Prolonged indwelling catheter use is a known risk factor for catheter-associated UTIs (CAUTIs). We sought to reduce catheter use by creating and implementing a trial of void (TOV) algorithm to standardize indwelling Foley catheter removal in surgical patients.
We partnered with the Departments of General Surgery and Nursing to develop an evidence-based TOV algorithm for a step-down unit at a large urban teaching hospital. Our cohort included patients treated with intra-abdominal, thoracic, vascular, urologic, and gynecologic surgeries. The primary outcome was mean cumulative indwelling urethral catheter patient-days. For example, if 2 patients had catheters for 3 and 7 days, respectively, then cumulative catheter days would be 10. We analyzed changes in catheter use 90 days before and after algorithm implementation.
The mean number of hospitalized patient-days before and after algorithm introduction did not differ (32.2 vs 32.0, P = .60). After implementation, mean cumulative catheter patient-days decreased (14.8 vs 9.9, P < .01), as did mean daily number of patients with catheters on the unit (3.7 vs 3.1, P = .02). There was 1 CAUTI before and after algorithm implementation, the latter deemed associated with algorithm nonadherence. Catheter use in a surgical floor control group where the algorithm was not implemented did not differ for any outcome over the same time period (P > .05).
A multidisciplinary approach to standardize catheter care with a TOV algorithm is feasible and effective in reducing catheter use. Further research is needed to determine its impact on CAUTI rate.
Urology practice. 2024 Jun 19 [Epub ahead of print]
David S Han, Srinath-Reddi Pingle, Lovie M Amolo, Maureen L Roach, Maria Sofia Luga, Shelley-Ann Layne, Coraima R Veliz, Leine Hurlbut, Bridgette Bennett, Hersy Contreras, Subhash Krishnamoorthy, David M Weiner, Christopher B Anderson, Gina M Badalato
Department of Urology, Columbia University Irving Medical Center, New York, New York., Department of Nursing, Columbia University Irving Medical Center, New York, New York., Department of General Surgery, Columbia University Irving Medical Center, New York, New York.