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.
2
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 devices to reduce the risk of CA-bacteriuria or CA-UTI.
