External female catheter could be 1 strategy to reduce the prevalence of CAUTIs.
Urinary tract infections (UTIs) are a serious threat for hospitalized patients. These infections can impact the bladder, ureters, and kidney, and are the most common type of health care-associated infection in the United States. For those acquired during hospitalization, 75% of UTIs are related to a urinary catheter, which is highly concerning as 15-25% of hospitalized patients have a catheter during their course of care.
It is estimated that each year, there are roughly half a million catheter-associated urinary tract infections (CAUTIs) in the United States, which result in 13,000 deaths. On top of the substantial morbidity and mortality, these infections are also costly, with an estimated overall cost of $340 million annually.
As a result of this very serious condition and its prevalence in the US health care system, prevention efforts have focused on a range of things—reducing the prevalence of catheters overall, ensuring catheter utilization is appropriate, and initiating new research and development (R&D) projects. One of these new R&D efforts has involved external female catheters, which are an alternative non-invasive effort to manage patients who are incontinent.
Not surprisingly, any effort to reduce CAUTIs is 1 that most hospitals would jump on. But just how well does an external female catheter work at reducing CAUTIs?
At the recent Association for Professionals in Infection Control and Epidemiology (APIC 2019) conference, external female catheters were an area of focus. A team of infection preventionists from NYC Health + Hospitals/Coney Island first noticed a spike in their CAUTI rate from 2016 to the first quarter of 2018 and decided to test out this alternative approach. At the conference they gave a presentation on their experiences and the impact of integrating this new approach to managing incontinent patients.
Since prolonged use of indwelling Foley catheters is the leading risk factor for CAUTIs, the research team was excited to see how they could improve patient safety while ensuring best care. Study author Briana Episcopia, BS, RN, CIC noted that “the female external catheter gave doctors and nurses an alternative that eliminated the need for an indwelling catheter, ultimately eliminating some patients’ risk of developing this type of infection.”
The infection prevention team assessed the impact of the new catheters by utilizing the reported US Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) data for inpatient CAUTIs, Foley utilization, and the standardized infection ratio (SIR) pre- and post-implementation of the external female catheter. From October 2017 to September 2018, the investigators found a hospital-wide reduction of inpatient CAUTIs by 51.7%. Foley catheter utilization rates dropped from 15.7% to 10.7%, which also contributed to the overall decrease in Foley days across the hospital.
The infection prevention team at NYC Health + Hospitals/Coney Island gave meaningful information on bringing forth a newer technology for patient care, as well as the hope that we can help reduce indwelling catheter utilization and overall CAUTI rates. Although this is just 1 strategy for tackling CAUTI prevalence, it’s a good sign that we are moving in the right direction. CAUTIs may represent the most common HAI, but that doesn’t mean we should settle for existing technologies and a plateau of efforts.