Reminders, Stop Orders Can Help Reduce CAUTI Rates

Prolonged catheterization is the primary risk factor for catheter-associated urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary urinary catheters. Through a systematic review and meta-analysis, Meddings, et al. (2010) sought to summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization.

The researchers targeted for review studies in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a urinary catheter was in use or stop orders to prompt catheter removal in hospitalized adults were included. A total of 6,679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria.

The researchers report that the rate of CAUTI (episodes per 1,000 catheter-days) was reduced by 52 percent with use of a reminder or stop order. The average duration of catheterization decreased by 37 percent, resulting in 2.61 fewer days of catheterization per patient in the intervention versus control groups; the pooled standardized mean difference (SMD) in the duration of catheterization was 1.11 overall, including a statistically significant decrease in studies that used a stop order (SMD, 0.30) but not in those that used a reminder (SMD, 1.54). Recatheterization rates were similar in control and intervention groups.

Meddings, et al. (2010) conclude that urinary catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.

Reference: Meddings J, Rogers MAM, Macy M and Saint S. Systematic Review and Meta-Analysis: Reminder Systems to Reduce Catheter-Associated Urinary Tract Infections and Urinary Catheter Use in Hospitalized Patients. Clinical Infectious Diseases 2010;51:550-560.