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Interventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review

Interventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review
Interventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review
Background

Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs.

Objectives

To evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care.

Design

Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review.

Data Sources

MEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library.

Review Methods

A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011.

Results

2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications.

Conclusions

More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs.
catheter-associated urinary tract infection, inappropriate use, infection prevention, systematic review, urinary catheterisation
0020-7489
4-13
Murphy, Catherine
b7f2dd56-3a8a-412a-9f6a-bf468ce7f749
Fader, Miranda
c318f942-2ddb-462a-9183-8b678faf7277
Prieto, Jacqui
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc
Murphy, Catherine
b7f2dd56-3a8a-412a-9f6a-bf468ce7f749
Fader, Miranda
c318f942-2ddb-462a-9183-8b678faf7277
Prieto, Jacqui
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc

Murphy, Catherine, Fader, Miranda and Prieto, Jacqui (2014) Interventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review. International Journal of Nursing Studies, 51 (1), 4-13. (doi:10.1016/j.ijnurstu.2012.12.007). (PMID:23332716)

Record type: Article

Abstract

Background

Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs.

Objectives

To evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care.

Design

Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review.

Data Sources

MEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library.

Review Methods

A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011.

Results

2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications.

Conclusions

More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs.

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More information

Accepted/In Press date: 13 December 2012
e-pub ahead of print date: 17 January 2013
Published date: 1 January 2014
Keywords: catheter-associated urinary tract infection, inappropriate use, infection prevention, systematic review, urinary catheterisation
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 352349
URI: http://eprints.soton.ac.uk/id/eprint/352349
ISSN: 0020-7489
PURE UUID: b7b2aef9-522e-49a7-970e-d4818f069041
ORCID for Jacqui Prieto: ORCID iD orcid.org/0000-0002-5524-6775

Catalogue record

Date deposited: 10 May 2013 09:13
Last modified: 20 Feb 2021 02:38

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