HPMC is the first acute-care facility to successfully limit its reliance on an invasive technique for collecting patient urine, currently under increased scrutiny for causing deadly infections in hospitals. The industry standard for draining and measuring urine output from patients requires a Foley catheter to be inserted into the bladder through the urethra.
"The majority of very ill patients are given catheters in the ER and the ICU," explains Dr. Alan F. Rothfeld, who led the six-month study, from January to October 2008, to reduce the incidence of urinary tract infection (UTI) at HPMC's ICU step-down units. "It is a long tradition with roots that go back more than a century."
But growing concern over the technique's fatal risks have hospitals reevaluating its benefits. "Foley-related urinary infections are the most common hospital acquired infection with a mortality of 10 percent to 35 percent and additional costs of about $50,000 per episode," Rothfeld says, noting that new incontinence management products now offer cheaper and more effective alternatives.
Plain paper diapers were the prior alternatives. "This was unacceptable to patients and nurses because they were always wet, as were the patient and the bed," he says, adding the new super-absorbent diapers, manufactured by Medline Restore, stay dry and hold significantly more urine per day.
"Urine output can be measured with catheters but it can be measured even more accurately by weighing these diapers," Rothfeld said. "Accuracy is important if you need to know a patient's real fluid balance."
According to his findings, catheters are needed in only about half the cases in which they are used. The study observed their use during two three-month periods in two separate units of the hospital with a total 60 beds, averaging 83 percent occupancy.
The first period introduced no changes, observing only the catheter-UTI relationship. The second reduced catheter use, promoting the new diapers instead.
Infections during the intervention period fell from an average of 1.06 per 1000 patient days to 0.45. "The reduction in infections was mainly due to the decrease in catheter use rather than other changes in patient care," Rothfeld explains, noting that catheter use during the intervention period fell from 330 to 190 per 1,000 patient days.
An anonymous questionnaire conducted at the end of the study revealed the diapers were a welcome alternative among physicians and nurses, "In fact, no patient reported decreased comfort and most of the staff was supportive of this program, indicating it increased overall satisfaction among nursing personnel," Rothfeld says.
The diapers also cost significantly less. The price of a Foley kit is $14, while one Medline diaper costs 59 cents, or about $6 for an average hospital stay.