A Review of Catheter Use and Catheter-Associated UTI Prevention in Geriatric Patients on the Stroke Unit

Introduction 

Urinary catheterisation is frequently required in older patients on the Stroke Unit. However, inappropriate use significantly increases the risk of catheter-associated urinary tract infections (CAUTIs), which are particularly harmful in frail, geriatric populations. The appropriate use of catheters is necessary and strict documentation of the indication should be noted upon insertion. Research suggests more than a third of catheters are unnecessary (Saint et al., 2000). Recognising the need for timely review and if appropriate, removal of indwelling catheters is imperative in reducing morbidity in older patients (Lee & Malatt, 2011). 

Method 

A retrospective audit, over 3 months, was carried out on stroke patients >65 years who had a urinary catheter inserted during admission. 18 patients were identified, of whom one was excluded due to having a long-term catheter, leaving 17 patients for analysis. The aims were to assess the need for catheterisation with clear documentation, to review if catheters were reviewed within a 5 day period and to identify the incidence of CAUTIs within that admission period. 

Results 

The data demonstrated that 77% of newly inserted catheters had clear reasoning documented within the notes. The indications were further analysed which showed that the most common reason for catheterisation was retention. Only 24% of the catheters had a documented review within 5 days. 35% of the patients from this project had a CAUTI within the same admission period. 

Conclusion 

This audit demonstrates significant gaps in catheter management among geriatric stroke patients. While most catheters were inserted appropriately, documentation of review was poor. The high CAUTI rate (35%) highlights the risks faced by this population. The active review of indwelling catheters can be aided by the introduction of a structured, and easily identifiable, catheter proforma for each patient who requires catheterisation. A re-audit will be done to assess the impact of these changes on patient safety.

References 

Lee, E.A. and Malatt, C. (2011) ‘Making the hospital safer for older adult patients: A focus on the indwelling urinary catheter’, The Permanente Journal, 15(1), pp. 49–52. doi:10.7812/tpp/10-067. 

Saint, S. et al. (2000) ‘Are physicians aware of which of their patients have indwelling urinary catheters?’, The American Journal of Medicine, 109(6), pp. 476–480. doi:10.1016/s0002-9343(00)00531-3.