Use of prevalence survey of indwelling urinary catheters and assessment of risk factors to enhance compliance with CDC guideline in Japanese hospitals

ISSUE: A new healthcare reimbursement system in Japan is driving hospitals to focus on patient outcomes and infection prevention. More than 20 years after publication of the Centers for Disease Control and Prevention (CDC) guideline for prevention of catheter-associated urinary tract infection (CAUTI), compliance with these important recommendations is still quite limited in Japan. Due to the lack of surveillance in Japanese hospitals, it is difficult to assess compliance with the most important CDC recommendation: “Urinary catheters should be inserted only when necessary and left in place only for as long as necessary.” We suspected overuse of the indwelling catheter in Japanese hospitals and were curious about actual catheter utilization rates. PROJECT: Sixteen (16) hospitals of various sizes and geographic locations in Japan were selected to conduct point prevalence surveys of the use of indwelling catheters and calculate the average period of catheterization. Other CDC recommendations prohibit the routine changing of catheters and emphasize the importance of closed drainage systems. These risk factors were also assessed in each hospital. RESULTS: The percentage of catheterized patients for the aggregate was 13.7%, and the average period of catheterization was 19.9 days. Use of a preconnected closed drainage system was 56.9% in the aggregate. The practice and protocol for routine changing of indwelling catheters was 14 days in most hospitals, with one hospital changing every 7 days and one changing every 21 days. Six of the 16 hospitals had abolished the routine changing of catheters. LESSONS LEARNED: Translation of the CDC guideline into Japanese and distribution to staff nurses and infection control teams was an important first step toward compliance. When nurses engaged in the collection of data related to the use of indwelling catheters and risk factors for CAUTI, changes in protocols and practice were more likely to take place and compliance with the CDC recommendations was enhanced. These elementary data collection activities conducted by link nurses and staff nurses provided needed inertia to help move Japanese hospitals toward traditional UTI surveillance and performance improvement.