ITS 102 - Utilizing a Data-driven Approach to Develop Nurse-driven Indwelling Urinary Catheter Removal and Urinary Retention Management Protocols

Background: Indwelling urinary catheterization (IUC) duration closely correlates with catheter-associated urinary tract infection (CAUTI). While literature supports nurse-driven removal protocols to reduce IUC utilization and CAUTI, limited information exists on tailoring protocols to specific populations. Currently we maintain IUCs for inpatients who fail trial of void (TOV) after 24-hours of in/out straight catheterization. We sought to develop nurse-driven IUC removal and acute urinary retention (AUR) management protocols based on best practices and institutional IUC and CAUTI data.

Methods: Following literature review and consulting Urology on AUR, we conducted a retrospective analysis of inpatient IUC utilization and CAUTI from 1/2019-6/2023 at an orthopedic surgery hospital. Sex, race, IUC duration, multiple IUC during admission, and CAUTI were evaluated following National Healthcare Safety Network definitions. Odds ratio (OR) (p-value cutoff=0.05) was calculated comparing CAUTI among longer versus shorter IUC duration.

Results: 25,275 inpatient IUCs were identified during the study period. 52.1% were among females and utilization by race aligned with our inpatient population. Most inpatients (96.5%) had only 1 IUC during admission. 2,238 IUCs (8.9%) were CAUTI-surveillance eligible and 18 CAUTIs were identified. 8 CAUTIs (4.3%) occurred in 8+-day IUCs; 2 (3.0%) in 7-day IUCs; 2 (1.8%) in 6-day IUCs; 2 (1.0%) in 5-day IUCs; and 4 (0.96%) in 4-day IUCs. CAUTI was 10.6 times more likely in 6+-day IUCs (p < 0.0001, 95% CI=3.95-28.47) than 3-5-day IUCs. Urology recommended 5-7-day bladder rest for AUR.

Conclusions: Aligning with Urology recommendations and our finding a 10.6-fold increased CAUTI risk among 6+-day IUCs, our AUR protocol includes removal at 5 days to reassess void status. We will monitor CAUTI and repeat TOV failures. Our findings also highlight opportunities for increased diligence with timely IUC removal and evaluating root causes underlying increased CAUTI risk at our institution beyond IUC utilization alone.