Reducing Intermittent Catheterization in Cases of Postvoid Residual Urine Without Increasing Hospital-Acquired...

Postvoid residual (PVR) urine is common in older patients. It is often managed with intermittent catheterization because of its assumed association with the risk of urinary tract infection (UTI). This association is uncertain, however, whereas the association between intermittent catheterization and increased risk of UTI is clear. Evidence further suggests that the threshold for intermittent catheterization in patients awaiting spontaneous urination after surgery can be raised without increasing the risk of UTI or voiding difficulties.

The purpose of this quality improvement project was to reduce the number of bladder scans and intermittent catheterizations in patients on a geriatric unit who had PVR urine and/or were awaiting spontaneous urination without an increase in hospital-acquired UTIs (HAUTIs).

The project took place on two geriatric units at Aarhus University Hospital in Aarhus, Central Denmark Region, Denmark. The Model for Improvement was used as the project framework. A workflow analysis was performed by two nurses from the units, who mapped the processes in place regarding patients' PVR urine from admission to discharge. A driver diagram was then created to map out the initiatives that would guide our process. Three cycles of the Plan-Do-Study-Act model were performed to develop a guideline on intermittent catheterization in cases of PVR urine. The data collection period was October 16, 2023, through June 30, 2024. The guideline was introduced in the third week of January 2024. Data on the number of bladder scans, intermittent catheterizations, and HAUTIs were obtained from external databases and analyzed weekly using run charts to evaluate whether changes occurred. The incidence rates (IRs) of HAUTIs in the project period were then compared with rates during the same period in the previous three years (2021, 2022, and 2023) to double-check that the IRs of HAUTIs did not increase when reducing intermittent catheterizations.

According to the run charts, the median number of bladder scans per week decreased from 146 to 99 (a reduction of 32.2%), and the median number of intermittent catheterizations per week dipped from 41 to 26.5 (a reduction of 35.4%), whereas the number of HAUTIs showed only random variation. The IRs of HAUTIs were similar to those in the previous three years.

These results suggest that use of a guideline on intermittent catheterization in patients with PVR urine may reduce the number of bladder scans and intermittent catheterizations without an increase in the incidence of HAUTIs.