1073. Improving Urinary Catheter Use: a Pilot of 18 Emergency Departments
Session: Poster Abstract Session: Surveillance of HAIs: Evaluating National Strategy
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • ED UC Intervention ID week 2013.pdf (466.2 kB)
  • Background: Urinary catheters (UCs) are frequently used in the hospital setting and are associated with infectious and non-infectious complications. Avoiding placement of unnecessary UCs in the emergency department (ED) may significantly decrease the risk of patient exposure during hospitalization.

    Methods: 18 ED units implemented institutional guidelines for UC placement and identified each physician and nurse champions to lead the work. The pre-post quasi-experimental design included baseline (7 days), intervention (14 days), and sustainability (1 day a month for 6 months) for UC use, indications for use, and presence of physician order. Changes were evaluated comparing the 3 periods.

    Results: 13215 patients admitted through the ED were evaluated during the 3 periods, with 889 (6.7%) having a catheter placed. Catheter placement dropped from 309/3381 (9.1%) baseline, to 423/6896 (6.1%) intervention, and 157/2938 (5.3%) sustainability periods (p<0.001). Indications deemed appropriate improved from 226/309 (73.1%) baseline, to 384/423 (90.8%) intervention, and 144/157 (91.7%) sustainability periods (p<0.001). Physician order documentation in the presence of the urinary catheter was 785/885 (88.7%) and did not significantly change over the 3 periods. Improvements were noted for different size hospitals, and were more pronounced for hospitals with higher placement baseline (Table).

    Conclusion: The implementation of institutional guidelines for UC placement in the ED, coupled with the support of clearly identified physician and nurse champions, are associated with a reduction in unnecessary UC placement. The effort has a substantial potential of reducing patient harm hospital wide.

    Table: Emergency department urinary catheter placement during the 3 periods of the study

    Baseline (%)

    Intervention (%)

    Sustainability (%)

    P value

    All 18 emergency departments

    309/3381 (9.1)

    423/6896 (6.1)

    157/2938 (5.3)


    Hospital size

    Large (>500 beds, n=5)

    97/1167 (8.3)

    130/2344 (5.5)

    50 (4.2)


    Medium (201-500 beds, n=8)

    179/1903 (9.4)

    257/3819 (6.7)

    88/1467  (6.0)


    Small (up to 200 beds, n=5)

    33/311 (10.6)

    36/733 (4.9)

    19/279 (6.8)


    Baseline urinary catheter use

    Baseline <10% (n=10)


    198/4198 (4.7)

    91/1791 (5.1)


    Baseline 10% or more (n=8)

    169/1333 (12.7)

    225/2698 (8.3)

    66/1147 (5.8)


    Mohamad Fakih, MD, MPH1, Michelle Heavens, BSN, MHA2, Julie Grotemeyer, BS2, Clariecia Groves, M.S.2 and Ascension Health Emergency Department Group to Reduce Catheter-Associated Urinary Tract Infection, (1)Infection Prevention and Control, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (2)Clinical Excellence, Ascension Health, St Louis, MO


    M. Fakih, None

    M. Heavens, None

    J. Grotemeyer, None

    C. Groves, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.