291. How Good Are Medical and Surgical Residents at Addressing Urinary Catheter Risk? A Survey of 2 Large Teaching Hospitals
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Fakih Urinary catheter risk poster ID week.pdf (7.0 MB)
  • Background: Catheter-associated urinary tract infections (CAUTI) are common preventable conditions. Resident physicians (RPs) play an important role in caring for patients with urinary catheters; improving their knowledge and practice will help lower the risk to patients.

    Methods: We surveyed Medicine and Surgery RPs at 2 large teaching hospitals (A and B). Questions addressed indications for urinary catheter use, training on placement, and RP views regarding risk mitigation.

     Results: 149/295 (50.5%) RPs completed the survey. 102/145 (70.3%) of RPs considered themselves knowledgeable of the indications for urinary catheter placement, and a majority answered the questions correctly (Table).  More RPs from hospital A reported formal training in placement and maintenance (48/66; 72.7%) compared to hospital B (37/75; 49.3%; p=0.006). Medical RPs rarely placed catheters (43/103; 41.7% never placed), compared to 81.6% (31/38) of surgical RPs reporting placing >14 urinary catheters over last year. RPs reported their preferred method to reduce unnecessary catheter use is by nurse driven evaluation and calling the physician for a discontinuation order (42/141; 29.8%), each physician daily evaluating catheter need (20.6%), and emergency department evaluation and avoiding catheter initial placement (13.5%). Less common was their 1st preference for electronic reminder to physicians (10.6%), evaluation for continued need at transfer from intensive care (10.6%), algorithm based nursing discontinuation without physician order (9.9%), and electronic reminder to nurses (5%). Only 39/138 (28.3%) reported daily evaluating patients for urinary catheter necessity >90% of the time. The majority viewed CAUTI as the most important harm related to the catheter (99/138; 71.7%), while non-infectious harms were uncommonly considered (trauma to urethra 13.8%; immobility 9.4%; patient discomfort 2.9%; risk for falls 2.2%).

    Conclusion: RPs may benefit from more structured education regarding the indications for urinary catheter use and risk avoidance. Moreover, promoting accountability at the RP level to daily evaluate urinary catheter risk and necessity may lead to a reduction in inappropriate use, thus less complications.

    Mohamad G. Fakih, MD, MPH, FIDSA, FSHEA1, Ana C. Bardossy, MD2, Takiah Williams, BSN, RN3, Katherine Reyes, MD, MPH4, Marcus Zervos, MD, FIDSA4, Steven Minnick, MD, MBA5, Raymond Hilu, MD6, Elango Edhayan, MD7, Mina El-Kateb, MD8, Susan Szpunar, PhD9, Karen Jones, RN, BSN10 and Louis Saravolatz, MD, FIDSA11, (1)Infection Prevention and Control, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, (2)Infectious Diseases, Henry Ford Health System, Detroit, MI, (3)Infection Prevention and Control, St John Hospital & Medical Center, Grosse Pointe Woods, MI, (4)Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, (5)Medical Education, St John Hospital and Medical Center, Grosse Pointe Woods, MI, (6)Internal Medicine, St John Hospital and Medical Center, Grosse Pointe Woods, MI, (7)Surgery, St John Hospital and Medical Center, Detroit, MI, (8)Internal Medicine, St John Hospital & Medical Center, Detroit, MI, (9)Graduate Medical Education, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (10)Infection Prevention, St John Hospital & Medical Center, Grosse Pointe Woods, MI, (11)Internal Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI

    Disclosures:

    M. G. Fakih, Agency for Healthcare Research and Quality: Research Contractor , Research grant

    A. C. Bardossy, None

    T. Williams, None

    K. Reyes, None

    M. Zervos, None

    S. Minnick, None

    R. Hilu, None

    E. Edhayan, None

    M. El-Kateb, None

    S. Szpunar, None

    K. Jones, None

    L. Saravolatz, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.