Recommendations on alternatives to indwelling urinary catheters to prevent infections

Aug. 28, 2023

On Aug. 25, the Society for Healthcare Epidemiology of America (SHEA) published a press release on new recommendations from five medical societies on alternatives to indwelling urinary catheters to help patients avoid infections and urethral trauma. The recommendations were also published in the journal Infection Control & Hospital Epidemiology.

The press release said, “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.”

Further, “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.”

The authors of the study recommend daily review of continued catheterization since duration of catheterization is the most important risk factor for developing infection. Additionally, other best practices include ensuring supplies are available for non-catheter and catheter management of patients’ urinary issues and when catheters are used, they are positioned to beds and wheelchairs in ways that avoid kinks in tubing. The authors stressed educating healthcare professionals about urine culture stewardship and providing indications for urine culture.

“The document updates Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals published in 2014,” the release added. “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. “

Payal Patel, M.D., an infectious disease physician at Intermountain Health and lead author of “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2022 Update” was quoted in the release. She said, “Urinary catheters can be associated with infection and also with non-infectious harms like trauma and obstruction. Prevention of infection related to use of typical indwelling urinary catheters is multidisciplinary. Many members of the healthcare team, including doctors and nurses, have a role.”

The urinary catheter paper is the last installment in the most recent Compendium update, which began with publication of strategies to prevent ventilator and non-ventilator associated pneumonia in May of 2022.

SHEA has the press release.