Implementation of a Female External Urinary Catheter Reduces Indwelling Urinary Catheter Use and Catheter-Associated Urinary Tract Infections

Abstract

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None

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

“…Warren et al (2021) recommended first implementing FEUWDs in ICUs given their observation that PureWick implementation had the greatest effect on IUC utilization and indwelling CAUTI rates in ICU patients 32 . Similarly, Gentile et al (2020) observed significant reductions in IUC utilization and indwelling CAUTI rates after introduction of PureWick in ICUs only 46 . Because ICUs tend to have the greatest number of patients using IUCs, CAUTI incidence is likely to be higher than on other hospital units.…”

“…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.…”

“…Further research is needed to ascertain FEUWD effectiveness in environments with traditionally lower IUC use. Still, even in settings with low baseline IUC utilization, Gentile et al (2020) found that successful FEUWD implementation can lead to further, if modest, reductions in IUC utilization and indwelling CAUTI rates 46 .…”