jueves, 10 de abril de 2014

New AHRQ Study Examines Urinary Catheter Use In Emergency Departments

New AHRQ Study Examines Urinary Catheter Use In Emergency Departments

A new AHRQ-funded study finds that two-thirds of urinary catheters placed in patients in U.S. emergency departments (ED) were potentially avoidable, as their use was inconsistent with Centers for Disease Control and Prevention guidelines. These findings suggest that reducing inappropriate use of ED-placed catheters may reduce catheter-associated urinary tract infection (CAUTI). The study and abstractappeared online March 13 in Academic Emergency Medicine. The study analyzed National Hospital Ambulatory Medical Care Survey data from 1995 through 2010 on the use of urinary catheters for adult patients in the ED setting. The authors noted that while CAUTI is the most prevalent hospital-acquired infection, little is known about ED use of urinary catheters. The study, “Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010,” concluded that EDs should actively engage in prevention efforts that can reduce CAUTI.
AHRQ Electronic Newsletter, April 8, 2014, Issue #419

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 2014 Mar;21(3):292-300. doi: 10.1111/acem.12334.

Urinary Catheter Use and Appropriateness in U.SEmergency Departments1995-2010.



Catheter-associated urinary tract infection (CAUTI) is the most prevalent hospital-acquired infection, yet little is known aboutemergency department (ED) use of urinary catheters. The objective was to describe use of urinary catheters in U.S. EDs and determine the proportion that was potentially avoidable.


The National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted probability sample of U.S. ED visits, was analyzed from 1995 through 2010 for use of urinary catheters in adults. Use of a urinary catheter was a specific chart review element and was classified as potentially avoidable if none of the Centers for Disease Control and Prevention (CDC) list of appropriate indications were met by ED visit diagnoses or patient disposition. Annual frequency of urinary catheter use and appropriateness were calculated. Predictors of ED-placed urinary catheters for admitted patients were assessed with multivariate logistic regression.


The annual rate of ED-placed urinary catheters varied from 2.2 to 3.3 per 100 adult ED visits. Among admitted patients, 8.5% (95% confidence interval [CI] = 8.0% to 9.1%) received urinary catheters; 64.9% (95% CI = 56.9% to 72.9%) were potentially avoidable. Among discharged patients 1.6% (95% CI = 1.5% to 1.7%) received urinary catheters. There was no significant trend over time in the use of urinary catheters or potentially avoidable urinary catheters (PAUCs). Predictors of catheter use in admitted patients included indicators of patient severity, female sex, and race/ethnicity. Hospital characteristics predicting catheter use included region, ownership type, and urban location. Predictors of potentially avoidable urinary catheter use were lower patient severity, female sex, care by a midlevel practitioner, and nonurban location.


Reducing use of urinary catheters outside of CDC guideline criteria in ED patients is a promising strategy to reduce CAUTIs.
© 2014 by the Society for Academic Emergency Medicine.
[PubMed - as supplied by publisher]

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