Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters

Infect Control Hosp Epidemiol. 2004 Nov;25(11):974-8. doi: 10.1086/502329.


Objective: Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion.

Design: A time-sequence nonrandomized intervention study.

Setting: Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center.

Patients: All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days).

Intervention: Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion.

Results: The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 + 1.1 days to 4.6 +/- 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 +/- 3.1 to 8.3 +/- 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from 4021 dollars +/- 1800 dollars to 1220 dollars +/- 941 dollars; P = .004).

Conclusion: This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use
  • Critical Care / methods*
  • Device Removal / nursing*
  • Drug Costs / statistics & numerical data
  • Female
  • Humans
  • Incidence
  • Length of Stay
  • Male
  • Middle Aged
  • Physician-Nurse Relations
  • Reminder Systems*
  • Taiwan / epidemiology
  • Urinary Catheterization / adverse effects*
  • Urinary Catheterization / nursing*
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / etiology*
  • Urinary Tract Infections / prevention & control*


  • Anti-Bacterial Agents