710. Indwelling Urinary Catheter Usage in the Emergency Department
Session: Poster Abstract Session: UTIs - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • 710_MeganRayman.pdf (973.5 kB)
  • Background: Indwelling urinary catheters (IUCs) are useful medical tools, yet can result in infections.  Minimizing catheter use is a key element in infection prevention; however, in the acute setting of the Emergency Department (ED), risks of catheters may be overlooked. The objective of this study was to determine the prevalence and appropriateness of IUC use in the ED of a tertiary care hospital with >50,000 ED visits per year.

    Methods: Catheter point prevalence was determined by bedside evaluation on 65 different days, 2009-2010.  To assess appropriateness of IUC placed in the ED, 79 chart reviews were conducted of patients evaluated at bedside and a random sample of 86 additional cases identified from billing data.  The definition of appropriate IUC use included critical illness (hemodynamic or respiratory instability, intensive care unit admission, urgent surgery, or major trauma), acute urinary retention or obstruction, or acute congestive heart failure in patients where it was not possible to measure urinary output by non-invasive means (e.g., urinal, bedpan). 

    Results: Of the 2,541 patients assessed at bedside, 3.1% had an IUC placed in the ED.  The analysis included 165 patients with IUC; 60% were female, 62% were ≥65 years old, and 70% had a physician’s order for catheter insertion. Sixty-two (38%) cases were considered inappropriate use of IUC; 66% were female and 66% were ≥65 years old. The predominant clinical association with inappropriate IUC was confusion (e.g., dementia, delirium) in 52%; another 16% were undergoing diuresis but non-invasive means to measure urine output likely could have been used; and in 15% a straight catheter could have been used to obtain urine samples or to assess post-void residuals. Most of the appropriate IUC were indicated for critical illness.

    Conclusion: IUCs were placed in a small subset of this ED population; however, by extrapolation, >500 inappropriate IUCs are placed per year in this ED. Analysis of inappropriate catheter use can guide interventions to minimize IUC use.  Educational messages should encourage avoidance of IUCs and promotion of incontinence care, especially for confused patients; and whenever possible, promotion of non-invasive means for measuring urine output or to rule-out urinary retention. 


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Megan Rayman, Penn State College of Medicine, Hershey, PA, Margaret Kreher, MD, Medicine, Penn State Hershey Medical Center, Hershey, PA, Louise Dobyns, RN, Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA and Kathleen G. Julian, MD, Medicine/Infectious Diseases, Penn State Hershey Medical Center, Hershey, PA

    Disclosures:

    M. Rayman, None

    M. Kreher, None

    L. Dobyns, None

    K. G. Julian, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.