Strategies
Reduction of Inappropriate Urinary Catheter Insertion and Duration
Limiting Unnecessary Catheterization ÎIndwelling catheters should be placed only when they are indicated (A-III).
> Indwelling urinary catheters should not be used for the management of urinary incontinence (A-III). In exceptional cases when all other approaches to management of incontinence have not been effective, it may be considered at patient request.
ÎInstitutions should develop a list of appropriate indications for inserting indwelling urinary catheters, educate staff about such indications, and periodically assess adherence to the institution-specific guidelines (A-III).
ÎInstitutions should require a physician's order in the chart before an indwelling catheter is placed (A-III).
ÎInstitutions should consider use of portable bladder scanners to determine whether catheterization is necessary in post-operative patients (B-II).
Discontinuation of Catheter
ÎTo reduce the risk of CA-bacteriuria (A-I) and CA-UTI (A-II), indwelling catheters should be removed as soon as they are no longer required.
ÎInstitutions should consider nurse-based or electronic physician reminder systems to reduce inappropriate urinary catheterization (A-II) and CA-UTI (A-II).
ÎInstitutions should consider automatic stop-orders to reduce inappropriate urinary catheterization (B-I).
Strategies to Consider Prior to Catheter Insertion Infection Prevention
ÎHospitals and long-term-care facilities should develop, maintain, and promulgate policies and procedures for recommended catheter insertion indications, insertion and maintenance techniques, discontinuation strategies and replacement indications (A-III).
> Strategies should include education and training of staff relevant to these policies and procedures (A-III).
ÎInstitutions may consider feedback of CA-bacteriuria rates to nurses and physicians on a regular basis to reduce the risk of CA-bacteriuria (C-II).
> Comment: Data are insufficient to make a recommendation as to whether such an intervention might reduce the risk of CA-UTI.
ÎData are insufficient to make a recommendation as to whether institutions should place patients with indwelling urinary catheters in different rooms from other patients who have indwelling urinary catheters or other invasive 2 devices to reduce the risk of CA-bacteriuria or CA-UTI.
