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Meta-Analysis
. 2014 Apr;23(4):277-89.
doi: 10.1136/bmjqs-2012-001774. Epub 2013 Sep 27.

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

Jennifer Meddings  1 , Mary A M Rogers, Sarah L Krein, Mohamad G Fakih, Russell N Olmsted, Sanjay Saint
Affiliations
Free PMC article
Meta-Analysis

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

Jennifer Meddings et al. BMJ Qual Saf. 2014 Apr.
Free PMC article

Abstract

Background: Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use.

Methods: To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation.

Results: 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; p<0.001) but not in reminder studies (SMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs.

Conclusions: UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

Keywords: Health Services Research; Implementation Science; Infection Control; Patient Safety; Quality Improvement.

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Figures

Figure 1
Figure 1
Lifecycle of the urinary catheter. This conceptual model illustrates four stages of the urinary catheter lifecycle as targets for interventions to decrease catheter use and catheter-associated urinary tract infection.
Figure 2
Figure 2
Meta-analysis of rate ratios for catheter-associated urinary tract infection episodes per 1000 catheter days, for intervention versus control groups, stratified by type of intervention to prompt catheter removal.
Figure 3
Figure 3
Meta-analysis of risk ratios for percentage of patients who developed catheter-associated urinary tract infection, for intervention versus control groups, stratified by type of intervention to prompt catheter removal.
Figure 4
Figure 4
Meta-analysis of the standardised mean difference in days of urinary catheter use, for intervention versus control groups, stratified by type of intervention to prompt catheter removal.
See this image and copyright information in PMC

References

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