Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
BACKGROUND
Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use.


METHODS
To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation.


RESULTS
30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; p<0.001) but not in reminder studies (SMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs.


CONCLUSIONS
UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.
Department of Internal Medicine, University of Michigan Medical School, , Ann Arbor, Michigan, USA.
Jennifer
J
Meddings
Mary A M
MA
Rogers
Sarah L
SL
Krein
Mohamad G
MG
Fakih
Russell N
RN
Olmsted
Sanjay
S
Saint
D055499:Catheter-Related Infections / Q000517:prevention & control*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D058996:Quality Improvement; D017010:Reminder Systems; D019564:Unnecessary Procedures / Q000009:adverse effects*; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*
Health Services Research; Implementation Science; Infection Control; Patient Safety; Quality Improvement