Addressing CAUTIs with an External Female Catheter

Abstract

A CNS-led initiative to achieve better patient outcomes-at a significantly lower cost.U rinary tract infections (UTIs) are one of the most common types of health careassociated infections and account for more than 30% of infections in acute care hospitals. 1 Most health care-associated UTIs are caused by indwelling urinary catheters. Also known as a Foley catheter, an indwelling urinary catheter is a drainage tube inserted into the urinary bladder through the urethra; the other end of the tube is connected to a drainage bag. 2 According to the National Healthcare Safety Network, about 12% to 16% of adult inpatients will have an indwelling urinary catheter inserted at some point during hospitalization and each day the catheter remains, there is a 3% to 7% increased risk of acquiring a catheter-associated UTI (CAUTI). 2 CAUTIs are diagnosed in hospitalized patients when a UTI occurs after an indwelling urinary catheter has been in place for two or more consecutive days. 2 The day of catheter insertion is considered day 1. 2 CAUTIs can lead to complications such as pyelonephritis and gram-negative bacteremia. 2 CAUTI-related complications can also prolong hospital stays by two to four days and result in patient discomfort and increased health care costs and mortality. 3 According to the most recent estimates available from the Agency for Healthcare Research and Quality, the approximate total cost of CAUTIs per year in the United States is $340 million to $450 million, but it's likely those costs have grown. 3 As of October 2008, the Centers for Medicare and Medicaid Services no longer reimburses costs associated with hospital-acquired CAUTIs. This makes it a priority to find ways to address factors that increase the risk of CAUTIs and find ways to decrease their incidence.According to the Centers for Disease Control and Prevention (CDC), "An estimated 17% to 69% of CAUTIs may be preventable with recommended infection control measures, which means that up to 380,000 infections and 9,000 deaths related to CAUTI per year could be prevented." 1 A significant number of indwelling urinary catheters are inserted for inappropriate indications, such as routine urine output monitoring, incontinence, confusion, or dementia. 3 According to professional guidelines

Clinical outcomes of female external urine wicking devices as alternatives to indwelling catheters: a systematic review and meta-analysis

“…Cost-Effectiveness 6 30,38,49,51,52,57 Analyses have shown potential savings associated with FEUWD use through the avoidance of toilet-related falls and reduction in time required for incontinence care. Individual institutions have also generated their own estimates of cost savings, ranging from $13,786 on a per-patient basis to $1 million per year at a large academic hospital due to reduced CAUTIs and Medicare fines.…”

“…Patient and Nurse Satisfaction 8 22,24,26,28,30,35,38,68 Satisfaction was high. Studies indicated good patient and caregiver satisfaction with home, outpatient community, and hospice care use of PureWick.…”

“…Skin Complications 8 20,23,25,30,34,38,42,65 3 studies reported erythema and skin breakdown due to device firmness, high suction, or allergic reaction to device material. 1 study found that hospital-associated pressure injuries (HAPIs) nonsignificantly increased after FEUWD implementation.…”

“…In addition to the joint reporting of IUC utilization and indwelling CAUTI rates, FEUWD utilization and FEUWD-UTI rates should be reported, as well as skin-and mobility-related complications associated with FEUWD use. Although some studies have reported measures of FEUWD use, they vary greatly and are often not expressed as device-days per patient-days 22,23,25,27,30,32,33,46,63 . It would also be useful for researchers to report IUC utilization and indwelling CAUTI rates among female patients only so that evaluations of the relationship between FEUWD and IUC use are specific to the patient population of interest.…”

Nurse's knowledge and practice towards prevention of catheter‐associated urinary tract infection: A systematic review

“…Complications from catheter-associated urinary tract infections (CAUTIs) can extend hospital stays, cause patient discomfort, and raise medical expenses and death. 1 Meanwhile, catheterization of the urinary tract is a routine hospital operation with a high risk of hospital-acquired urinary tract infections (UTIs). It is responsible for over 70% of all UTIs.…”