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PubMed2004

Reflections on clinical audit in palliative care following an attempt to audit urinary catheterization.

Audit has a high profile within palliative care quality initiatives. However, there are numerous potential pitfalls to auditing. We had hoped to perform a multicentred multiprofessional audit on urinary catheterization of hospice patients. Unexpectedly, the problems encountered highlighted numerous flaws in our approach to audit. An initial standard-setting pilot study, using a prospective observational methodology, generated results for 25 patients. The audit cycle was not pursued, as the data and the process did not appear valid. Conversely there were valuable lessons from reflecting on our mistakes and reviewing historical 'wisdom'. For example, audit's interface with research can easily be misunderstood and the difficulties of audit in palliative care can be underestimated. Particularly concerning was the potential for harm from insufficient rigour within audit processes, in allowing invalid data to influence practice. Conversely, despite risks, robust studies within audit may inform the limited palliative care research base.

Adult↗
PubMed2001

Water or antiseptic for periurethral cleaning before urinary catheterization: a randomized controlled trial.

BACKGROUND: Despite a lack of empiric data to support the practice, traditionally, antiseptic solutions have been used to clean the periurethral area before inserting an indwelling catheter. The purpose of this study was to compare urinary colonization rates of subjects whose periurethral area was cleaned with water versus chlorhexidine 0.1% before the insertion of an indwelling urinary catheter. METHODS: Obstetric patients who required urinary catheterization as part of their routine care were randomly assigned to either the "water" or "chlorhexidine" group with a sealed envelope. A sterile specimen of urine was collected 24 hours after insertion of the catheter. RESULTS: Of the 436 patients (86.2%) with complete data (water group, 219; antiseptic group, 217), 38 (8.7%) had urinary tract bacteriuria >10(6) cfu/L. Rates of urinary tract infection were similar in each group (water group, 8.2%; antiseptic group, 9.2%; odds ratio 1.13; 95% confidence interval 0.58-2.21). CONCLUSION: The practice of periurethral cleaning with an antiseptic did not decrease the rates of bacteriuria in this population and is probably not useful.

Adult↗
PubMed2005

A reminder reduces urinary catheterization in hospitalized patients.

BACKGROUND: Indwelling urinary catheters are placed in up to 25% of hospitalized patients and are a leading cause of hospital-acquired infection. Duration of catheterization is the dominant risk factor for hospital-acquired urinary tract infection. Physicians are often unaware that their patients have a urinary catheter, and these "forgotten" catheters are frequently unnecessary. METHODS: A controlled trial, using a pretest-posttest design, was conducted on four hospital wards at an academic medical center. A simple written reminder was designed to aid the hospitalized patient's team in remembering that the patient had a urinary catheter. Two of the four wards were assigned to the intervention group, and two served as controls. A research nurse monitored the urethral catheter status of each patient daily. RESULTS: A total of 5,678 subjects were evaluated. After adjusting for age, sex, and length of stay, the average proportion of time patients were catheterized increased by 15.1% in the control group but decreased by 7.6% in the intervention group in the intention-to-treat analysis (p = .007). There was no significant difference in urethral recatheterizations between intervention and control groups. The hospital cost savings provided by the intervention offset the necessary costs of this nurse-based intervention. CONCLUSIORN: In the approximately 90% of U.S. hospitals currently without computerized order-entry systems, a written reminder should be considered as one method for improving the safety of hospitalized patients.

Academic Medical Centers↗
PubMed1999

Microbiological characteristics of yeasts isolated from urinary tracts of intensive care unit patients undergoing urinary catheterization.

We studied 70 intensive care unit patients to determine the incidence of nosocomial candiduria associated with indwelling urinary catheters and to assess microbiological characteristics of the yeasts. The yeasts were isolated, 13 of 17 in urine cultures and 4 of 17 in blood cultures, and colonization had occurred 3 days after the insertion of indwelling urinary catheters. For four strains the MICs of the antifungal drugs were high.

Adult↗
PubMed2004

The artificial urinary sphincter and urinary catheterization: what every physician should know and do to avoid serious complications.

The artificial urinary sphincter is an effective tool for urinary incontinence that is being seen in more patients because of the increased numbers of artificial sphincters being implanted and increased patient lifespan. If a patient with an artificial urinary sphincter is catheterized without manipulation of the artificial sphincter, serious irreversible complications may result. All of these complications are easily preventable by physician and nurse awareness of the artificial urinary sphincter and knowledge of how it works. Therefore, it is important for every physician to be knowledgeable about the artificial urinary sphincter.

Aged↗
PubMed1991

[Urinary catheterization: transurethral or suprapubic approach?].

75 patients, needing a bladder drainage for nonurological indications and having sterile urines were studied after randomization into two groups. In the first group, drained with an urethral catheter, urinary infection took place in 12 (= 30%) patients, while it was detected in 4 (= 11%) drained with a suprapubic catheter. In this latter group, patients felt more comfortable, had less pain; the duration of urinary drainage and hospital stay was shorter.

Aged↗