Diagnostic precision: Exchanging urinary catheters before urine specimen collection to reduce catheter-associated urinary tract infection Journal Article
| Authors: | Romano, K.; Leone, J.; Love, N.; Caramore, A. |
| Article Title: | Diagnostic precision: Exchanging urinary catheters before urine specimen collection to reduce catheter-associated urinary tract infection |
| Abstract: | Background Catheter-associated urinary tract infections are among the most prevalent and costly types of hospital-acquired infections. During the COVID-19 pandemic, growing numbers of critical care patients required indwelling urinary catheters, leading to higher infection rates. Local Problem A critical care unit saw a 7-fold increase in the rate of catheter-associated urinary tract infection during the COVID-19 pandemic. A review of procedures showed that the current standard of care for preventing such infections was inadequate. In particular, patients who could not have indwelling urinary catheters promptly removed risked a potential false-positive diagnosis of catheter-associated urinary tract infection due to clinicians’ use of long-term catheters to obtain urine specimens for microbiological evaluation. Methods A literature review was performed to gather evidence on best practices for urine specimen collection in the critical care unit. An interprofessional task force including frontline nurses advocated implementation of a pilot project in 2 critical care units involving exchange of catheters before obtaining urine specimens for microbiological evaluation in any patient who had an indwelling catheter in place for more than 24 hours. Results Implementation of the new protocol resulted in a major reduction in the diagnosis of catheter-associated urinary tract infection, with no incidents occurring for 2 consecutive quarters. Based on these results, the new evidence-based workflow was incorporated as the standard of care for all adult inpatients. Conclusion Catheter exchange before collection of urine specimens in patients requiring urine culture evaluation can improve accuracy of diagnosis of catheter-associated urinary tract infection and promote antibiotic stewardship. © 2025 American Association of Critical-Care Nurses. |
| Keywords: | adult; aged; aged, 80 and over; middle aged; intensive care unit; intensive care units; diagnosis; urinary tract infection; urinary catheter; catheter infection; catheter-related infections; cross infection; catheters, indwelling; prevention and control; adverse event; intensive care nursing; pandemic; urinary tract infections; procedures; bladder catheterization; indwelling catheter; urinary catheterization; very elderly; critical care nursing; humans; human; male; female; urinary catheters; urine sampling; pandemics; severe acute respiratory syndrome coronavirus 2; coronavirus disease 2019; covid-19; sars-cov-2; urine specimen collection |
| Journal Title: | Critical Care Nurse |
| Volume: | 45 |
| Issue: | 2 |
| ISSN: | 0279-5442 |
| Publisher: | Amer Assoc Critical Care Nurses |
| Date Published: | 2025-04-01 |
| Start Page: | 25 |
| End Page: | 32 |
| Language: | English |
| DOI: | 10.4037/ccn2025857 |
| PUBMED: | 40168012 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- MSK corresponding author is Kathleen Romano -- Source: Scopus |
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