Report: Reminder systems reduce rate of catheter infections by half

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Reminder systems that encourage hospital staff to remove urinary catheters promptly can reduce the rate of catheter-associated urinary tract infections (CAUTIs) by 52 percent, according to research published in Clinical Infectious Diseases.

Jennifer Meddings, MD, from the University of Michigan in Ann Arbor, and colleagues studied the effectiveness of reminder systems to decrease catheter use and reduce CAUTIs. A CAUTI is the most common hospital acquired infection and was the first complication chosen for non-payment by Medicare, beginning in late 2008.

“[R]eminder systems [could potentially] have a cascade of benefits to patients beyond prevention of CAUTI, because reducing catheter use can improve patient comfort, reduce bloodstream infections, reduce need for antibiotics, improve patient mobility and decrease length-of-stay,” wrote the authors.

Urinary catheters are commonly placed to drain bladders in hospitalized patients.  Unfortunately, catheters are often left in place longer than needed because doctors forget the catheter is still being used or do not routinely assess if it is still needed, according to the authors. Having a catheter increases the patient’s risk for CAUTIs, bloodstream infections and other risks associated with decreased patient mobility when catheters are in place, such as life-threatening blood clots. But prior research by the university’s patient safety enhancement program indicated that only one in 10 hospitals use reminders to prompt removal of urinary catheters.

The reminders can take many forms, according to the researchers, such as stickers placed on charts or on catheter bags that remind nurses or physicians to remove the catheter. Some hospitals have used computer-generated reminders that appear when someone logs into a patient’s chart online. Stop orders also can be directed at physicians, where a catheter is discontinued unless a physician directly renews it.

Meddings and her colleagues noted that hospitals should consider “nurse-empowered” catheter stop orders, which empower nurses to remove urinary catheters based on criteria, without requiring them to request an order from physicians. The researchers also found no evidence that reminder systems would lead to catheters being removed too early.

“Because catheter reminders and stop orders are beneficial regardless of the technology used—from verbal bedside reminders to computer-generated stop orders—these interventions appear to be low-cost strategies that could be implemented in any healthcare system,” concluded the authors.