Safe urinary catheterization

Urinary tract infections and injuries related to bladder catheters are a frequent and substantial health risk for patients in hospital. The national progress! Safe urinary catheterization shows how the quality of treatment and the safety of patients using bladder catheters can be improved.

In Switzerland, every sixth hospitalised person receives a urinary catheter, although in 20 to 25 per cent of cases there is no clear indication for this. Bladder catheters are one of the main sources of infection for urinary tract infections.

Bacteria colonise the urinary tract in all patients with a bladder catheter. After 30 days, all catheterised patients have bacteriuria despite proper care. A quarter of them develop a symptomatic urinary tract infection.

Less well studied, but equally problematic for patient safety, are non-infectious complications such as injury to the urethra or bladder caused by a catheter. According to international studies, 2 to 3 out of 1,000 patients suffer an injury during insertion.

The pilot program, jointly launched by Patient Safety Switzerland and Swissnoso, provides hospitals for the first time with a concrete action guide containing an evidence-based intervention bundle for the safe use of bladder catheters. Seven Swiss hospitals participated in the pilot project. The program lasted from 2015 to 2018 and aims to reduce the use of bladder catheters and thus the incidence of bladder catheter-related injuries and infections.
 

Program structure:

Axes

• Intervention axis 1: Addressing, raising awareness and communicating new standards. Visibility and presence in the professional community and partly also in the public.
• Intervention axis 2: In-depth project in the pilot hospitals with a bundle of interventions consisting of scientifically supported measures.

Intervention bundle with the aim of reducing the risk of infections and injuries

Bladder catheters should be inserted less frequently, for shorter periods and more safely in the future.

1. Less frequently: Bladder catheters will only be placed if there is a clear indication according to the indication list.
2. Shorter: The duration of placement of bladder catheters is as short as possible, the indication is checked daily.
3. Safer: The placement and care of urinary catheters is carried out by specially and regularly trained professionals with clear responsibilities.

Evaluation instruments

• Surveillance: The survey of the number of catheterizations, the frequency of infectious and non-infectious complications and the process variables allows the potential for improvement to be assessed and the effectiveness of the intervention to be demonstrated. One measurement was done before the intervention and one after the intervention.
• Staff survey: Problem awareness is central, so a systematic survey of staff examined their knowledge, values and attitudes. A first survey was conducted before the start of the in-depth project, a second one afterwards.
• Process evaluation: In addition to the surveillance and the staff survey, further project-related evaluation surveys are required in order to obtain information on the type of implementation, on factors that promote and hinder implementation, and on compliance with the measures. The process evaluation was carried out selectively over the entire duration of the improvement period.

The program was reviewed and approved by the Cantonal Ethics Committee of Bern.

>>> Synopsis progress! Safe urinary catheterization

• Inselspital Bern
• Ente Ospedaliero Cantonale (EOC) Lugano Civico
• Spital Lachen
• Hôpital Neuchâtelois
• Luzerner Kantonsspital
• Kantonsspital Winterthur
• UniversitätsSpital Zürich

The program achieved its objectives: in the hospitals, the intervention set helped to avoid unnecessary catheterizations. Catheter use also decreased, and there were fewer non-infectious complications due to catheterization. There was no change in the incidence of urinary tract infections associated with urinary catheters, which was very low in the pilot hospitals from the beginning. The correct use of urinary catheters was increasingly discussed in the pilot hospitals, and the knowledge of the staff regarding safe use increased. The aim now is to introduce and implement the intervention bundle in other hospitals as well.