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Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts
University of Massachusetts Medical School Faculty Publications
  • Jerry H. Gurwitz, University of Massachusetts Medical School
  • Catherine E. DuBeau, University of Massachusetts Medical School
  • Kathleen M. Mazor, University of Massachusetts Medical School
  • Meera Sreedhara, University of Massachusetts Medical School
  • Celeste A. Lemay, University of Massachusetts Medical School Worcester
  • Ann Spenard, Qualidigm
  • Michelle Pandolfi, Qualidigm
  • Florence Johnson, Qualidigm
  • Terry S. Field, University of Massachusetts Medical School
UMMS Affiliation
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Publication Date
11-1-2016
Document Type
Article
Abstract

OBJECTIVES: To describe the epidemiology of indwelling urinary catheter use in nursing homes (NHs). DESIGN: Observational cohort study. SETTING: A purposeful sampling strategy was used to identify a diverse sample of 28 Connecticut NHs, defined in terms of ownership, quality ratings, and bed size.

PARTICIPANTS: Long-stay (>100 days) residents of study NHs with an indwelling urinary catheter present at any time over a 1-year period.

MEASUREMENTS: Duration of catheter use was determined, and indications for catheter placement were documented. Indications considered appropriate included urinary retention or outlet obstruction, pressure ulcer (Stage 3 or 4 with risk of contamination by urine), hospice care, and need for accurate measurement of input and output. During quarterly follow-up assessments, whether the catheter was still in place or had been removed for any reason other than routine maintenance was determined.

RESULTS: The overall rate of any urinary catheter use per 100 resident-beds over a 1-year period was 4.8 (range 1.0-9.9, median 5.1). Of the 228 residents meeting eligibility criteria, a documented indication for the catheter was present in the NH record for 195 (86%). Of those with a documented indication, 99% (n = 193) had one or more indications deemed appropriate, including urinary retention (83%), pressure ulcer (21%), hospice care (10%), and need for accurate measurement of input and output (6%). The urinary catheter was removed at some point during the period of observation in 49% (n = 111) of participants; those with a shorter duration of catheter use before study enrollment were more likely to have the catheter removed during the follow-up period. Of the 111 residents who had the catheter removed, 58 (52.3%) had it reinserted at some point during follow-up.

CONCLUSION: These findings suggest that indwelling urinary catheter use in long-stay NH residents is uncommon and generally appropriate and that efforts to improve catheter care and outcomes should extend beyond a singular focus on reducing use.

Keywords
  • CAUTI,
  • healthcare-associated infections,
  • nursing home,
  • urinary catheter
DOI of Published Version
10.1111/jgs.14464
Source
J Am Geriatr Soc. 2016 Nov;64(11):2204-2209. Sep 19. Link to article on publisher's site
Related Resources
Link to Article in PubMed
PubMed ID
27640341
Citation Information
Jerry H. Gurwitz, Catherine E. DuBeau, Kathleen M. Mazor, Meera Sreedhara, et al.. "Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts" Vol. 64 Iss. 11 (2016) ISSN: 0002-8614 (Linking)
Available at: http://works.bepress.com/terry_field/127/