title: Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts.
abstract: To describe the epidemiology of indwelling urinary catheter use in nursing homes (NHs).
  
  
  
  Observational cohort study.
  
  
  
  A purposeful sampling strategy was used to identify a diverse sample of 28 Connecticut NHs, defined in terms of ownership, quality ratings, and bed size.
  
  
  
  Long-stay (>100 days) residents of study NHs with an indwelling urinary catheter present at any time over a 1-year period.
  
  
  
  Duration of catheter use was determined, and indications for catheter placement were documented. Indications considered appropriate included urinary retention or outlet obstruction, pressure ulcer (Stage 3 or 4 with risk of contamination by urine), hospice care, and need for accurate measurement of input and output. During quarterly follow-up assessments, whether the catheter was still in place or had been removed for any reason other than routine maintenance was determined.
  
  
  
  The overall rate of any urinary catheter use per 100 resident-beds over a 1-year period was 4.8 (range 1.0-9.9, median 5.1). Of the 228 residents meeting eligibility criteria, a documented indication for the catheter was present in the NH record for 195 (86%). Of those with a documented indication, 99% (n = 193) had one or more indications deemed appropriate, including urinary retention (83%), pressure ulcer (21%), hospice care (10%), and need for accurate measurement of input and output (6%). The urinary catheter was removed at some point during the period of observation in 49% (n = 111) of participants; those with a shorter duration of catheter use before study enrollment were more likely to have the catheter removed during the follow-up period. Of the 111 residents who had the catheter removed, 58 (52.3%) had it reinserted at some point during follow-up.
  
  
  
  These findings suggest that indwelling urinary catheter use in long-stay NH residents is uncommon and generally appropriate and that efforts to improve catheter care and outcomes should extend beyond a singular focus on reducing use.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.|Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.|Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Catherine
authors.initials: C
authors.lastname: DuBeau
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.|Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mazor
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.|Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Meera
authors.initials: M
authors.lastname: Sreedhara
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.
authors.forename: Celeste
authors.initials: C
authors.lastname: Lemay
authors.affiliation: Qualidigm, Wethersfield, Connecticut.
authors.forename: Ann
authors.initials: A
authors.lastname: Spenard
authors.affiliation: Qualidigm, Wethersfield, Connecticut.
authors.forename: Michelle
authors.initials: M
authors.lastname: Pandolfi
authors.affiliation: Qualidigm, Wethersfield, Connecticut.
authors.forename: Florence
authors.initials: F
authors.lastname: Johnson
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.|Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Terry
authors.initials: T
authors.lastname: Field
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data; D015331:Cohort Studies; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D020878:Device Removal / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000379:methods; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D058996:Quality Improvement; D014481:United States; D014524:Urethral Obstruction / Q000628:therapy*; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods; D062885:Urinary Catheters / Q000009:adverse effects / Q000706:statistics & numerical data; D016055:Urinary Retention / Q000628:therapy*; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control
keywords: 
  CAUTI
  ; healthcare-associated infections; nursing home; urinary catheter