ETC 06 - Implementation of a Urinary Retention Algorithm Can Reduce Urinary Catheter Utilization and Catheter Associated Urinary Tract Infections

Background: Urinary retention (UR) is the most prevalent indication for an indwelling urinary catheter (IUC) at our facility, a main risk for Catheter Associated Urinary Tract Infections (CAUTI). Significant variability exists among providers on management of UR. There is limited evidence on how to manage acute UR in hospitals; therefore we sought to develop a UR evaluation algorithm to reduce IUC placement and CAUTI.

Methods: We conducted a literature search on management of acute UR, but found little evidence based guidance. Through collaboration between Nursing, Urology, and Hospitalist stakeholders, a UR algorithm was developed using the Delphi Method, incorporating literature findings. The UR algorithm provided a systematic framework of evaluation and intervention, once UR was suspected. The decision tree guides an assessment of symptoms, bladder volume, urologic history, and possible cause of UR. Bladder scanning, intermittent catheterization, and change of voiding positions are advised interventions prior to insertion of IUC. Nurses and Providers were educated through a multitude of platforms. In May 2022, the algorithm was embedded into a nursing policy and into provider order sets, for ease of use. CAUTI incidence and IUC utilization were measured and compared pre- and post-intervention, using National Healthcare Safety Network Standardized Infection Ratios (SIR) and Standardized Utilization Ratios (SUR).

Results: The CAUTI SIR was significantly reduced from 1.427 in the year prior to implementation of the algorithm to 0.866 in the year following (p-value=0.01). Utilization was significantly reduced as well, from an IUC SUR of 1.087 to 0.983 between pre- and post-intervention years (p-value < 0.01).

Conclusions: This study found that the implementation of a facility UR algorithm can significantly reduce IUC utilization and CAUTI. Sustained reductions were achieved by providing education and increasing ease of access to the UR algorithm. Other facilities can successfully adopt this process.