title: Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes.
abstract: OBJECTIVE
  To evaluate the epidemiology and outcomes for initiation of inappropriate urinary catheterization (IUC) among hospitalized patients.
  
  
  METHODS
  A 450-bed, tertiary-care hospital.
  
  
  METHODS
  All patients admitted to the hospital from September 1, 2003 to June 12, 2004 with urinary catheter (UC). An independent observer reviewed the patient's chart, interviewed the patient and nursing staff, and assessed the need for the UC daily until the catheter was removed or the patient was discharged.
  
  
  RESULTS
  One hundred thirty-one (15%) of 895 patients had initiation of IUC. The median age was 61 (range, 15-92). Medicine (0.52 catheter utilization ratio), surgery (0.24 catheter utilization ratio) and the ICUs (0.32) had the most UC use. Main reasons for initial IUC included no clear indication (28%), inappropriate urine output monitoring (26%), and urinary incontinence (18%). Admission to the medical ICU (adjusted odds ratio [aOR]=2.3; P<0.001), nonambulatory functional status (aOR=2.1; P<0.001), and female sex (aOR=1.9; P=0.001) were independently associated with IUC. Catheter-associated urinary tract infections (CA-UTI) occurred in 129 patients (14%). Patients with IUC had a longer duration of catheterization (12 vs. 3 days; P<0.01) were more likely to develop CA-UTI (82% vs. 8%; P=0.001) and had prolonged hospital length of stay (median, 15 vs. 5 days; P<0.001). The mean monthly cost of antibiotics for treatment of CA-UTI was $3480 (range, $1874-$5584).
  
  
  CONCLUSIONS
  UC were inappropriately used more commonly among female, nonambulatory, and medical ICU patients. Careful attention to this aspect of medical care may reduce the incidence CA-UTI with subsequent decreases in length of stay, cost of hospitalization, and cost for treatment of CA-UTI.
authors.affiliation: Division of Infectious Diseases & Infection Control, Faculty of Medicine, Thamamsart University Hospital, Pratumthani, Thailand. anapisarn@yahoo.com
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Sasinuj
authors.initials: S
authors.lastname: Rutjanawech
authors.forename: Sanit
authors.initials: S
authors.lastname: Wichansawakun
authors.forename: Hataiwan
authors.initials: H
authors.lastname: Ratanabunjerdkul
authors.forename: Patarawin
authors.initials: P
authors.lastname: Patthranitima
authors.forename: Kanokporn
authors.initials: K
authors.lastname: Thongphubeth
authors.forename: Akeruetai
authors.initials: A
authors.lastname: Suwannakin
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013785:Thailand / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology