Adherence to guidelines for preventing catheter-associated urinary tract infections in hospitalized patients in a tertiary teaching hospital

Abstract

AimUrinary catheterization contributes significantly to hospital-acquired infections. Adhering to CDC guidelines is vital to prevent inappropriate use and reduce infection rates. This study evaluated compliance with these guidelines in hospitalized patients at a tertiary hospital in 2024.MethodologyA cross-sectional study assessed compliance with CDC guidelines for preventing catheter-associated urinary tract infections (CAUTIs) in hospitalized patients at Al-Zahra Hospital, Isfahan. Data were gathered through patient observation and chart reviews, evaluating demographics, catheter indications, retention duration, and guideline adherence. Department-specific compliance rates were also analyzed. Standardized checklists ensured consistent data recording.ResultsOf 1262 patients evaluated, 477 (37.8) underwent urinary catheterization, with a 57.3 adherence rate to CDC guidelines. The most common appropriate indication was acute urinary retention (15.4), followed by urine output monitoring in critically ill patients (14.5) and intraoperative monitoring (11.1). Adherence was highest in cardiology and urology, while gynecology, rheumatology, plastic surgery, and vascular surgery had the lowest rates. The emergency department showed only 27.8 adherence.ConclusionThe findings highlight a suboptimal adherence rate to CDC guidelines in urinary catheterization, emphasizing the need for targeted interventions to improve compliance. Strategic interventions can enhance adherence and subsequently reduce catheter-associated urinary tract infections.Clinical trial numberNot applicable.What is already known about this topic?center dot Catheter-associated urinary tract infections (CAUTIs) account for a significant proportion of healthcare-associated infections, with approximately 36 of such infections linked to urinary catheters.center dot Previous studies have reported varying rates of inappropriate catheter placements across different settings, such as 39 in Chinese hospitals and 64.9 in U.S. emergency departments.center dot Adherence to catheterization guidelines, such as those from the Centers for Disease Control and Prevention (CDC), is essential to reduce CAUTIs and associated complications, including urethral trauma and antimicrobial resistance.What this paper adds:center dot The study revealed a 57.3 adherence rate to CDC guidelines for catheter placement in hospitalized patients at a tertiary teaching hospital.center dot Acute urinary retention and monitoring of urine output in critically ill patients were the most frequent appropriate indications for catheter use, whereas substitution for nursing care in incontinent patients was a common inappropriate reason.center dot Adherence rates varied significantly across hospital departments, with the cardiology department achieving full compliance and gynecology recording the lowest adherence.The implications of this paper:1. How can these findings influence clinical practice? center dot Implementing regular training sessions and audits can enhance healthcare providers' adherence to catheterization guidelines, thereby reducing inappropriate catheter use.2. How can this research guide future interventions? center dot Focused interventions targeting departments with low adherence rates, such as gynecology and the emergency room, could significantly improve patient outcomes and reduce CAUTI rates.3. What role can policy play in addressing the identified issues? center dot Hospitals could adopt policy changes that mandate real-time feedback and automated reminders for timely catheter removal, ensuring compliance with established guidelines.