207. Survey of Urinary Catheter Management Practices at an Academic Medical Center
Session: Poster Abstract Session: Catheter-associated UTIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Urinary Catheter Practices Survey Talbot IDWeek 2013.pdf (31.0 kB)
  • Background:  Catheter-associated urinary tract infections (CAUTIs) are often due to lapses in infection prevention practices. Following implementation of a CAUTI prevention program at an academic medical center, nursing and support personnel in adult and pediatric inpatient and emergency units were surveyed regarding urinary catheter (UC) management practices.

    Methods:  An online survey was distributed via email invitation from facility leadership to all inpatient nursing personnelDescriptive statistics were calculated.

    Results:   A total of 1800 personnel were sent the survey invitation, of which 891 (49.5%) responded.  Respondents were predominantly registered nurses (82.0%, 721/879 respondents to this survey question), with an additional 142 (16.2%) patient care technicians. These groups were the two roles predominantly noted as responsible for placing UCs (registered nurses, 64.9%, 515/793; patient care technicians, 28.4%, 225/793).  Most respondents worked on adult units (82.4%, 594/721), while 17.6% (127/721) worked on pediatric units.  

    Respondents noted that the closed catheter system may be opened for the following reasons:  irrigation (35.5% of respondents, 278/782), replacement of collection bag with a urometer (35.5%, 275/782), and replacement of urometer to a collection bag (10.1%, 79/782).  While 86.8% (686/790) of respondents reported the UC indication during change of shift report, only 42.2% (323/790) included this information during unit multidisciplinary rounds. Of respondents, 46.7% (307/658) agreed that the catheter discontinuation protocol was an effective tool to remove unnecessary UCs; however, 34.2% (225/658) were unaware that the protocol existed. Reported reasons why UCs remained in place even after discontinuation criteria had been met included a lack of a discontinuation order (51.9%, 390/751), patient comfort or convenience (39.1%, 294/751), patient refusal (28.9%, 217/751), and staff convenience (14.6% 110/751). 

    Conclusion:  Despite efforts at practice standardization, marked variability in UC maintenance practices were evident. Practices known to increase CAUTI risk, such as unnecessary opening of the closed system, were reported and provide targets for future improvement efforts.

    Thomas Talbot, MD, MPH, FIDSA, FSHEA1, Roger Dmochowski, MD2, Roxelyn Baumgartner, APN-BC2, James Johnson, MD MPH1, Joann Jones, RN MSN3, Tracy Mcgrane, MD MPH4, Jackie Smith, RN MSN3 and Barbara Martin, RN MBA5, (1)Medicine, Vanderbilt University School of Medicine, Nashville, TN, (2)Urology, Vanderbilt University School of Medicine, Nashville, TN, (3)Infection Control & Prevention, Vanderbilt University Medical Center, Nashville, TN, (4)Anesthesiology/Critical Care, Vanderbilt University School of Medicine, Nashville, TN, (5)Central for Clinical Improvement, Vanderbilt University Medical Center, Nashville, TN

    Disclosures:

    T. Talbot, Joint Commission Resources: Consultant, Consulting fee
    Community Health Systems: Consultant, Consulting fee

    R. Dmochowski, None

    R. Baumgartner, None

    J. Johnson, None

    J. Jones, None

    T. Mcgrane, None

    J. Smith, None

    B. Martin, 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.