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Effect Of Nurse-Led Multidisciplinary Rounds On Reducing the Unnecessary Use Of Urinary Catheterization in Hospitalized Patients

  • Mohamad G. Fakih (a1) (a2) (a3), Cathleen Dueweke (a2), Susan Meisner (a2), Dorine Berriel-Cass (a4), Ruth Savoy-Moore (a5), Nicole Brach (a6), Janice Rey (a2), Laura Desantis (a4) and Louis D. Saravolatz (a1) (a3)...

To determine the effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheters (UCs).


Quasi-experimental study with a control group, in 3 phases: preintervention, intervention, and postintervention.


Twelve medical-surgical units within a 608-bed teaching hospital, from May 2006 through April 2007.


A nurse trained in the indications for UC utilization participated in daily multidisciplinary rounds on 10 medical-surgical units. If no appropriate indication for a patient's UC was found, the patient's nurse was asked to contact the physician to request discontinuation. Data were collected before the intervention (for 5 days), during the intervention (for 10 days), and 4 weeks after the intervention (for 5 days). Two units served as controls.


Of 4,963 patient-days observed, a UC was present in 885 (for a total of 885 “UC-days”). There was a significant reduction in the rate of UC utilization from 203 UC-days per 1,000 patient-days in the preintervention phase to 162 UC-days per 1,000 patient-days in the intervention phase (P = .002). The postintervention rate of 187 UC-days per 1,000 patient-days was higher than the rate during the intervention (P = .05) but not significantly different from the preintervention rate (P = .32). The rate of unnecessary use of UCs also decreased from 102 UC-days per 1,000 patient-days in the preintervention phase to 64 UC-days per 1,000 patient-days during the intervention phase (P < .001); and, significantly, the rate rose to 91 UC-days per 1,000 patient-days in the postintervention phase (P = .01). The rate of discontinuation of unnecessary UCs in the intervention phase was 73 (45%) of 162.


A nurse-led multidisciplinary approach to evaluate the need for UCs was associated with a reduction of unnecessary UC use. Efforts to sustain the intervention-induced reduction may be successful when trained advocates continue this effort with each team.

Corresponding author
Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center, 19251 Mack Ave, Suite 340, Grosse Pointe Woods, MI 48236 (
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1.Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:6875.
2.Tambyah PA, Knazinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23:2731.
3.Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125127.
4.Baumgarten M, Margolis DJ, Localio AR, et al.Pressure ulcers among elderly patients early in the hospital stay. J Gerontol A Biol Sci Med Sci 2006;61:749754.
5.Fakih MG, Nunu O. A multidisciplinary effort to reduce the risk of urinary catheter associated infection: an intervention to get and keep the Foley out. In: Program and abstracts of the 16th Annual Meeting of the Society for Healthcare Epidemiology of America; Chicago, IL; March 2006. Abstract 9.
6.Wong ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11:2836.
7.Huang WC, Wann SR, Lin SL, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974978.
8.Topal J, Conklin S, Camp K, Morris V, Balcezak T, Herbert P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20:121126.
9.Cornia PB, Amory JK, Fraser S, Saint S, Lipsky BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114:404407.
10.Munasinghe RL, Yazdani H, Siddique M, Hafeez W. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol 2001;22:647649.
11.Gokula RRM, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a Midwestern community teaching hospital. Am J Infect Control 2004;32:196199.
12.Saint S, Wiese J, Amory JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476480.
13.Saint S, Kowalski CP, Forman J, et al.A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp Epidemiol 2008;29:333341.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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