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ABSTRACT
This study examined the incidence and duration of urinary catheters in acute care older adults before and after the implementation of a protocol developed to make clinicians aware of the appropriate use of catheters and the parameters for catheter removal. A total of 187 patients (99 pre-intervention, 88 post-intervention) age 65 and older admitted to a community hospital were assessed for the insertion of an indwelling urinary catheter using retrospective record review. A significant reduction was found in the incidence of indwelling urinary catheters in the post-intervention sample (from 33% to 15.3%, p = 0.006). There was a 20.4% reduction in the mean duration of urinary catheterization (from 4.9 days to 3.9 days). The catheter device-days were significantly reduced (from 136 to 44, p < 0.000). This study supports the use of a nurse-driven protocol to reduce the incidence of catheterization and improve the quality of care for hospitalized older adults.
Hospitalized older adults are often at risk for complications from having indwelling catheters placed in their urinary tracts. Approximately 15% to 25% of hospitalized patients receive indwelling urinary catheters for specific clinical indications, such as the need to accurately monitor urine output or treat urinary retention (Gokula, Hickner, & Smith, 2004). However, this procedure is associated with significant morbidity for hospitalized older adults (Griffiths, Fernandez, & Murie, 2004).
Urinary tract infections (UTIs) are the most common kind of hospital-acquired infections in older patients. UTIs account for up to 40% of all nosocomial infections, and 80% of UTIs are associated with urinary catheter use (Gokula et al., 2004; Sujijantararat, Booth, & Davis, 2005). The strongest predictor of a catheter-related UTI is the duration of catheterization (Cornia, Amory, Fraser, Saint, & Lipsky, 2003). Use of an indwelling urinary catheter for more than 48 hours is associated with an increased likelihood of UTI; however, UTIs can be prevented by using an indwelling catheter only when necessary and by removing it when no longer needed (Johansson, Athlin, Frykholm, Bolinder, & Larsson, 2002).
Any method to shorten the duration of catheterization should reduce the risk of complications from indwelling urinary catheters (Cornia et al., 2003). Clinical protocols help ensure clinicians treat patients in ways that minimize the risk of complications (Des Peres Hospital, 2005). This study was...