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. Author manuscript; available in PMC: 2010 Jun 16.
Published in final edited form as: Ann Intern Med. 2009 Jun 16;150(12):877–884. doi: 10.7326/0003-4819-150-12-200906160-00013

Table 3.

Recommendations for hospitals to address the Center for Medicare and Medicaid rule changes regarding catheter-related urinary tract infection

1) Develop or adopt existing protocols (19, 23, 25) to ensure that indwelling urinary catheters are used only when medically indicated and that they are inserted and maintained using proper technique. Using, for example, the following specific strategies:
    • Develop a list of indications for the use of indwelling urinary catheters and make sure that catheter use is limited to persons with an accepted indication. Indications for catheter insertion may include: urinary retention, close monitoring of urinary output in critically ill patients, urinary incontinence that poses a risk to the patient (e.g., associated with major skin breakdown or at risk of contaminating a surgical site), and some surgical procedures.
    • Develop training standards for those who insert catheters and manipulate urinary catheters and drainage bags in daily patient care.
    • Provide all necessary supplies for proper catheter insertion and maintenance.
2) Develop systems to promote removal of urinary catheters when they are no longer indicated. These systems may include:
    • Daily review of catheter necessity during medical, nursing, or multidisciplinary rounds.
    • Automated nurse or physician reminders of catheter presence.
    • A protocol that authorizes nurses to discontinue catheters without a physician order when patients meet established criteria.
    • Catheter stop-orders that are entered automatically with each order for catheter insertion so that discontinuation of the catheter becomes the default after a pre-designated period of time, rather than catheter continuation (which would require an additional physician order).
3) Educate clinicians about the appropriate use and interpretation of urinalysis and urine culture.
    • Bacteriuria and pyuria are relatively common among patients with indwelling urinary catheters. These findings do not necessarily indicate the presence of infection or the need for treatment in the absence of symptoms.
    • Adequate knowledge of these issues may result in improved accuracy of documentation and more appropriate use of antimicrobial therapy.