Urethral catheters are small tubes inserted through the urethra to drain urine. These
devices are often linked with high rates of urinary tract infections (UTI) and are frequently used
in the older population. This contributes to lengthier hospital stays leading to increased medical
costs. In 2008, the Centers of Medicare and Medicaid Services (CMS) included catheterassociated
bacteriuria (CAB) as one of the preventable hospital-acquired conditions (HAC) that
will affect reimbursement if contracted by a patient in the acute and long-term setting. This paper
focuses on three best evidence-based practices and nursing strategies to prevent CABs.
Van Buren is the second largest city in the Fort Smith, Arkansas (AR)-Oklahoma (OK)
metropolitan statistical area and is the county seat of Crawford County, AR. The city of Van
Buren has numerous subsystems dedicated to the well-being of the community, which includes
one medical facility, five medical clinics, three nursing homes, three ambulance services, and the
Crawford County Health Department (Yellow Pages, 2010).
The medical facility, Summit Medical Center, provides full-service general acute care to
approximately 160,000 residents annually in Crawford, Franklin, and Sebastian Counties in AR
and Sequoyah County in OK. The facility has 103 beds, has more than 100 nurses on staff, and
has over 140 physicians in the medical clinics (Summit Medical Center, 2011).
In 2009, the medical facility emergency department (ED) treated 170 residents from
nursing homes, 70 of which were hospitalized after examination and treatment in the ED, 58
were treated as “ED outpatient” visits, and 42 were direct hospitalization visits (Summit Medical
Center, 2011). The majority of these patients either had urethral catheters inserted in the nursing
home or required the insertion of urethral catheters prior to hospital admission. In most cases, the
PREVENTING CATHETER-ASSOCIATED 3
indications for catheter insertion were urinary incontinence and staff convenience. Additionally,
the catheters were left in place for several days, even weeks.
Studies have shown that the urinary system is the most frequent site for nosocomial
infections or HACs. The use of urethral catheters increases the daily risk of CAB for
institutionalized patients by 3% to 10%, and the risk increases to 100% within the first 30 days
(Lo, Nicolle, & Classen, 2008). According to Gokula, Hickner, and Smith (2004), urinary tract
infections comprise about 40% of all HACs. CABs are also seen in long-term care facilities,
where the rate of catheter use is widespread. Approximately 5% to 10% of nursing home
residents have indwelling catheters, in most cases for years (Smith, Bennett, & Bradley, 2008).
As mentioned, CABs can have a huge economic impact on healthcare facilities.
Tambyah and Maki (2000) reported that more than 1 million cases of CABs occur each year in
acute and long-term care facilities. Results of a study by...