Appropriateness of urinary catheterization in the hospital setting: A multicenter observational study

Objective

The objective of this study is to analyze the appropriateness of the indication for urinary catheterization (UC) in hospitalized patients and to analyze possible associated factors.

Methods

Cross-sectional observational study conducted in 15 hospitals. Patients over the age of 18 with UC were included in the study. Information on age, sex, healthcare area, documentation of the order in the medical record, and reason for UC was collected. Indications were considered appropriate according to the Centers for Disease Control's (CDC) Urinary Tract Infection Prevention Guidelines. Logistic regression was used to study the relationship of different variables with the appropriateness of UC and the presence of documentation of the reason for UC.

Results

696 patients with UC at the time of evaluation were included, with a mean age of 73.3 years (SD 14.6), and 45.0% of them were female. The main indications for UC were preoperative, hemodynamic instability, and acute urinary retention. In 17.4% of cases, the reason for UC was not documented, and the prevalence of inappropriateness was 20.3%. Inappropriateness of UC was higher in the Emergency Department (35.1%), followed by medical services (17.2%) and surgical services (8.4%) (p < 0.001 in all comparisons). Appropriateness was lower in older patients (p = 0.021) and in centers with a higher number of beds (p < 0.001).

Conclusions

Unappropriateness of urinary catheterization is a significant problem in our centers, especially in the Emergency Department and in older patients. Specific and multifocal quality improvement programs are needed to enhance knowledge of appropriate indications for UC and potential adverse consequences.