
Wei-Chun
WC
Intensive Care Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
Wann
Shue-Ren
SR
Lin
Shoa-Lin
SL
Kunin
Calvin M
CM
Kung
Ming-Ho
MH
Lin
Chin-Hsun
CH
Hsu
Chien-Wei
CW
Liu
Chun-Peng
CP
Lee
Susan Shin-jung
SS
Liu
Yung-Ching
YC
Lai
Kwok-Hung
KH
Lin
Tzu-Wen
TW
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*
D000900:Anti-Bacterial Agents