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Indwelling urinary catheters lead to both infectious and non-infectious complications. Despite these potential harms, studies have found that initial catheterization was inappropriate 21% to 50% of the time, and that continued catheter use was inappropriate almost half of the days that patients are catheterized.
A common reason for inappropriate continued catheter use is that physicians forget, or are never aware of, the presence of the catheter. In one multi-center evaluation, inpatient physicians at 4 hospitals were asked whether or not each patient on their service had a urinary catheter in place. Incorrect negative responses were recorded for over one-third of attending physicians and more than a quarter of resident physicians. For inappropriately catheterized patients, the proportion of physicians unaware of the presence of a catheter was even higher (over 50% for attending physicians and over 40% of senior residents). These “forgotten” catheters often remain in the patient until either a catheter-related complication occurs or the patient’s discharge is imminent.
Physicians should assess daily whether or not their catheterized patient still requires the catheter. While nursing involvement in catheter insertion, care, and removal is paramount, physicians also play an important role in prevention efforts. The physician champion – often an infectious diseases specialist, hospital epidemiologist, urologist, or hospitalist – can inform physicians about the planned prevention program, encourage support for the program, be available to answer questions, and help educate other physicians about the appropriate indications for catheter use.
Below, we provide specific strategies for engaging physicians in CAUTI prevention.