Cutting ‘unnecessary’ surgical catheter use also cuts UTIs

Theatre teams at a teaching hospital in Chicago targeted UTI prevention during short procedures by decreasing catheter use that was deemed to be unnecessary.

“Our thought was to look at… how we can get surgeons… and nurses to think critically about using catheters”

Anthony Yang

The study authors said current guidelines tended to concentrate on the postoperative period, after patients have left theatre and are in the recovery room, or after they have been transferred to beds on the hospital floor.

Anthony Yang, an assistant professor of surgical oncology at Northwestern University Feinberg School of Medicine, said: “Our thought was to look at what happens in the operating room and how we can get surgeons… and nurses to think critically about using catheters.”

He said the objective was to change clinical culture, because clinicians tended to “err on the conservative side and order catheters routinely”.

The research team developed consensus criteria for the placement of catheters depending on the expected length of each procedure.

“Using catheters to measure urine output is more important in long surgical cases, but catheters may not be necessary in shorter ones,” said Dr Yang.

For cases lasting three hours or less, a catheter would not be inserted unless there was specific indication for it, and it would be removed in the surgical theatre or the recovery room immediately after the procedure.

The move followed data showing the catheter-related UTIs were previously higher at the Northwestern Memorial Hospital than at other similar hospitals.

In the year before the study, the researchers said 67% of all catheters in those who underwent surgical procedures were used in patients who may not have needed them and only 22% of the catheters were removed immediately after the procedure.

In the five months after the study, there was a 12% decrease in the rate of catheter insertion in patients whose procedure required less than three hours, and a 6% increase in the number of catheters that were removed within minutes of the completion of surgical procedures.

As a result, the programme has reduced the number of UTIs associated with catheters that were placed in surgical patients while they were in the operating theatre, according to the researchers.

The rate of catheter-associated UTI averaged two per month in the months before the programme, but afterwards fell to 0.4 per month over five months and was zero in three of them.

The study results were presented on Sunday at the 2015 conference of the American College of Surgeons National Surgical Quality Improvement Program.