Feasibility of audit and feedback to reduce postoperative urinary catheter duration.

BACKGROUND: Indwelling urinary catheter duration is an important risk factor for catheter-associated urinary tract infections (CAUTIs).
OBJECTIVE: To audit patient-level postoperative catheter duration and measure the impact of its feedback to nursing staff on postoperative catheter duration and CAUTI rates.
DESIGN: Preobservational and postobservational study.
SETTING: Two surgical units at an urban academic medical center. PATIENTS: Postoperative patients with indwelling urinary catheters. INTERVENTION: Audit and feedback of postoperative urinary catheter duration to nurses during an educational session. MEASUREMENTS: Patient-level postoperative catheter duration obtained from electronic clinical documentation. Mean catheter duration and proportion of patients with postoperative catheter duration <3 days were determined.
RESULTS: Following the intervention, the mean postoperative catheter duration decreased (1.7-1.4 days [P = 0.01] on orthopedic surgery, and 2.6 to 2.2 days [P = 0.01] on general surgery). The proportion of patients with catheter duration <3 days increased significantly on orthopedic surgery (86-92% [P = 0.04]), and nonsignificantly on general surgery (56-63% [P = 0.14]). When adjusted for length of stay differences, the odds of catheter duration <3 days on general surgery increased from 1.38 (P = 0.14) to 1.69 (P = 0.02). The CAUTI rates did not significantly decrease. The rate on orthopedic surgery dropped from 8.9 infections per 1000 device-days to 0 (confidence interval [CI], -1.1 to 18.3); on general surgery the rate was constant at 7 infections per 1000 device-days (CI, -12.1 to 10.8).
CONCLUSIONS: Audit and feedback of aggregated patient-level urinary catheter duration determined from electronic documentation may prove effective in improving urinary catheter management for surgical patients.