LETTER TO THE EDITOR
U.K. e x p e r i e n c e w i t h indwelling urethral c a t h e t e r s To the Editor: I read with interest the letter in the JOURNALby Lai ~ concerning the use of urethral catheters (October 1990) and would like to offer some comments regarding our experience in the United Kingdom. The Nursing Practice Research Unit conducted a survey of patients with indwelling urethral catheters during 14 days in five randomly selected District General Hospitals in England. 2 Of 1909 patients resident on the first day of the study, 240 had a catheter in situ, representing a prevalence of 12.6%. During the period of study, 294 patients were catheterized, giving an incidence of 11.2/1000 average daily population. The reasons for catheterization are summarized in Table 1. Fourteen percent of patients catheterized underwent the procedure for incontinence (the presence of pressure sores was not recorded). Bacteriuria was recorded in 44% of our patients, with this complication being most strongly related to the duration of catheterization) Although the prevalence in our U.K. study is lower than that recorded by Lai, l I agree that catheterization for the m a n a g e m e n t of incontinence should be carefully considered. Nordqvist and associates 4 demonstrated that in elderly patients the introduction of a continence training p r o g r a m and the use of pads resulted in a reduction in the use of antibiotics and lower hospital costs, with no increase in nursing workload. In addition, our study recorded leakage of urine (bypassing) around the catheter in 41% of the patients studied, s The assumption that catheterization will prevent urinary soilage, and thus ensure tissue integrity in patients vulnerable to pressure sores, may not therefore hold true. Although doctors inserted all the catheters that were placed in the operating theater, nurses performed 42% of catheterizations overall. In addition, once a catheter
164
T a b l e 1. Reason for catheterization, by patient sex
Surgical repair Monitoring output Obstruction Incontinence Other Not known TOTAL
Male
Female
TOTAL
49 30 34 11 4 1 129
72 37 20 31 4 1 165
121 67 54 42 8 2 294
has been inserted it is nurses who are responsible for its care and maintenance. It is essential therefore that the nursing assessment of catheterized patients be both ongoing and conducted by highly qualified and trained staff. Anne Mulhall, BSc, PhD Senior Research Fellow University of Surrey Guildford, England
References 1, Lai KK. [Urinary catheters (Letter)] AM J INFECTCONTROL 1990;18:340-1. 2. Crow R, Mulhall AB, Chapman R. Indwelling urethral catheterisation and related nursing practice. J Adv Nurs 1988;13:489-95. 3, Mulhall AB, Chapman RG, Crow R. Bacteriuria during indwelling urethral catheterisation. J Hosp Infect 1988; 11: 253-62. 4, Nordqvist P, Ekelund P, Edouard L, et al. Catheter-free geriatric care: routine and consequences for clinical infection, care and economy. J Hosp Infect 1984;5:298-304. 5, Crow R, Chapman R, Roe B, Wilson J. A study of patients with an indwelling urethral catheter and related nursing practice. Report from the Nursing Practice Research Unit, University of Surrey. Guildford, UK: Nursing Practice Research Unit, 1986.
U.K. e x p e r i e n c e w i t h indwelling urethral c a t h e t e r s To the Editor: I read with interest the letter in the JOURNALby Lai ~ concerning the use of urethral catheters (October 1990) and would like to offer some comments regarding our experience in the United Kingdom. The Nursing Practice Research Unit conducted a survey of patients with indwelling urethral catheters during 14 days in five randomly selected District General Hospitals in England. 2 Of 1909 patients resident on the first day of the study, 240 had a catheter in situ, representing a prevalence of 12.6%. During the period of study, 294 patients were catheterized, giving an incidence of 11.2/1000 average daily population. The reasons for catheterization are summarized in Table 1. Fourteen percent of patients catheterized underwent the procedure for incontinence (the presence of pressure sores was not recorded). Bacteriuria was recorded in 44% of our patients, with this complication being most strongly related to the duration of catheterization) Although the prevalence in our U.K. study is lower than that recorded by Lai, l I agree that catheterization for the m a n a g e m e n t of incontinence should be carefully considered. Nordqvist and associates 4 demonstrated that in elderly patients the introduction of a continence training p r o g r a m and the use of pads resulted in a reduction in the use of antibiotics and lower hospital costs, with no increase in nursing workload. In addition, our study recorded leakage of urine (bypassing) around the catheter in 41% of the patients studied, s The assumption that catheterization will prevent urinary soilage, and thus ensure tissue integrity in patients vulnerable to pressure sores, may not therefore hold true. Although doctors inserted all the catheters that were placed in the operating theater, nurses performed 42% of catheterizations overall. In addition, once a catheter
164
T a b l e 1. Reason for catheterization, by patient sex
Surgical repair Monitoring output Obstruction Incontinence Other Not known TOTAL
Male
Female
TOTAL
49 30 34 11 4 1 129
72 37 20 31 4 1 165
121 67 54 42 8 2 294
has been inserted it is nurses who are responsible for its care and maintenance. It is essential therefore that the nursing assessment of catheterized patients be both ongoing and conducted by highly qualified and trained staff. Anne Mulhall, BSc, PhD Senior Research Fellow University of Surrey Guildford, England
References 1, Lai KK. [Urinary catheters (Letter)] AM J INFECTCONTROL 1990;18:340-1. 2. Crow R, Mulhall AB, Chapman R. Indwelling urethral catheterisation and related nursing practice. J Adv Nurs 1988;13:489-95. 3, Mulhall AB, Chapman RG, Crow R. Bacteriuria during indwelling urethral catheterisation. J Hosp Infect 1988; 11: 253-62. 4, Nordqvist P, Ekelund P, Edouard L, et al. Catheter-free geriatric care: routine and consequences for clinical infection, care and economy. J Hosp Infect 1984;5:298-304. 5, Crow R, Chapman R, Roe B, Wilson J. A study of patients with an indwelling urethral catheter and related nursing practice. Report from the Nursing Practice Research Unit, University of Surrey. Guildford, UK: Nursing Practice Research Unit, 1986.
