Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections.

OBJECTIVE: To assess the impact of the overutilization of indwelling urinary catheters in the emergency department on the development of nosocomial urinary tract infection.

DESIGN: Prospective cohort study.

SETTING: 638-bed tertiary-care hospital.

PATIENTS: 118 consecutive medical and surgical admissions from the emergency department collected over 3 weeks.

INTERVENTION: Catheterized patients were assessed. The completeness of documentation relating to catheter insertion and two outcomes were measured: asymptomatic bacteriuria and urinary tract infection.

RESULTS: 24 (20.3%) had catheters inserted, of whom 12 (50%) were catheterized for justifiable indications. Positive urine cultures were found in 10 of the catheterized patients (42%), 5 of whom fulfilled the definition for catheter-associated urinary tract infection. Three of the five infections occurred in patients for whom catheterization was not justifiable. An order was written for catheter insertion in 62.5% of charts, while the rationale for catheterization was documented in 16.7%.

CONCLUSIONS: Many nosocomial urinary tract infections are due to the inappropriate placement of indwelling urinary catheters in the emergency department. The prevention of these infections should begin with restricting catheterization to those patients for whom it is appropriate.