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Practice problem
Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections, and the single strongest modifiable risk factor is the number of days a catheter stays in place. On the medical-surgical unit described in this proposal, catheters are often left in place until a provider remembers to write a removal order, which extends catheter days beyond what is clinically necessary.
PICOT question
In adult medical-surgical inpatients with indwelling urinary catheters (P), does a nurse-driven catheter removal protocol (I), compared with provider-initiated removal (C), reduce CAUTI rates (O) over six months (T)?
Summary of the evidence
National guidance recommends inserting catheters only for appropriate indications and removing them as soon as they are no longer needed (Gould et al., 2010). Nurse-driven protocols operationalise that recommendation by letting nurses remove catheters when no approved indication remains, without waiting for an order. Appraising evidence with a hierarchy of evidence helps the unit judge how strongly each source should shape the change (Melnyk & Fineout-Overholt, 2023).
Recommendation
The unit should adopt a nurse-driven removal protocol with a daily indication check at the morning safety huddle, a laminated list of appropriate indications, and monthly reporting of catheter days and CAUTI rates.
References
Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & the Healthcare Infection Control Practices Advisory Committee. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31(4), 319–326. https://doi.org/10.1086/651091
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
