Intermountain Health Physician Leads National Effort to Improve Use of Urinary Catheters in Hospital Patients to Improve Care and Reduce Unnecessary Costs

A physician at Intermountain Health is leading a national effort to reduce one of the most common types of infections that occur in hospital patients to improve care and reduce unnecessary costs. 
 
Payal Patel, MD, an infectious diseases physician at Intermountain Health, is the lead author of new national recommendations developed by five medical societies and published in the journal Infection Control & Hospital Epidemiology, that address updated guidelines for the use of indwelling urinary catheters in hospital patients. 
 
An indwelling urinary catheter is a tube that is inserted into the bladder, allowing urine to drain freely while a patient is in the hospital. As many as one-fourth of all hospital inpatients may have a short-term, indwelling urinary catheter placed during their hospital stay. 
 
However, use of catheters can lead to the development of urinary catheter complications, including catheter-associated urinary tract infection (CAUTI), which can result in additional illness, longer hospital stays, and additional healthcare costs. 
 
Dr. Patel is lead author of the new national guidelines – Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2022 Update – which advocate avoiding unnecessary use of indwelling catheters and recommend caregivers promptly remove catheters in hospital patients that are no longer needed as first steps in preventing catheter-associated urinary tract infections. 
 
“Urinary catheters can be associated with infection and also with non-infectious harms like trauma and obstruction,” said Dr. Patel “Prevention of infection related to use of typical indwelling urinary catheters is multidisciplinary. Many members of the healthcare team, including doctors and nurses, have an important role in this process.”
 
Urinary tract infections are one of the most common healthcare-associated infections, and up to three-quarters of urinary tract infections are caused by an indwelling urinary catheter. 
 
Catheter-related infections have been associated with higher hospital mortality and increased length of stay at a cost of nearly $2,000 per hospitalized patient.
 
The updated recommendations include a model, “Disrupting the Lifecycle of the Urinary Catheter,” which identifies alternatives to indwelling catheters, shows how to follow guidance for safely inserting and maintaining catheters, and prompts healthcare personnel to initiate timely removal. 
 
Non-catheter strategies include prompt toileting, urinals, bedside commodes, incontinence garments, and/or the use of non-indwelling catheter strategies such as intermittent straight catheterization or external urinary catheters.

Since duration of catheterization is the most important risk factor for developing infection, Dr. Patel and the authors recommend at least daily review of continued catheterization, which can include automated reminders of the presence of a catheter or review during rounds of all patients with urinary catheters. 
 
Other essential practices include ensuring supplies are readily available for non-catheter and catheter management of patients’ urinary issues, and ensuring when catheters are used, they are positioned to beds and wheelchairs in ways that avoid kinking of tubing, which increases the risk of infection. 
 
Educating healthcare professionals about urine culture stewardship while providing indications for urine cultures is another new essential practice.
 
The document updates Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals published in 2014. 
 
The Compendium, first published in 2008, is sponsored by the Society for Healthcare Epidemiology (SHEA) and is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of several organizations and societies with content expertise. 
 
It is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world.  
 
The urinary catheter paper is the final installment in the latest Compendium update, which began with publication of strategies to prevent ventilator and non-ventilator associated pneumonia in May of 2022. 

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