J.G. Shin1, S. Abduselam1, H. Cho1, P. Fereydouni1, B.J. Hasjim1, M. Jebbia1, T. Huang1, S. Korouri1, A. Grigorian1, J. Nahmias1, L. Swentek1 1University Of California – Irvine, Department Of Trauma Surgery, Orange, CA, USA
Introduction:
Catheter Associated Urinary Tract Infection (CAUTI) is one of the most common nosocomial infections1. CAUTIs are associated with longer hospital stays, increased cost, and the potential for sepsis 2,3. A nurse-driven protocol (NDP) for urinary catheter removal was developed at our institution, to empower nurses to remove urinary catheters based on clinical criteria. Compared to physician-driven removal (PD), NDPs may expedite urinary catheter removal and reduce CAUTIs 4,5. Therefore, this study aimed to evaluate the efficacy of a NDP compared to PD, hypothesizing a decreased incidence of CAUTIs with NDP.
Methods:
We conducted a retrospective study (1/2022-12/2022) of adult, male patients admitted at a Level 1, academic trauma center who required an indwelling urinary catheter during their admission. Patients under the age of 18 were excluded. Patients under the NDP were compared to patients with PD using Mann-Whitney U and Pearson’s chi square test when appropriate.
Results:
Among 1000 patients with catheters, 620 (62%) had their catheters removed via NDP. There were no differences in comorbidities between the NDP and PDP groups, including diabetes (27.7% vs 29.7%, p=0.544) or congestive heart failure (7.6% vs 10.5%, p=0.137). Urinary specific co-morbid conditions such as prior urinary retention (5.7% vs 6.6%, p=0.641), and history of frequent UTIs (0.7% vs 1.8%, p=0.702) were also similar between cohorts. Catheter use for PD patients were more commonly from post-operative settings after non-urologic procedures (15.0% vs 24.2%, p<0.001) and patients undergoing diuresis (0.3% vs 4.5%, p<0.001). However, there were no differences in the total urinary catheter days (median 2 vs 2, p=0.029), the rate of CAUTI (7.4% vs 7.3%, p=1.000), or need for catheter replacement post removal (12.1% vs 11.9%, p=1.000).
Conclusion:
The rate of CAUTI was approximately 7% for patients, regardless of whether the foley catheter was removed by NDP or PD. Since NDP or PD were associated with similar outcomes, implementing a NDP for urinary catheter removal may offset physician and advanced practitioner workload without compromising patient care.