Invited Commentary

Commentary on “Can In-Hospital Urinary Catheterization Rates Be Reduced with Benefits Outweighing the Risks?

Authors: Gregory W. Rutecki, MD

Abstract

Although historical records imply that ancient physicians relieved distended urinary bladders as early as the 1st century BCE, the iconic figure Frederick Foley published his definitive experiences with urinary catheterization in 1937.1 Foley’s publication, reporting innovation by way of a simple latex rubber catheter, ushered in the modern era of urinary catheterization. The flexible, sterile, and balloon-tipped urinary catheter has dramatically changed the practice of urology, surgery, and medicine for both better and worse. Foley’s original intent was not only modest but also specific: to safely and humanely catheterize the bladder in an effort to control hemorrhage after prostatectomy. It is time to contrast Foley’s restrained debut of urinary catheters with a recent unbridled exuberance. It has been estimated that urinary catheters are placed in 25% of hospitalized patients for various indications, some clinically compelling, others simply expedient.2 This proliferation of bladder catheterizations comes at a substantial price, not only in dollars and cents (by increasing length of stay) but also in morbidity and mortality. Catheter-associated urinary tract infections have become the most common nosocomial infection in the world, annually affecting 800,000 people and thereby comprising 40% of all nosocomial infections.2,3 The staggering statistics have been appreciated for some time, but wholesale practice improvement has been glacial. Therein lies the rub.

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References

1. Foley FE. A hemostatic bag catheter: one-piece latex rubber structure for control of bleeding and constant drainage following prostate resection. J Urol. 1937; 38: 134–139.
 
2. Tiwari MM, Charlton ME, Anderson JR, et al. Inappropriate use of urinary catheters: a prospective observational study. Am J Infect Control. 2012; 40: 51–54.
 
3. Andreessen L, Wilde MH, Herendeen P. Preventing catheter-associated urinary tract infections in acute care: the bundle approach. J Nurs Care Qual. 2012; 27: 209–217.
 
4. Shimoni Z, Niven M, Froom P. Can in-hospital urinary catheterization rates be reduced with benefits outweighing the risks? South Med J. 2013; 106: 369–371.
 
5. Pfisterer MH, Johnson TM 2nd, Jenetzky E, et al. Geriatric patients’ preferences for treatment of urinary incontinence: a study of hospitalized, cognitively competent adults aged 80 and older. J Am Geriatr Soc. 2007; 55: 2016–2022.
 
6. Chan JY, Semenov YR, Gourin CG. Postoperative urinary tract infection and short-term outcomes and costs in head and neck cancer surgery. Otolaryngol Head Neck Surg. 2013; 148: 602–610.