Dr. Payal Patel, an infectious diseases specialist at Intermountain Health, is spearheading a national initiative aimed at reducing frequent types of hospital-acquired infections, thereby enhancing patient care and curbing unnecessary expenditures. Being the lead author, Dr. Patel presents the newly formulated national guidelines, developed collaboratively by five medical societies and recently published in the journal ‘Infection Control and Hospital Epidemiology.’ These guidelines offer updated protocols for indwelling urinary catheter use in hospitalized patients.
An indwelling urinary catheter, a tube positioned into the patient’s bladder to facilitate urine drainage, is a routine part of inpatient care, utilized by approximately a quarter of all hospital inpatients. However, the deployment of catheters is linked with some complications, chief among them is the catheter-associated urinary tract infection (CAUTI). Catheter-associated illnesses can invariably lead to prolonged hospital stay and increased healthcare costs. The fresh national recommendations titled ‘Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2022 Update’ endorse minimal use of indwelling catheters. The guidelines further advance the prompt removal of any unrequired catheters from hospital patients as primary steps in averting catheter-associated urinary tract infections. Despite being crucial in patient care, urinary catheters can potentially trigger infections along with non-infectious damage such as trauma and obstruction.
The recent recommendations also highlight a multidisciplinary approach in preventing infections resulting from standard indwelling urinary catheter use. It underscores the significance of the collective roles of healthcare teams involving doctors and nurses in this process. Given the high prevalence of urinary tract infections among healthcare-associated infections, the importance of careful catheter management cannot be overstated. The newly updated recommendations consist of a model named ‘Disrupting the Lifecycle of the Urinary Catheter.’ This model delineates alternatives to the standard indwelling catheters, charts out the guidelines for their safe insertion and maintenance, and urges healthcare personnel to initiate prompt removal when they no longer serve their purpose. It suggests adaptations of non-catheter strategies such as timely use of toilets, urinals, bedside commodes, incontinence attire, or alternately, the use of non-indwelling catheter methods like intermittent straight catheterization or external urinary catheters.
The guidelines bring to light the necessity for daily review of the need for continued catheterization, which can entail automated reminders or a manual review during rounds. Other critical practices underscored by the guidelines include the availability of supplies for non-catheter and catheter management of patients’ urinary issues and the correct positioning of catheters to prevent any kinking of tubing that escalates the risk of infection. An emergent critical practice is to enlighten healthcare professionals about urine culture stewardship while offering indications for urine cultures.
A culmination of the joint efforts of SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, these guidelines supersede the initial document published in 2014. It symbolizes an intensive, collaborative endeavor involving over a hundred experts from around the globe, with the urinary catheter document being the latest and final additions to this compendium.